Session 7 & 8: Chapter 9 PowerPoint Presentation

Lecture Notes

Classroom Activity to Accompany Diseases of the Human Body Fifth EditionCarol D. Tamparo Marcia A. Lewis

9Musculoskeletal

System Diseases and

Disorders

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Seeing yourself as you want to be is the key to personal growth.

—Anonymous

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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

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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

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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

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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”

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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.

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Herniated Intervertebral Disk• Treatment

• Rest• Alternating heat/cold applications• Analgesics• Muscle relaxants• Microdiskectomy• Laminectomy if conservative treatment unsuccessful

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Herniated Intervertebral DiscComplementary 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

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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

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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

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Osteoporosis• Etiology

• Heredity• Longtime steroid therapy, alcoholism, lactose intolerance, hyperthyroidism

• Diet high in protein, fat; low lifetime intake of calcium

• Cigarette smoking

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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.

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Osteoporosis• Treatment

• Dependent upon cause• Goal: slow loss of mineral calcium, prevent fractures, control pain

• Calcium, phosphate supplements, multivitamins

• Bisphosphonate drug therapy• Physical therapy

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OsteoporosisComplementary therapy

•Increase natural calcium substances

•Stop smoking•Avoid sugar, soft drinks, caffeine, alcohol, fried foods

•Vitamins B, C, D, magnesium, zinc, phosphorous may benefit

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OsteoporosisClient communication

•Teach proper body mechanics•Nutritional support for beneficial diet

•Encourage weight-bearing exercise

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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

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Osteoporosis• A DEXA scan measures bone

1. mineral density2. mass3. ossification4. mineral deposits

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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

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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

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Dislocations• Description

• A dislocation or luxation occurs when bone is separated from the joint

• A subluxation is a partial dislocation

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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

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Osteoarthritis• Etiology

• Unknown• Autoimmune, genetic, metabolic, mechanical factors possible; aging and obesity are risk factors

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Osteoarthritis• Signs and symptoms

• Insidious onset• Deep, aching joint pain• Stiffness• Aching during weather changes• Crepitation• Minimal deformity

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Osteoarthritis• Diagnostic procedures

• History and physical examination• X-rays• Bone scan• MRI

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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.

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OsteoarthritisComplementary 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

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Osteoarthritis• Prognosis

• Depends upon site, severity• Disability can be minor or severe• No cure

• Prevention• None known

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Rheumatoid Arthritis (RA)• Description

• Chronic, systemic, inflammatory disease of synovial membranes of multiple joints

• RA destroys cartilage; erodes bone; deforms joints, causing immobility

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Rheumatoid Arthritis (RA)• Etiology

• Unknown• Genetic predisposition• Autoimmune disease

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Rheumatoid Arthritis (RA)• Signs and symptoms

• Insidious development• Malaise, fatigue, fever, weight loss

• Joint pain, stiffness• Swollen interphalangeal joints

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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.

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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.

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Rheumatoid Arthritis (RA)

Complementary therapy• Same as for osteoarthritis• 8 to 10 hours of sleep at night• Periodic rests during daily activitiesClient communication

• Provide emotional support• Recommend occupational therapy

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Rheumatoid Arthritis (RA)• Prognosis

• RA requires lifelong treatment• Has no cure• Disease generally is progressive

•Prevention• None known

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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

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Gout (Gouty Arthritis)• Etiology

• Metabolic gout inherited• Renal gout caused by renal dysfunctions

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Gout (Gouty Arthritis)• Signs and symptoms

• Sudden, excruciating joint pain; usually in big toes, feet, ankles, or knees

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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.

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Gout (Gouty Arthritis)• Treatment

• Rest, immobilization of affected part, applications of heat or cold

• Analgesics, NSAIDs, corticosteroids, colchicines

• Low purine diet• Drink fluids frequently

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Gout (Gouty Arthritis)Complementary therapy

• Abstinence from alcohol• Low-fat, high-fiber diet• Intake of bioflavinoids• Increase fluidsClient communication

• Take NSAIDs with meals• Encourage increased fluid intake

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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

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Gout (Gouty Arthritis)•Gout is characterized by ____ in the synovial fluid.

1. calcium crystals2. urea3. uric acid crystals4. carbonate

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Sprains and Strains• Description

• Sprains: tearing or stretching of a ligament surrounding a joint

• Strains: over-stretching of a tendon or muscle

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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

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Bursitis and Tendonitis• Etiology

• Bursitis: caused by frictional forces, trauma, systemic diseases, infection

• Tendonitis: results from overuse, RA, postural misalignment, or hypermobility

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Bursitis and Tendonitis• Signs and symptoms

• Tenderness or pain upon movement of affected part

• Swelling, edema at site• Pain may interfere with sleep

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Bursitis and Tendonitis• Diagnostic procedures

• Clinical picture and history• CT and MRI• X-ray

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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

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Bursitis and TendonitisComplementary 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

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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

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Carpal Tunnel Syndrome• Description

• Common syndrome compresses median nerve in wrist within the carpal tunnel

• Seen in individuals performing repetitive motion

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Carpal Tunnel Syndrome• Etiology

• Overuse and incorrect use of hands and fingers causes inflammation

• Edema, compression of the median nerve

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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

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Carpal Tunnel Syndrome• Diagnostic procedures

• History• Decreased sensation to pinpricks• Positive Tinel sign• Tingling over median nerve• Electromyogram

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Carpal Tunnel Syndrome• Treatment

• Rest of wrist, wearing splint• NSAIDs• Surgical decompression of the nerve through resection of the carpal tunnel ligament

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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

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Carpal Tunnel Syndrome• Prognosis

• Good, especially with proper care and attention

• Prevention• Proper work place ergonomics• Avoid repetitive movements of the hand and wrist

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Carpal Tunnel Syndrome•Carpal tunnel is caused by compression of the

1. median nerve2. ulnar nerve3. radial nerve4. carpal nerve

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Systemic Lupus Erythematosus

• Description• Chronic, inflammatory connective-tissue disorder damaging cells and tissues in the body

• Affects women 8 times more than men

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Systemic Lupus Erythematosus• Etiology

• Autoimmune response that is unknown

• Genetic, hormonal, environmental factors considered

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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

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Systemic Lupus Erythematosus• Diagnostic procedures

• Anti-DNA test is most specific test for SLE

• CBC with differential• ESR, serum electrophoresis

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Systemic Lupus Erythematosus• Treatment

• Dependent upon organs affected• Corticosteroids• Protective clothing/sunscreen to protect skin

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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

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Systemic Lupus Erythematosus

• Prognosis• Improves with early detection, careful treatment

• Poor if cardiovascular, renal, or neurologic complications occur

• Prevention• None known

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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

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Fibromyalgia• Etiology

• Unknown, though genetics may be a factor

• There may be an increase in pain signals to the brain

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Fibromyalgia• Signs and symptoms

• Pain begins as a dull muscle ache• Tender points develop• Exhaustion due to lack of restful sleep

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Fibromyalgia• Diagnostic procedures

• Physical examination showing widespread pain lasting 3 months at 11 out of 18 possible tender points

• CBC, ESR, thyroid function

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Fibromyalgia• Treatment

• Goal is reduction of pain and to improve sleep

• Analgesics, antidepressants, antiseizure medications

• The drug milnacipran

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FibromyalgiaComplementary 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

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Fibromyalgia• Prognosis

• Chronic condition• Dependent on response to treatment

• Prevention• None known

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Fibromyalgia• Fibromyalgia begins as

1. sharp muscle pain

2. dull muscle aches

3. widespread pain

4. muscle weakness

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Credits

Publisher: Margaret BiblisAcquisitions Editor: Andy McPheeDevelopmental Editors: Yvonne Gillam, Julie MundenBackgrounds: Joseph John Clark, Jr.Production Manager: Sam RondinelliManager of Electronic Product Development: Kirk PedrickElectronic Publishing: Frank MusickThe 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.