lecture notes classroom activity to accompany diseases of the human body fifth edition carol d....

Lecture NotesLecture 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.

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

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 SpineDeformities 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 DiskHerniated 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 DiskHerniated 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 DiskHerniated 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 DiskHerniated Intervertebral Disk• Treatment

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

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Herniated Intervertebral DiscHerniated 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

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Herniated Intervertebral DiskHerniated 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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OsteoporosisOsteoporosis

• 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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OsteoporosisOsteoporosis

• 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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OsteoporosisOsteoporosis

• 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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OsteoporosisOsteoporosis

• 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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OsteoporosisOsteoporosis

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

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OsteoporosisOsteoporosis

Client communication•Teach proper body mechanics•Nutritional support for beneficial diet

•Encourage weight-bearing exercise

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OsteoporosisOsteoporosis

• 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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OsteoporosisOsteoporosis

• A DEXA scan measures bone 1. mineral density

2. mass

3. ossification

4. mineral deposits

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FracturesFractures

• 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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FracturesFractures

• 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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DislocationsDislocations

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

• A subluxation is a partial dislocation

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Osteoarthritis 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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OsteoarthritisOsteoarthritis

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

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OsteoarthritisOsteoarthritis

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

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OsteoarthritisOsteoarthritis

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

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OsteoarthritisOsteoarthritis

• 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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OsteoarthritisOsteoarthritis

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

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OsteoarthritisOsteoarthritis

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

• Prevention• None known

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Rheumatoid Arthritis (RA)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)Rheumatoid Arthritis (RA)• Etiology

• Unknown• Genetic predisposition• Autoimmune disease

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Rheumatoid Arthritis (RA)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)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)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)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

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Rheumatoid Arthritis (RA)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)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)Gout (Gouty Arthritis)

• Etiology• Metabolic gout inherited• Renal gout caused by renal dysfunctions

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Gout (Gouty Arthritis)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)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)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)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

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Gout (Gouty Arthritis)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 (Gouty Arthritis)

•Gout is characterized by ____ in the synovial fluid.

1. calcium crystals

2. urea

3. uric acid crystals

4. carbonate

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Sprains and StrainsSprains 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 TendonitisBursitis 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 TendonitisBursitis 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 TendonitisBursitis 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 TendonitisBursitis and Tendonitis• Diagnostic procedures

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

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Bursitis and TendonitisBursitis 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 TendonitisBursitis 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

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Bursitis and TendonitisBursitis 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 SyndromeCarpal 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 SyndromeCarpal 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 SyndromeCarpal 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 SyndromeCarpal Tunnel Syndrome• Diagnostic procedures

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

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

1. median nerve2. ulnar nerve

3. radial nerve

4. carpal nerve

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Systemic Lupus ErythematosusSystemic 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 ErythematosusSystemic Lupus Erythematosus

• Etiology• Autoimmune response that is unknown

• Genetic, hormonal, environmental factors considered

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Systemic Lupus ErythematosusSystemic 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 ErythematosusSystemic 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 ErythematosusSystemic Lupus Erythematosus• Treatment

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

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Systemic Lupus ErythematosusSystemic 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 ErythematosusSystemic Lupus Erythematosus

• Prognosis• Improves with early detection, careful treatment

• Poor if cardiovascular, renal, or neurologic complications occur

• Prevention• None known

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FibromyalgiaFibromyalgia

• 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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FibromyalgiaFibromyalgia

• Etiology• Unknown, though genetics may be a factor

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

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FibromyalgiaFibromyalgia

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

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FibromyalgiaFibromyalgia

• 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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FibromyalgiaFibromyalgia

• Treatment• Goal is reduction of pain and to improve sleep

• Analgesics, antidepressants, antiseizure medications

• The drug milnacipran

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FibromyalgiaFibromyalgia

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

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FibromyalgiaFibromyalgia

• Prognosis• Chronic condition• Dependent on response to treatment

• Prevention• None known

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FibromyalgiaFibromyalgia

• Fibromyalgia begins as 1. sharp muscle pain

2. dull muscle aches

3. widespread pain

4. muscle weakness

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CreditsCredits

Publisher: Margaret Biblis

Acquisitions Editor: Andy McPhee

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Electronic 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.