Degenerative Conditions

Question 1

What are some common degenerative muskuloskeletal system conditions?

Answer 1

• osteoporosis
• osteoarthritis
• spondylosis
• spinal stenosis
• chondromalacia

Question 2

Signs and symptoms, differential diagnosis, and treatment for degenerative joint disease (osteoarthritis)?

Answer 2

• nonrheumatoid, nonsystemic disease
• often affects weight-bearing joints by degeneration or articular cartilage
  SS - usually no morning stiffness (any stiffness can be improved w/Ex, gradual onset, initially one or few joints, as it progresses joint motion decreases, flexion contractures occur, tenderness and crepitus or grating appear.
  DD - normal erythrocyte sedimentation rate (ESR), abnormal radiographs, problems with weight-bearing joints
  Tx - NSAIDS, functional training and edu, A/AA/PROM, isometric, isotonic, isokinetic, and postural Ex, ADL training, continue physical activities, possible surgery or joint replacement.

Question 3

Signs and symptoms, differential diagnosis, and treatment for osteoporosis?

Answer 3

• most common metabolic disease (white females most commonly)
• depletes bone mineral density which may predispose the individual to fracture (common sites = thoracic/lumbar spine, femoral neck, proximal humerus, proximal tibia, pelvis, distal radius)
• postmenopausal osteoporosis is directly related to a decrease in the production of estrogen
  Tx - pain management, posture edu, breathing Ex, general conditioning, pectoral stretching, abdominal strength w/caution to avoid excessive/repeated spine flexion, weight-bearing Ex.

Question 4

What is Paget’s disease (osteitis deformans)?

Answer 4

• a slowly progressive metabolic bone disease
• initial phase of excessive bone reabsorption follow by a reactive phase of excessive abnormal bone formation
• usually affects several areas including spine, pelvis, femur, and skull
• can be fatal if associated with congested heart failure, bone sarcoma, or giant cell tumors
• vertebral collapse or vascular changes can lead to paraplegia
  Tx - asymptomatic = no treatment, if symptoms pt will need drug therapy

Question 5

What is RA and what are the Signs and symptoms?

Answer 5

• chronic, systemic inflammatory disease, most often women in 30’s/40’s, unknown etiology but immunological mechanism appears to play a important role.
• usually involves a symmetrical pattern of dysfunction in synovial tissues and articular cartilage of hand/wrists, elbows, shoulders, knees, ankles, and feet.
• additional manifestations include eye lesions, infection, and osteoporosis.

Question 6

Differential diagnosis of Rheumatoid Arthritis (RA)?

Answer 6

• rule out other diseases cause arthritis and + blood test for rheumatoid factor, insidious onset and slow progression.
• complaints of fatigue, weakness, and general diffuse MSK pain are often the initial presentation
• symmetrical bilateral presentation of specific joints
• intense joint pain/stiffness can last 30 min to several hours when initiating activities.
• deformities of fingers are common including ulnar deviation, swan neck or boutonniere deformities

Question 7

Treatment for Rheumatoid Arthritis (RA)?

Answer 7

• reduce pain
• maintain mobility
• minimize joint stiffness, edema, or destruction
• prevent deformities with orthoses
• pt edu and continue adherence to the tx program are vital. Energy conservation is stressed.
• medications, rest, ambulatory devices, and ice are used during acute phases.

Question 8

What is osteomyelitis?

Answer 8

• acute of chronic bone infection

- commonly from traumatic injury and acute infection

Question 9

How is osteomyelitis treated?

Answer 9

• high doses of IV antibiotics
• infected extremity is immobilized by cast
• traction or bed rest
• sometime surgical intervention to drain infection
• if chronic, may require amputation.

Question 10

What is osteoporosis?

Answer 10

• most common metabolic bone disease
• most common in white females
• depletes bone mineral density, predispose to fracture
• primarly postmenopausal osteoporosis is directly related to decrease in production of estrogen

Question 11

How is osteoporosis treated?

Answer 11

• pain management
• postural re-edu
• breathing Ex
• general conditioning
• pectoral stretching
• abdominal strengthening (with caution)
• wt bearing Ex

Question 12

This condition is a progressive neurologic disorder characterized by hypo and hypertonia, LMN signs of fasciculations especially of tongue, primarily a motor disorder and cognition and sensation usually remain in tact.

Answer 12

• ALS