Integumentary Dysfunction and how it can cause MSK dysfunction Flashcards
Risk factors for Integ disorders
- immobility
- BMI
- impaired sensation
- poor nutrition
- impaired circulation
- burns
- rashs/infection
- age
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integumentary screening
- Interview
- inspection
- history
Other things to consider that could cause integumentary dysfunction
- pressure/friction/shear
- moisture
- BP
- mechanical ventilation
- comorbidities
- LOS in ICU/hospital
- Mental status: ability to follow precautions
- continence
How can PT prevent skin breakdown
- braden scale
- positioning
- education
- consultation
- durabale medical equipment
Kennedy terminal ulcer
- scale (skin changes at life’s end)
- related to multiple organ failure
- unavoidable skin breakdown
- distinctive: sacral, pear/butterfly shaped, rapid deterioration, red, yellow, black, purple
Post amputation: post surgical lab test
- C-reactive protein
- albumin and pre-albumin: protein with skin repair
- hemoglobin
- absolute lymphocyte count
Common prosthetic gait deviations: transtibial
1. socket too anterior
2. socket too posterior
3. stiff heel cushion
4. soft heel cushion
- increased knee flexion in stance
- decreased knee flexion in early stance, delayed knee flexion in late stance
- limits PF, increased knee flexion in stance
- encourages PF, decreased knee flexion in early stance
not fitted prosthetic can cause breakdown
Common prosthetic gait deviations: transfemoral
1. prosthesis too long
2. high medial wall
3. small or loose socket/inadequate suspension
4. short prothesis
5. prosthetic knee internally rotated
6. Prosthetic knee externally rotated
7. prosthetic knee unstable
8. inadequate socket flexion
- abduction in stance, circumduction, vault of hip hike in swing
- abduction in stance, lateral trunk shift in stance
- cicumduction, vault or hip hike in swing
- lateral trunk shift in stance
- lateral whip in initial swing
- medial whip in initial swing
- trunk flexion in stance
- lumbar lordosis in stance
how can Integumentary dysfunction cause MSK dysfunction
- post surgical wounds make it hard to move
Examples of when MSK disorder and systemic disorder can impair mobility and skin integrity or healing
- DM
- herpes zoster: painful (not disruptive of healing)
- anemia
Connective tissue disorders typically are…
- assoicated with widespread inflammation
- rheumatic disease
- autoimmune compnent
- have MSK component
- may have assoicated integumentary component (rash or wound)
polymyalgia rheumatic:
what types of tissue does this affect?
- more Connective tissue
- joint pain as well
- not big integumentary disease
Dermatomyositis
common presentation
- rash
- muscle/joint pain
- usually in 50s-60s
Reactive arthritis
- usually occurs after an infection
- arthritis in larger joints (elbows, hands, back, ankles, knees) and distance from disease location
- also affects nails
- usually infection is STD or GI (GI most commonly)
reactive arthritis symptoms onset
- 1-4 weeks after infection
- asymmetrical
- typically affects large and medium joints in
Reactive arthritis:
Medical management
PT management
- NSAIDs, steriods
- Pain management, mobility
Reiter syndrome
What is it
- subtype of reactive arthritis
- triad of urethritis, conjunctivitis, arthritis
- in addition to arthritis may synovitis and erosion at insertion sites of ligaments and tendons
Reiter syndrome
symptoms/presentation
- LBP occurs in about 50% of patients
- usually resolves in 3-12 months
- self limiting = gets better overtime
Psoriatic arthritis
what does it affect
- primarily affects DIPs
- assoicated with psoriasis
- may affect axial skeleton as disease progresses
- can get monthly infusions
Gout
- Metabolic condition, acute and chronic arthritis
- due to increased levels of serum uric acid
gout
associated with
- diet (beer, organ meats, spinach, asparagus)
- obesity
- family history
- mediations (thiazide diuretic*, levodopa, salicylates/asprin)
- lead exposure
- renal insufficiency
*due to kidney dysfunction that can occur with this medication
