Interventions for Clients with Musculoskeletal Problems Slide 2
Osteoporosis Metabolic disease, in which bone demineralization
results in decreased density and subsequent fractures Metabolic
disease, in which bone demineralization results in decreased
density and subsequent fractures Osteopenia (low bone mass), which
occurs when there is a disruption in the bone remodeling process
Osteopenia (low bone mass), which occurs when there is a disruption
in the bone remodeling process Slide 3 Classification of
Osteoporosis Primary osteoporosis occurs most commonly in
postmenopausal women and men in their 60s and 70s. Primary
osteoporosis occurs most commonly in postmenopausal women and men
in their 60s and 70s. Secondary osteoporosis results from an
associated medical condition such as hyperparathyroidism, long-term
drug therapy, long-term immobility. Secondary osteoporosis results
from an associated medical condition such as hyperparathyroidism,
long-term drug therapy, long-term immobility. Regional osteoporosis
occurs when a limb is immobilized. Regional osteoporosis occurs
when a limb is immobilized. Slide 4 Health Promotion/Illness
Prevention Ensure adequate calcium intake. Ensure adequate calcium
intake. Avoid sedentary life style. Avoid sedentary life style.
Continue program of weight-bearing exercises. Continue program of
weight-bearing exercises. Slide 5 Slide 6 Drug Therapy Hormone
replacement therapy Hormone replacement therapy Parathyroid hormone
Parathyroid hormone Calcium and vitamin D Calcium and vitamin D
Bisphosphonates Bisphosphonates Selective estrogen receptor
modulators Selective estrogen receptor modulators Calcitonin
Calcitonin Other agents used with varying results Other agents used
with varying results Slide 7 Diet Therapy Protein Protein Magnesium
Magnesium Vitamin K Vitamin K Trace minerals Trace minerals Calcium
and vitamin D Calcium and vitamin D Avoid alcohol and caffeine
Avoid alcohol and caffeine Slide 8 Others Exercise Exercise Pain
management Pain management Orthotic devices Orthotic devices Slide
9 Osteomalacia Softening of the bone tissue characterized by
inadequate mineralization of osteoid Softening of the bone tissue
characterized by inadequate mineralization of osteoid Vitamin D
deficiency, lack of sunlight exposure Vitamin D deficiency, lack of
sunlight exposure Similar, but not the same as osteoporosis
Similar, but not the same as osteoporosis Major treatment: vitamin
D from exposure to sun and certain foods Major treatment: vitamin D
from exposure to sun and certain foods Slide 10 Slide 11 Pagets
Disease of the Bone Metabolic disorder of bone remodeling, or
turnover; increased resorption of loss results in bone deposits
that are weak, enlarged, and disorganized Metabolic disorder of
bone remodeling, or turnover; increased resorption of loss results
in bone deposits that are weak, enlarged, and disorganized Slide 12
Pagets Disease of the Bone Nonsurgical management: calcitonin,
selected bisphosphonates, mithramycin Nonsurgical management:
calcitonin, selected bisphosphonates, mithramycin Surgical
management: tibial osteotomy or partial or total joint replacement
Surgical management: tibial osteotomy or partial or total joint
replacement Slide 13 Osteomyelitis A condition caused by the
invasion by one or more pathogenic microorganisms that stimulates
the inflammatory response in bone tissue A condition caused by the
invasion by one or more pathogenic microorganisms that stimulates
the inflammatory response in bone tissue Exogenous, endogenous,
hematogenous, contiguous Exogenous, endogenous, hematogenous,
contiguous Slide 14 Slide 15 Nonsurgical Management Drug therapy
Drug therapy Infection control Infection control Hyperbaric oxygen
therapy Hyperbaric oxygen therapy Slide 16 Surgical Management
Sequestrectomy Sequestrectomy Bone grafts Bone grafts Bone segment
transfers Bone segment transfers Muscle flaps Muscle flaps
Amputation Amputation Slide 17 Bone Tumors Benign bone tumors
(noncancerous): Benign bone tumors (noncancerous): Chrondrogenic
tumors: osteochondroma, chondroma Osteogenic tumors: osteoid
osteoma, osteoblastoma, giant cell tumor Fibrogenic tumors Slide 18
Interventions Nondrug pain relief measures Nondrug pain relief
measures Drug therapy: analgesics, NSAIDs Drug therapy: analgesics,
NSAIDs Surgical therapy: curettage (simple excision of the tumor
tissue), joint replacement, or arthrodesis Surgical therapy:
curettage (simple excision of the tumor tissue), joint replacement,
or arthrodesis Slide 19 Malignant Bone Tumors Primary tumors, those
tumors that originate in the bone Primary tumors, those tumors that
originate in the bone Osteosarcoma Ewings sarcoma Chondrosarcoma
Fibrosarcoma Metastatic bone disease Slide 20 Acute Pain; Chronic
Pain Interventions include: Interventions include: Treatment aimed
at reducing the size or removing the tumor Drug therapy;
chemotherapy Radiation therapy Surgical management Promotion of
physical mobility with ROM exercises Slide 21 Potential for
Fractures Interventions Interventions Nonsurgical management:
radiation therapy and strengthening exercises. Surgical management:
replace as much of the defective bone as possible, avoid a second
procedure, and return client to a functioning state with a minimum
of hospitalization and immobilization. Slide 22 Carpal Tunnel
Syndrome Common condition; the median nerve in the wrist becomes
compressed, causing pain and numbness Common condition; the median
nerve in the wrist becomes compressed, causing pain and numbness
Common repetitive strain injury via occupational or sports motions
Common repetitive strain injury via occupational or sports motions
Nonsurgical management: drug therapy and immobilization Nonsurgical
management: drug therapy and immobilization Possible surgical
management Possible surgical management Slide 23 Phalens maneuver
for detection of carpal tunnel syndrome Slide 24 Hand Disorders
Dupuytren's contractureslowly progressive contracture of the palmar
fascia resulting in flexion of the fourth or fifth digit of the
hand Dupuytren's contractureslowly progressive contracture of the
palmar fascia resulting in flexion of the fourth or fifth digit of
the hand Gangliona round, cystlike lesion, often overlying a wrist
joint or tendon Gangliona round, cystlike lesion, often overlying a
wrist joint or tendon Slide 25 Disorders of the Foot Hallux valgus
Hallux valgus Hammertoe Hammertoe Mortons neuroma Mortons neuroma
Tarsal tunnel syndrome Tarsal tunnel syndrome Plantar fasciitis
Plantar fasciitis Other problems of the foot Other problems of the
foot Slide 26 Slide 27 Slide 28 Scoliosis Changes in muscles and
ligaments on the concave side of the spinal column Changes in
muscles and ligaments on the concave side of the spinal column
Congenital, neuromuscular, or idiopathic in type Congenital,
neuromuscular, or idiopathic in type Assessment: complete history,
pain assessment, observation of posture Assessment: complete
history, pain assessment, observation of posture Interventions:
exercise, weight reduction, bracing, casting, surgery
Interventions: exercise, weight reduction, bracing, casting,
surgery Slide 29 Osteogenesis Imperfecta Rare genetic disorder in
which the bones are fragile and fracture easily, resulting in bone
deformity Rare genetic disorder in which the bones are fragile and
fracture easily, resulting in bone deformity Clinical
manifestations: poor skeletal development Clinical manifestations:
poor skeletal development Treatment: palliative; clients life span
is often shortened Treatment: palliative; clients life span is
often shortened Steroids, calcium, vitamin C, and possibly sodium
fluoride Steroids, calcium, vitamin C, and possibly sodium fluoride
Slide 30 Progressive Muscular Dystrophies At least nine types of
muscular dystrophies identified; categorized as slowly or rapidly
progressive At least nine types of muscular dystrophies identified;
categorized as slowly or rapidly progressive Diagnosis often
difficult Diagnosis often difficult Management Management
Supportive, making client as comfortable as possible Prednisone,
immunosuppressive agents, anabolic steroids
