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9 Lecture Notes Musculoskeletal System Diseases and Disorders Classroom Activity to Accompany Diseases of the Human Body Fifth Edition Carol D. Tamparo Marcia A. Lewis Copyright © 2011 by F.A. Davis Company. All rights reserved. This product is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means—electronic, mechanical, photocopying, recording, or otherwise— without written permission from the publisher. Seeing yourself as you want to be is the key to personal growth. —Anonymous 3 Common Signs and Symptoms of Musculoskeletal System Diseases and Disorders • Pain • Tenderness, swelling • Malaise, weakness, fatigue • Fever • Obvious bone deformation, including spontaneous fractures • Inflammation • Stiffness • Weight, height loss 4 Deformities of the Spine • Description • Lordosis: abnormal inward curvature of the lumbar spine, also called “swayback” • Kyphosis: abnormal outward curvature of the upper thoracic vertebra, also called “humpback” • Scoliosis: abnormal sideways curvature to either the right or the left 5 Herniated Intervertebral Disk • Description • Nucleous pulposus leaks through disk wall into the spinal canal, pressing on spinal nerves • Called slipped or ruptured disk • Commonly occurs between 4th and 5th lumbar or 5th lumbar and 1st sacral vertebrae • More common in men 6 Herniated Intervertebral Disk • Etiology • Spinal trauma from fall, straining, heavy lifting • Intervertebral joint degeneration • Signs and symptoms • Severe back pain; worse with movement • Paresthesia; pain in sciatic nerve • May be referred to as “sciatica” 7 Herniated Intervertebral Disk • Diagnostic procedures • Sciatic pain with straight-leg raising test • CT scan, MRI • Myelography • Rule out other causes of back pain CT = computed tomography; MRI = magnetic resonance imaging. 8 Herniated Intervertebral Disk • Treatment • • • • • • Rest Alternating heat/cold applications Analgesics Muscle relaxants Microdiskectomy Laminectomy if conservative treatment unsuccessful 9 Herniated Intervertebral Disc Complementary therapy • Prolotherapy may be successful • Acupuncture and massage Client communication • Tell clients to be “patient” with treatment • Rest is essential but can frustrate client • Refer to physical therapist 10 Herniated Intervertebral Disk • Prognosis • 80% to 90% get better over time • Disabling pain after 3 months may require surgery • Prevention • Proper exercise and correct lifting techniques 11 Osteoporosis • Description • Metabolic bone disease affecting 10 million Americans • Bones are brittle, porous, fracture easily due to decreased calcium, phosphate • Women, over age 50, small boned at greater risk 12 Osteoporosis • Etiology • Heredity • Longtime steroid therapy, alcoholism, lactose intolerance, hyperthyroidism • Diet high in protein, fat; low lifetime intake of calcium • Cigarette smoking 13 Osteoporosis • Signs and symptoms • Bone fracture • Bone pain, especially in lower back and hips • Diagnostic procedures • DEXA to measure bone mineral density • Blood tests • X-ray DEXA = Dual-energy x-ray absorptiometry. 14 Osteoporosis • Treatment • Dependent upon cause • Goal: slow loss of mineral calcium, prevent fractures, control pain • Calcium, phosphate supplements, multivitamins • Bisphosphonate drug therapy • Physical therapy 15 Osteoporosis Complementary therapy • Increase natural calcium substances • Stop smoking • Avoid sugar, soft drinks, caffeine, alcohol, fried foods • Vitamins B, C, D, magnesium, zinc, phosphorous may benefit 16 Osteoporosis Client communication • Teach proper body mechanics • Nutritional support for beneficial diet • Encourage weight-bearing exercise 17 Osteoporosis • Prognosis • Fracture risk increases with age as bone mass weakens • Strict adherence to therapy helps • Permanent disability is possible • Prevention • Calcium-rich diet • DEXA screening for women age 65 and over 18 Osteoporosis • A DEXA scan measures bone 1. mineral density 2. mass 3. ossification 4. mineral deposits 19 Fractures • Description • Break or crack in a bone • Closed simple: break with no external skin wound • Open or compound: break protrudes through the skin • Greenstick: bone is partially bent or split 20 Fractures • Description (cont.) • Comminuted: bone is broken or splintered • Impacted: one bone end is forced into the interior of the other • Incomplete partial: fraction line does not include whole bone 21 Dislocations • Description • A dislocation or luxation occurs when bone is separated from the joint • A subluxation is a partial dislocation 22 Osteoarthritis • Description • Chronic inflammatory degeneration of joint cartilage and bone • Most common form of arthritis • Occurs equally in the sexes until after age 55; then women are more at risk 23 Osteoarthritis • Etiology • Unknown • Autoimmune, genetic, metabolic, mechanical factors possible; aging and obesity are risk factors 24 Osteoarthritis • Signs and symptoms • Insidious onset • Deep, aching joint pain • Stiffness • Aching during weather changes • Crepitation • Minimal deformity 25 Osteoarthritis • Diagnostic procedures • History and physical examination • X-rays • Bone scan • MRI 26 Osteoarthritis • Treatment • Goal: minimize pain, inflammation, disability, maintain joint function • NSAIDs • Physical therapy • Injection of artificial joint fluid • Orthopedic surgery in some cases NSAIDs = nonsteroidal anti-inflammatory drugs. 27 Osteoarthritis Complementary therapy • Proper nutrition, stress reduction • Biofeedback, glucosamine, acupuncture, massage therapy • Low intensity exercise, especially in warm water Client communication • Promote personal care, adequate rest, appropriate exercise • Physical therapy 28 Osteoarthritis • Prognosis • Depends upon site, severity • Disability can be minor or severe • No cure • Prevention • None known 29 Rheumatoid Arthritis (RA) • Description • Chronic, systemic, inflammatory disease of synovial membranes of multiple joints • RA destroys cartilage; erodes bone; deforms joints, causing immobility 30 Rheumatoid Arthritis (RA) • Etiology • Unknown • Genetic predisposition • Autoimmune disease 31 Rheumatoid Arthritis (RA) • Signs and symptoms • Insidious development • Malaise, fatigue, fever, weight loss • Joint pain, stiffness • Swollen interphalangeal joints 32 Rheumatoid Arthritis (RA) • Diagnostic procedures • Positive rheumatoid factor blood test • ESR, CBC, x-rays • MRI or CT scan ESR = erythrocyte sedimentation rate; CBC = complete blood count. 33 Rheumatoid Arthritis (RA) • Treatment • Goal: reduce inflammation, pain, joint deformity • Preserve joint function • NSAIDs or DMARDs • Biological injectables • Surgical repair if necessary DMARDs = disease-modifying antirheumatic drugs. 34 Rheumatoid Arthritis (RA) Complementary therapy • Same as for osteoarthritis • 8 to 10 hours of sleep at night • Periodic rests during daily activities Client communication • Provide emotional support • Recommend occupational therapy 35 Rheumatoid Arthritis (RA) • Prognosis • RA requires lifelong treatment • Has no cure • Disease generally is progressive • Prevention • None known 36 Gout (Gouty Arthritis) • Description • Chronic disorder of uric acid metabolism • Uric acid crystals appear in synovial joint fluid • Urate compound deposits (tophi) are in, around extremity joints • Affects men more than women 37 Gout (Gouty Arthritis) • Etiology • Metabolic gout inherited • Renal gout caused by renal dysfunctions 38 Gout (Gouty Arthritis) • Signs and symptoms • Sudden, excruciating joint pain; usually in big toes, feet, ankles, or knees 39 Gout (Gouty Arthritis) • Diagnostic procedures • Identify urate crystals in joint fluid, tophi in joints • UA • ESR • Differential (WBC) • Skeletal x-rays UA = urine analysis; WBC = white blood cell count. 40 Gout (Gouty Arthritis) • Treatment • Rest, immobilization of affected part, applications of heat or cold • Analgesics, NSAIDs, corticosteroids, colchicines • Low purine diet • Drink fluids frequently 41 Gout (Gouty Arthritis) Complementary therapy • Abstinence from alcohol • Low-fat, high-fiber diet • Intake of bioflavinoids • Increase fluids Client communication • Take NSAIDs with meals • Encourage increased fluid intake 42 Gout (Gouty Arthritis) • Prognosis • Good with proper treatment • Complications include hypertension, kidney stones, renal damage • Prevention • None known • Low-purine diet, adequate hydration may lessen risk of gout 43 Gout (Gouty Arthritis) • Gout is characterized by ____ synovial fluid. in the 1. calcium crystals 2. urea 3. uric acid crystals 4. carbonate 44 Sprains and Strains • Description • Sprains: tearing or stretching of a ligament surrounding a joint • Strains: over-stretching of a tendon or muscle 45 Bursitis and Tendonitis • Description • Bursitis: inflammation of bursa; commonly found in shoulder, arm, elbow, knee • Tendonitis: inflammation of tendon; commonly found in shoulder rotator cuff, hip, Achilles tendon, or hamstring 46 Bursitis and Tendonitis • Etiology • Bursitis: caused by frictional forces, trauma, systemic diseases, infection • Tendonitis: results from overuse, RA, postural misalignment, or hypermobility 47 Bursitis and Tendonitis • Signs and symptoms • Tenderness or pain upon movement of affected part • Swelling, edema at site • Pain may interfere with sleep 48 Bursitis and Tendonitis • Diagnostic procedures • Clinical picture and history • CT and MRI • X-ray 49 Bursitis and Tendonitis • Treatment • Applications of cold and heat • Immobilization of affected part, analgesics, NSAIDs, local steroid injections • Physical therapy or hydrotherapy to help maintain range of motion 50 Bursitis and Tendonitis Complementary therapy • Immobilization and rest of affected part • Acupuncture, gentle massage Client communication • Teach clients to avoid offending activity • Impress the necessity for rest • Teach daily activity skills using decreased mobility as necessary 51 Bursitis and Tendonitis • Prognosis • Bursitis is good if treated promptly; can become chronic • Tendonitis can become disabling if untreated • Prevention • Avoid trauma, strenuous exercise, or overuse of joints 52 Carpal Tunnel Syndrome • Description • Common syndrome compresses median nerve in wrist within the carpal tunnel • Seen in individuals performing repetitive motion 53 Carpal Tunnel Syndrome • Etiology • Overuse and incorrect use of hands and fingers causes inflammation • Edema, compression of the median nerve 54 Carpal Tunnel Syndrome • Signs and symptoms • Pain, burning, numbness, or weakness in one or both hands • Inability to make a fist or grip • Pain may interfere with sleep 55 Carpal Tunnel Syndrome • Diagnostic procedures • History • Decreased sensation to pinpricks • Positive Tinel sign • Tingling over median nerve • Electromyogram 56 Carpal Tunnel Syndrome • Treatment • Rest of wrist, wearing splint • NSAIDs • Surgical decompression of the nerve through resection of the carpal tunnel ligament 57 Carpal Tunnel Syndrome Complementary therapy • Yoga, relaxation techniques, acupuncture Client communication • Information on posture; wrist rests; ergonomic keyboards; proper holding, carrying, lifting can be helpful 58 Carpal Tunnel Syndrome • Prognosis • Good, especially with proper care and attention • Prevention • Proper work place ergonomics • Avoid repetitive movements of the hand and wrist 59 Carpal Tunnel Syndrome • Carpal tunnel is caused by compression of the 1. median nerve 2. ulnar nerve 3. radial nerve 4. carpal nerve 60 Systemic Lupus Erythematosus • Description • Chronic, inflammatory connective-tissue disorder damaging cells and tissues in the body • Affects women 8 times more than men 61 Systemic Lupus Erythematosus • Etiology • Autoimmune response that is unknown • Genetic, hormonal, environmental factors considered 62 Systemic Lupus Erythematosus • Signs and symptoms • • • • • • • • Weight loss Fatigue Fever “Butterfly rash” on face and neck Skin photosensitivity Joint, muscle pain Nausea, vomiting, diarrhea Raynaud phenomenon 63 Systemic Lupus Erythematosus • Diagnostic procedures • Anti-DNA test is most specific test for SLE • CBC with differential • ESR, serum electrophoresis 64 Systemic Lupus Erythematosus • Treatment • Dependent upon organs affected • Corticosteroids • Protective clothing/sunscreen to protect skin 65 Systemic Lupus Erythematosus Complementary therapy • Avoid cow’s milk, beef products • Increase green, yellow, orange vegetables • Supplements with vitamins C, B complex Client communication • Rest, low-sodium, low-protein diet recommended • Heat for joint pain and stiffness 66 Systemic Lupus Erythematosus • Prognosis • Improves with early detection, careful treatment • Poor if cardiovascular, renal, or neurologic complications occur • Prevention • None known 67 Fibromyalgia • Description • Chronic condition characterized by pain in the muscles, ligaments, tendons, muscle tenderness, and constant fatigue • Women are 80% more likely than men to develop this condition 68 Fibromyalgia • Etiology • Unknown, though genetics may be a factor • There may be an increase in pain signals to the brain 69 Fibromyalgia • Signs and symptoms • Pain begins as a dull muscle ache • Tender points develop • Exhaustion due to lack of restful sleep 70 Fibromyalgia • Diagnostic procedures • Physical examination showing widespread pain lasting 3 months at 11 out of 18 possible tender points • CBC, ESR, thyroid function 71 Fibromyalgia • Treatment • Goal is reduction of pain and to improve sleep • Analgesics, antidepressants, antiseizure medications • The drug milnacipran 72 Fibromyalgia Complementary therapy • Acupuncture, massage, chiropractic • Yoga, meditation, low impact exercise Client communication • Advise that healthy diet, reduction of stress, and adequate sleep can help alleviate symptoms 73 Fibromyalgia • Prognosis • Chronic condition • Dependent on response to treatment • Prevention • None known 74 Fibromyalgia • Fibromyalgia begins as 1. sharp muscle pain 2. dull muscle aches 3. widespread pain 4. muscle weakness 75 Credits Publisher: Margaret Biblis Acquisitions Editor: Andy McPhee Developmental Editors: Yvonne Gillam, Julie Munden Backgrounds: Joseph John Clark, Jr. Production Manager: Sam Rondinelli Manager of Electronic Product Development: Kirk Pedrick Electronic Publishing: Frank Musick The publisher is not responsible for errors of omission or for consequences from application of information in this presentation, and makes no warranty, expressed or implied, in regard to its content. Any practice described in this presentation should be applied by the reader in accordance with professional standards of care used with regard to the unique circumstances that may apply in each situation. 76