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Musculoskeletal Disorders

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Title: Musculoskeletal Disorders


1
Musculoskeletal Disorders
  • B. Pimentel, M.D.
  • University of Makati
  • College of Nursing

2
Bunions (Hallux valgus)
  • What is it?
  • When the big toe points toward the second toe
    causing a bump to appear on the outside edge of
    the toe.
  • Caused by wearing narrow, high heeled shoes.
  • Symptoms
  • Red, calloused skin along the inside edge of the
    big toe
  • A bony bump at the site
  • Pain over the joint, which pressure from shoes
    makes worse
  • Big toe turned toward the other toes

3
Bunions (Hallux valgus)
  • Treatment
  • Wear wide toed shoes
  • Wear felt or foam pads on your foot to protect
    the bunion or a spacer to separate the first and
    second toes.
  • Surgery if severe

4
Carpal Tunnel Syndrome
  • What is it?
  • Median nerve is compressed causing sensation and
    circulation to thumb and fingers is compromised
  • Usually in women ages 30-60
  • Increasing incidence
  • Predisposing factors and causes
  • Repetitive hand and wrist motions (sewing,
    painting, sports, playing musical instruments,
    typing)
  • Bone fractures
  • Diabetes, Obesity
  • Rheumatoid arthritis, Lupus, Scleroderma

5
Carpal Tunnel Syndrome
6
Carpal Tunnel Syndrome
  • Symptoms
  • Numbness or tingling, weakness
  • Pain
  • Fine finger coordination problems
  • Treatment
  • Splinting
  • Corticosteroid injections
  • Surgery
  • Medications Nonsteroidal anti-inflammatory
    (NSAIDS)

7
Carpal Tunnel Syndrome- Surgery
8
Fibromyalgia
  • What is it?
  • Syndrome in which the patient has long-term,
    body-wide pain and tenderness in the joints,
    muscles, tendons and other soft tissues.
  • Linked to fatigue, sleep problems, headaches,
    depression and anxiety.
  • Possible causes
  • Physical and emotional trauma, stress
  • Abnormal pain response
  • Sleep disturbances
  • Infection

9
Fibromyalgia
  • Symptoms
  • Painful areas called tender points
  • May be localized or generalized
  • Extreme fatigue, sleep problems
  • Other Irritable bowel, memory probs,
    palpitations, headaches, tremors, bladder spasms,
    blurred vision
  • Diagnosis
  • Minimum of 3 months of widespread pain in at
    least 11 of 18 areas

10
Fibromyalgia
  • Treatment
  • Physical Therapy
  • Exercise
  • Light massage
  • Relaxation techniques
  • Medications antidepressants, anti-seizure,
    muscle relaxants, pain relievers, sleeping aids
  • Cognitive behavioral therapy
  • Support groups

11
Gout
  • What is it? What causes it?
  • Painful arthritic disease that occurs most often
    in men
  • Disruption of body's control over uric acid
    production or excretion, resulting in high levels
    of uric acid in the blood
  • When uric acid builds to a certain level, it
    crystallizes, and these crystals are deposited in
    connective tissue all over the body
  • When crystals are deposited in the synovial
    fluid, they cause sudden sharp pain in the joint

12
Gout
13
Gout
14
Gout
  • Symptoms
  • Big toe, knee or ankle joints are most often
    affected.
  • Pain starts suddenly, often during the night
  • Joint appears warm and red, very tender
  • Possible fever
  • Treatment
  • NSAIDs, Analgesics, Corticosteroids
  • Allopurinol or probenecid to decrease uric acid
    levels
  • Decrease consumption of purine-rich foods
    (sardines, organ meat, legumes, fatty foods,
    protein)

15
Ankylosing Spondylitis
  • What is it?
  • Rheumatic disorder causing inflammation of the
    axial skeleton and large peripheral joints
  • Etiology unknown, but thought to have genetic
    basis with possible environmental influences
  • More common in men usually begins at age 20-40
    when women have it, more peripheral involvement

16
Ankylosing Spondylitis
  • Signs and symptoms
  • Back pain
  • Early morning stiffness, relieved by activity
  • Pain is eased by assuming kyphotic posture
  • Diminished chest expansion, fever, weight loss,
    fatigue
  • Articular cartilage is destroyed causing fibrous
    adhesions, bone fusion, and calcification of the
    intervertebral disks

17
Ankylosing Spondylitis
  • Treatment
  • PT for postural training, especially to
    strengthen back extensors
  • NSAIDs to reduce inflammation and pain
  • Corticosteroids
  • Surgery

18
Herniated Disk
  • What is it?
  • Lumbar radiculopathy, cervical radiculopathy,
    herniated intervertebral disk, prolapsed
    intervertebral disk, slipped disk, ruptured disk,
    herniated nucleus pulposus
  • All or part of the disk in the spine is forced
    through a weakened part of the disk, placing
    pressure on the nearby nerves.
  • Lumbar area is the most common area, followed by
    cervical.

19
Herniated Disk
20
Herniated Disk
  • Symptoms
  • Pain in one part of the leg, hip or buttocks.
  • Numbness, tingling
  • May worsen after standing or sitting or at night
  • Diagnosis / Treatment
  • Myelogram, MRI, CT scan, Bone scan
  • NSAIDs, narcotics/analgesics, muscle relaxants
  • Steroid injections
  • Physical Therapy
  • Surgery

21
Muscular Dystophy
  • What is it?
  • Group of inherited disorders that involve muscle
    weakness and loss of muscle tissue. Worsens over
    time.
  • Genetic
  • Symptoms
  • Vary with the different types.
  • Muscle weakness, delayed development of muscle
    motor skills, falls, loss of strength, atrophy

22
Muscular Dystophy
  • Treatment
  • No cure. Symptom management is the goal.
  • Physical therapy to maintain muscle strength and
    function.
  • Orthopedic appliances braces, wheelchair to
    improve mobility and self care.
  • Complications
  • Cardiomyopathy
  • Decreased ability to care for self
  • Lung failure
  • Contractures, scoliosis

23
Osteoarthritis
  • What is it?
  • The most common joint disorder, due to aging and
    wear and tear on the joint.
  • Cartilage breaks down and wears away causing the
    bones of the joint to rub together
  • Bone spurs may form. Ligaments and muscles
    weaken and stiffen.
  • Symptoms
  • Pain and stiffness worse after exercise and
    with weight bearing
  • Morning stiffness
  • May be asymptomatic

24
Osteoarthritis
25
Osteoarthritis
26
Osteoarthritis
27
Osteoarthritis
28
Osteoarthritis
29
Osteoarthritis
  • Prevention
  • sensible exercise routines
  • avoidance of activities that cause constant
    stress
  • Treatment
  • pain relievers
  • rest
  • surgery to correct deformity or replace joint
  • weight loss if overweight
  • Physical Therapy

30
Osteoporosis
  • What is it?
  • Most common form of metabolic bone disease
  • Thinning of bone tissue and loss of bone density
    over time.
  • Body fails to form enough new bone, when too much
    old bone is reabsorbed by the body.
  • Commonly seen in people over 60 (50 of women
    over 60 have it)
  • Linked to low levels of estrogen in women and
    testosterone in men.
  • Other causes chronic RA, long term prednisone
    use, hyperparathyroidism, Vit D deficiency,
    Amenorrhea, smoking, low calcium

31
Osteoporosis
32
Osteoporosis
  • Predisposing factors
  • Caucasian, European nationality or descent
  • Smoking
  • Alcohol consumption
  • Sedentary living
  • Inadequate estrogen
  • Underweight
  • Low calcium intake

33
Osteoporosis
  • Signs and symptoms
  • Often diagnosed with fracture, often hip
  • Back pain that radiates around to the front
  • Kyphosis
  • Prevention
  • Exercise
  • Adequate calcium intake
  • Treatment
  • Regular individualized activity program
    (weight-bearing activities) and increased dietary
    calcium
  • Estrogen supplements, fluoride, calcium
    supplements and Vit D supplements

34
Rheumatoid arthritis
  • What is it?
  • Long term disease that leads to inflammation of
    the joints and surrounding tissues.
  • Most dangerous, destructive, and crippling type
    of arthritis
  • Particularly affect small joints of the hands and
    feet, can also affect large joints
  • Autoimmune disease that causes the body to attack
    synovial membranes
  • Chronic inflammation begins in the synovial
    membrane of the joints and spreads to other joint
    tissues

35
Rheumatoid arthritis
36
Rheumatoid arthritis
37
Rheumatoid arthritis
  • Symptoms
  • Chronic inflammation begins in the synovial
    membrane of the joints and spreads to other joint
    tissues
  • Outgrowths of the inflamed tissue may invade and
    damage the cartilage of the joints, deforming and
    fusing the joints ligaments become softened and
    absorbed permanent joint injury
  • Marked by periods of remission and exacerbation
  • Stiffness, pain, decreased range of motion,
    deformities, decreased mobility, nodules under
    the skin

38
Rheumatoid arthritis
  • Diagnosis
  • Rheumatoid factor test, Anti CCP antibody test,
    MRI, X-ray, CBC, C reactive protein, Erythrocyte
    sedimentation rate, synovial fluid analysis
  • Treatment
  • Disease modifying antirheumatic drugs (DMARDs)
    Methotrexate, Leflunomide
  • NSAIDs ibuprofen, naprosen, Aspirin, Celebrex
    (heart disease and stroke risk factors),
    analgesics
  • Surgery (joint replacement), physical therapy
    (pain, gait training), nutrition, support groups

39
Scoliosis
  • What is it?
  • Abnormal curving of the spine. Cause is unknown
    (idiopathic).
  • Symptoms
  • Backache, low back pain, uneven hips or shoulders
  • Treatment
  • Back brace
  • Surgery
  • Physical therapy

40
Scoliosis
41
Trauma Fractures
  • Fracture is described according to
  • Site
  • Extent
  • Configuration
  • Relationship of the fractured fragments to each
    other
  • The relationship of the fracture to the external
    environment
  • The presence or absence of complications

42
Trauma Fractures
  • Fracture site
  • Diaphyseal (shaft of long bone)
  • Metaphyseal (wider part at the end of a long
    bone, adjacent to the epiphyseal disk)
  • Epiphyseal (end of along bone, usually wider than
    the shaft entirely cartilaginous or separated
    from the shaft by a cartilaginous disk)
  • Intra-articular (within the joint)
  • Fracture-dislocation (associated with dislocation
    of the adjacent joint)

43
Trauma Fractures
  • Extent of fracture
  • Complete
  • Incomplete
  • Hairline
  • Greenstick (in child's pliable bone)
  • Configuration of fracture
  • Transverse
  • Oblique
  • Spiral
  • Comminuted (more than one fracture line and
    therefore more than two fragments)

44
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45
Greenstick Fracture of a Forearm
46
Transverse Fracture
47
Compound Fracture
48
Comminuted Fracture
49
Trauma Fractures
  • Relationship of fracture fragments to each other
  • Undisplaced
  • Displaced
  • Shifted sideways
  • Angulated
  • Rotated
  • Distracted
  • Overriding
  • Impacted

50
Trauma Fractures
  • Relationship of the fracture to the external
    environment
  • Closed (covering skin is intact)
  • Open (either fracture fragment has penetrate the
    skin from within or a sharp object has penetrated
    the skin to fracture the bone from outside) risk
    of infection

51
Fractures
  • When bone breaks, bleeding occurs from the blood
    vessels in the bone and periosteum
  • Hematoma or clot forms in the medullary canal,
    under the periosteum and between the ends of the
    bone fragments
  • Necrosis occurs at the ends of the bone because
    the torn blood vessels are unable to continue
    delivery of nutrients
  • Inflammatory response develops as a reaction to
    the trauma and the presence of debris at the site
  • Clot serves as the basis for a fibrin network
    into which granulation tissue grows

52
Fractures
  • New capillaries grow into area and phagocytic
    cells and fibroblasts migrate to it
  • Chondroblasts also begin to form new cartilage
    fibrocartilaginous callus holds bone ends
    together (not strong enough to bear weight)
  • Osteoblasts from the periosteum and endosteum
    begin to generate new bone to fill in the gap
  • Bony callus formed

53
Fractures
  • During following months the repaired bone is
    remodeled by osteoblastic and osteoclastic
    activity in response to mechanical stresses on
    the bone
  • Excessive bone in the callus is removed, more
    compact bone is laid down and eventually the bone
    assumes a normal appearance

54
Fractures
  • Complications
  • Uncomplicated
  • Complicated
  • Skin injuries, vascular injuries, neurologic
    injuries, any soft tissue injuries
  • Mal-union (fracture heals in an unsatisfactory
    position with residual body deformity)
  • Delayed union (fracture may heal eventually but
    takes considerably longer than expected)
  • Non-union (fracture completely fails to heal)
  • Complication of skull fracture hemorrhage or
    tear of meningeal artery

55
Fractures
  • Treatment of fractures
  • Reduction the correction of a fracture
  • Closed manipulation reduction without incision
  • Open reduction after incision into the fracture
    site
  • Fixation holding or fastening in a fixed
    position
  • External casting, splinting
  • Internal surgically implanting rods, planes
    nails, or screws
  • ORIF seen frequently in hip fractures

56
ORIF with pins plate
57
ORIF
58
The End
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