Bone and JointRoel Tolentino, MD, MBARoel Tolentino, MD, MBA, FACS, FPCS, FPSGS, FPSO, FMOSP

Surgical OncologistTV, Radio and Lay Health Educator

Surgery Professor Level IV

Memorial Sloan Kettering Cancer Center (NYC)University Hospitals of Columbia University and Cornell Medical College (NYC)MD Anderson Cancer (Texas)Beijing Cancer Hospital (China)Chongqing Medical University (China)Suining Central Hospital (China)

De La Salle University – De La Salle University – BS. Biology; BS. Biology; MedicineMedicine

Manila Med – Manila Med – General SurgeryGeneral Surgery

SLMC – SLMC – Surgical OncologySurgical Oncology

Ateneo GSB - Ateneo GSB - MBAMBA

Prof. Roel Tolentino, MD, MBA

MusculoskeletalDiseases

Roel Tolentino, MD, MBARoel Tolentino, MD, MBA, FACS, FPCS, FPSGS, FPSO, FMOSPSurgical Oncologist

TV, Radio and Lay Health EducatorSurgery Professor Level IV

To educate the audience on the different To educate the audience on the different bone and joint problems.bone and joint problems.

Arthritis Degenerative Joint Disease Arthritis = joint inflammation. Arthralgia= joint pain

Arthritis

Arthritis Different types of arthritis:

Osteoarthritis Rheumatoid arthritis Gouty arthritis

Osteoarthritis

Most common form.

One or many joints undergo degenerative and progressive changes.

Deformity, incomplete dislocation and synovial effusion.

Osteoarthritis- Risk Factors Age

Decreased muscle strength

Obesity

Possible genetic risk

History of trauma

Signs and Symptoms Joint pain and stiffness that resolves with rest

or inactivity

Pain with joint palpation

Crepitus in one or more joints

Enlarged joints

OsteoarthritisTreatment: Treatment:

Rest

Heat

Anti inflammatory drugs

Decrease weight

Injectable corticosteroids

Surgery

Osteoarthritis - Treatment Glucosamine - maintains health of cartilage

Auto-Immune Disease Inflammatory and immune response are normally helpful.

BUT these responses can fail to recognize self cells and attack normal body tissues.

Auto-Immune Disease Can severely damage cells, tissues and organs

Rheumatoid Arthritis

Rheumatoid Arthritis Chronic, systemic, progressive inflammatory

disease of the synovial tissue.

Can cause severe deformities that restrict function

RA - Risk Factors Female gender Age 20-50 years Genetic predisposition Stress

Rheumatoid Arthritis - Treatment

Rest, during day, decrease wt. bearing stress.

Maintain joint function, exercise, water

Medication

Immunosuppressive drugs

Gouty Arthritis

Gouty Arthritis Very painful joint inflammation, swollen and reddened

Inborn error of uric acid metabolism

Excess uric acid – converted to sodium uric acid crystals and precipitate from blood

deposited in: - joints - tophi - kidneys - renal calculi

Gouty Arthritis - Treatment Analgesics/anti-inflammatory

Allopurinol

Modify diet

Osteoporosis

Osteoporosis Metabolic bone disorder- progressively porous,

brittle, fragile bones, low bone density, susceptible to fractures

Occurs in postmenopausal women

Loss of height

Osteoporosis - Risk Factors Aging - over 80 yrs. old, 84% have

osteoporosis.

Family history

Postmenopausal estrogen deficiency

Osteoporosis - Risk Factors Low Calcium intake and low levels of Vit. D

Long tem steroid use

Lack of physical activity/prolonged immobility

History of smoking, high alcohol intake

Patient teachings

Adequate dietary calcium

Exercise, weight-bearing (beneficial)

Walking outdoors- vitamin D absorption.

Safe home environment, fall prevention

Balanced diet - protein, Mg, Vit K & D, Ca

Patient teachings

Modify lifestyle choices - smoking, alcohol, salt and caffeine intake and sedentary lifestyle.

Patient teachings

Patient teachings

Hormone Replacement Therapy

Bisphosphonates - Fosamax

Analgesics/anti-inflammatory

Patient teachings

Contusions, Strains, Sprains Contusion - soft tissue injury, hematoma.

Contusions, Strains, Sprains Strain- “muscle pull” over use over stretching.

Contusions, Strains, Sprains Sprain – an injury to ligaments surrounding

joint, caused by twisting.

Contusions, Strains, Sprains Management- RICE = rest, ice, compression,

elevation.

Orthopedic Injuries Joint dislocation

Fractures

Hip fractures High incidence in elderly due to risk for falls,

osteoporosis.

Back Pain

Back Pain

Back Pain

Ergonomics

“Science of workwork; of the peoplepeople who do it and the ways it is done; the tools and equipmenttools and equipment they use, the placesplaces they work in, and the psychosocialpsychosocial aspects of the working situation”

Pheasant, 1998

Work comfortably:

& vary your postureposture

often.

Working in Comfort• Feet

• Flat on floor

• Head• Up, not tilting back • Facing forward

Working in Comfort• Knees

• At right angle or greater• Free of edge of seat

• Arms• Relaxed by sides• Elbows at right angle

• Wrist (hands on keyboard)• Straight or slightly bent forward

Arranging Your Work Area• Chair• Desk/Workstation• Monitor• Keyboard & Pointing Device• Papers & Books• Telephone

Chair• Adjustable• Back support • Stable base

supported by legs with casters

Desk/Workstation

• Sufficient work space• Uncluttered• Sufficient light

Monitor• Positioned directly in front of you and at an

arm’s length away

• Screen top at eye level

Keyboard & Pointing Device• Position keyboard & mouse just below elbow height

& at the same height

• Use a keyboard tray

Telephone

• Avoid cradling the phone• Use a wireless head set or

speaker phone

Healthy Notebook Computing

Stretch BreaksTake a break every 20 minutes

Hazards

ErgonomErgonomic ic

stressesstresses

•Limited workspace•Repetitive task•Mental and physical workload

Tumors of the musculoskeletal system

Tumors of the musculoskeletal system

Soft tissue sarcoma

Osteosarcoma

In Summary…..

Prevent bone and joint problems.

Consult your doctor for any health issues.

Take supplements: calcium; glucosamine