Musculoskeletal Conditions Flashcards
Why do musculoskeletal conditions develop
Increase progesterone levels and relaxin cause joint laxity
Growing weight of uterus changes Center of gravity and posture
Increased body mass increase mechanical stress
Fluid retention leads to compression of soft tissues
Most frequent reported symptoms
Lower back pain
Hip pain
Pelvic girdle pain
Carpal tunnel syndrome
Leg muscle cramps
Carpal tunnel syndrome
Compression of media nerve in carpal tunnel
Indecency increases approx 15 in pregnancy women
Controls movement and feeling of the thumb and first three fingers
Symptoms - tingling, numbness and pain in the hans
High levels of progesterone cause odeoma. This compresses the nerve in the narrow tunnel of the wrist
Pelvic girdle pain
High live;s of relaxin and change in pelvic and abdominal muscle activation cause uneven movement of the joints
Also linked to activation in pain receptors as a proactive mechanisms in pregnancy
Affects 1 in 5 pregnant women
Starts around 28 weeks and for 14-22% the pain will be disabling and lead to severe mobility difficulties
Managing PGP
Maintain good posture
Warm baths
Refer to physio
Manual therapy
Heat or ice pack
Start with regular parectomol and see GP
Consider accessible positions in labour - avoid lithotomy
1 in 10 womens will have ongoing pain - continue analgesia
Spinal cord injuries
Incomplete - some function remain
Complete - all function lost
At higher risk of autonomic dysreflexia ( sudden high bloood pressure), pressure ulcers, UTIs, resps infections, anaemia
SCI pre conception
Ppointment in specialist clinic
Plan to conceive once physica; and emotional rehab has taken place
Signpost for support groups
SCI antenatal care
Early care plannning from booking
Consultant led care
Aim for vaginal birth unless SCI sustained in childhood or has pelvic trauma
Can be referred from clinical pelvimetry
If cephalo pelvic disproportion suspected, book ELCS for 39/40
- management of skin - water low scoring and pressure relieving mattress
Risk assess for venous thromboembolism
Consider perception of fetal movements and contractions
Bp and pulse recorded at every AN visit
SCI Intrapartum care
Bladder and bowel care
Catheter in situ
Autonomic dysreflexia can be fatal - symptoms throbbing headache nausea anxiety, vigilant monitoring of blood pressure comparing to baseline. Even 120/80 may suggest it. Early epidural may help reduce risk of i
Sense off contractions and perineal stretching according to SCI level - consider ad,itting to hospital once 37/40 for regular ctgs
Care by SCI nurse and midwife and involvement of obstretric and specialist team
Anagelsia required as routine even if thee is no perception of pain
Episiotomy and surturing wwithout analgesia without analgesia an trigger spasms or D
SCI postnatal care
They can breastfeed but if above T4 they may require nasal oxytocin spray or additional stimulation as the neuronal pathway from breast to brain is affected
Additional help required for self care and neonatal care
Contraception - SCI doesn’t affect fertility, so contraception should be considered. Avoid oestrogen based product as risk of VTE
Elders Danlo’s syndrome
Inherited condition which affects the connective tissue - colllagen disorder
Hyper mobile EDS is most common type of-characterised by hyper mobile joints
Symptoms: hyper mobile,and unstable joint, joint pain, fatigue dizziness stress incontinence. Can cause dsyregulation of autonomic nervous system
No specific treatment - symptoms may be managed with physio, occupational therapy, counselling and CBT to help cope with long term pain
EDS pre conception care
May opt for genetic counselling to determine likelihood of passing condition on. Eds may be recessive or dominant depending on type
EDS pregnancy considerations
Higher risk of preterm SROM
Mal position
Precipitation active stage of labour
Impaired wound healing
Likely to exacerbate pelvic girdle and musculoskeletal pain
Rheumatoid arthritis
Auto immune condition where the immune system attacks the lining of the joints, resulting in inflammation and thickening of the joint capsule
Affects 0.5-1% of adults twice as many women as men
Life expectancy is reduced from 3-12 years
RA symptoms
Warm, painful, swollen pints which may reduce mobility
RA preconception care
Should use contraceptive to avoid pregnancy and to discontinue its use if pregnancy is planned
RA pregnancy considerations
Tetrogenic meds stopped
Low dose of prednisolene, hydroxychloroquine and sulfasalazine are considered safe in pregnant women with RA
Lupus
Auto immune condition
Where the immune system produces auto nuclear antibodies which attacks healthy cells
Diagnosed by blood tests
Lupus symptoms
Painful swollen joint
Rash
Fever
Chest pain
Hair loss
Often flares up then has a period of recession
Lupus treatment
NSAIDS and anti malarial commonly used to treat in non pregnant population
Treatment will need to change pre conception
Lupus pre conception
Planpregnancy for when lupus is inactive for a minimum of 6 months on stable therapy
Conceiving when lupus is active will increase the risk of diseases flares during the pregnancy and increase the chance of complications for mum and baby
Change med to avoid warfarin, ACE inhibitors and for some anti malarials
Lupus antenatal care
Consultant les
Requiring regular blood tests for antibodies and serial growth scans
Increased risk of miscarriage. Stillbirth, premature birth and fetal growth restriction
Lupus neonatal care
In mums wh are positive for anti-Ro/or anti-la antibodies the baby may develop neonatal lupus syndrome. This syndrome may present as a transient rash heart block, liver abnormalities or low platelets.
Caused my maternal antibodies crossing the placenta in uteri and causing damage to the fetal cells
Protect the baby from light and using sunscreen
Rash usually doesn’t scar the skin significantly
This is not neonatal lupus
Antiphospholipid syndrome
Immune system attacked healthy tissues
Produces abnormal antibodies called antiphospholipid antibodies
These target protein attached to fat molecules which makes the blood more likely to clot
Approx affects 2% of women
Result of APL on MSK
Bone and bone marrow necrosis,arthritis, muscle infarction,non traumatic fracture and oestoporosis
APL treatment
Anti coagulant and anti platelet (aspirin) to stop blood clots
With treatment around 80% of women will have a successful pregnancy
Women may have been on warfarin pre pregnancy which need to be changes pre conception
APL is most important cause of recurrent miscarriage affecting 15% of women experiencing recurrent miscarriage
