Musculoskeletal DISORDERS Flashcards
Musculoskeletal Disorders
affect the human body’s movement or musculoskeletal system
What are the causes of lower back pain?
- overactivity
- poor body mechanics
- obesity
- muscle strain
- bulging vertebral disc
- compression of sciatic nerve
- vertebral disc degeneration
- osteoporosis
What is the best way to diagnose lower back pain?
Signs and Symptoms
When is lower back pain considered acute?
< 3 months
When is lower back pain considered chronic?
> 3 months
What s/s are used to diagnose lower back pain?
- localized pain
- sciatica/radiculopathy
- muscle spasms
- paresthesia
- weakness
- abnormal reflexes
Sciatica
pain radiating through sciatic nerve from the back, through the buttocks, and down the leg
-from a pinched nerve
When are diagnostic exams used for lower back pain?
after 3-4 weeks
What diagnostic exams may be used for lower back pain?
- x-ray
- CT scan
- MRI
- bone scan
- EMG
What will an x-ray show?
fractures, dislocations, degeneration, and deformities
CT Scan
ruptured disc, spinal stenosis, vertebral damage
MRI
nerve/tissue/muscle/ligament damage
Bone Scan
infections, bone tumors
EMG
problems with spinal nerves
What conservative treatments are used for lower back pain?
- Relaxation techniques
- Physical therapy
- Pain meds
What pain medications are used for lower back pain?
- NSAIDS
- Muscle relaxers
- Topical Analgesics
- Narcotics
- Epidural Steroid injections
Epidural Steroid Injections
injection of a steroid around the membranous sac covering the spine to reduce inflammation
How often may an epidural steroid injection be given?
3 within a 6 month period
What are some side effects of epidural steroid injections?
- spinal headache, bleeding, or nerve damage
- may cause a weakening of spinal bones and closely related muscles
How should a person with lower back pain get out of bed?
Roll, keeping the back straight
What are two ways a person with lower back pain may lay down?
- lateral lying “curled” position
- using pillows while on back to elevate head 30 degrees and help flex the knees
What should you tell the patient with lower back pain about resuming activities?
- resume slowly as pain decreases
- avoid activities w/ excessive strain on back
- reduce weight if needed
When may a person with lower back pain require surgery?
- if pain becomes severe
- lasts longer than 6-12 weeks
- ability to function is affected
Micro-discectomy
relieves the pressure on the spinal nerve root by removing the material causing the pain
Laminectomy
removal of a small portion of the bone over the nerve root/disc material form under the nerve root to give it more space and relieve compression
What should you educate the patient on after lower back pain surgery?
- Use straight back chairs
- NO stomach lying
- NO bending, lifting, or twisting for 6 weeks
- NO driving until off meds
- NO stairs for 1 week post op and then w/ assistance
Bursitis
Inflammation of the bursae
-fluid filled sac b/t bones
Ligaments
bone to bone
Tendons
muscle to bone
Tendinitis
inflammation of the tendons
What would a patient with tendinitis/bursitis complain of?
tenderness, warmth, erythema, and burning pain
What would help with tendinitis/bursitis?
- rest
- ice then heat
- corticosteroid injections
Impingement Syndrome (rotator cuff tendinitis)
- shoulder aches
- pain w/ positioning/movement
- limited mobility
- muscle spasms
What can be done for a patient w/ impingement syndrome?
- Rest/support affected shoulder
- Ice then heat
- Physical therapy
- Slow resumption of activities
Carpal Tunnel
pain in the nerves from repetitive motion in the hands and wrists
What are the symptoms of carpal tunnel?
pain, numbness, paresthesia, and weakness
What are the two diagnostic tests for carpal tunnel?
Phalen’s Test and Tinel’s Sign
Phalen’s Test
- Most common
- Have patient put backs of the hands together and if symptoms appear after 60 seconds the test is positive
Tinel’s Sign
- Very serious stage
- Tap on the nerve and symptoms occur
What are some conservative treatment options for carpal tunnel?
- wrist splints
- reduction of movements
- NSAIDs
- corticosteroid injections
If conservative treatment fails what is the next step for treating carpal tunnel?
Surgery to release the pressure on the nerve by cutting the transverse carpal ligament
What would you tell the patient after carpal tunnel surgery?
- use of wrist splints
- physical therapy
- limited use of the affected hand/ wrist 6-8 weeks
Ganglion Cyst
- typically asymptomatic fluid filled sacs
- many resolve without treatment
What may a patient experience with a ganglion cyst?
Localized tenderness that occurs w/ extreme wrist movements
What can be done for a ganglion cyst if pain continues or it begins to cause problems?
- aspiration of cyst
- corticosteroid injections
- removal of cyst surgically
What can cause a bunion to develop?
Improper footwear
Symptoms of bunions
Pain
Treatment for bunions
- proper footwear
- bunionectomy
- nonsteroidal anti-inflammatories
What are some complication of a bunionectomy?
- paresthesia
- limited ROM
Plantar Fasciitis Symptoms
-heel pain that is worse in the morning or when first standing after sitting for long periods
Treatment for Plantar Fasciitis
- physical therapy
- gentle stretching
- weight loss
- night splints
- custom shoe inserts
- nonsteroidal anti-inflammatories
Morton’s Neuroma
thickening of tissues around the nerves of the toes
Morton’s Neuroma Symptoms
- pain
- tingling
- burning
- numbness
- *feels as if there is a rock in their shoe
Treatment for Morton’s Neuroma
- metatarsal padding
- orthotics
- ice and then heat
- rest
- NSAIDs
- cortisone injections
- local anesthetics
- neurectomy
Complication of a Neurectomy
can cause numbness where the nerve was
What should the nurse do for upper and lower extremities?
- Neurovascular checks q 1-2 hrs
- Assess for increasing edema
- Relieve pain
- Assist w/ ADL’s
- Assistive devices
- Safety
- S/S infection and compromise perfusion
Osteoporosis
Bones become weakened secondary to a decrease in bone tissue and density
Primary Risk Factors for Osteoporosis
- age (50+)
- gender (female)
- race
- familial history
- dietary
- lifestyle
Secondary Risk Factors for Osteoporosis
- prolonged corticosteroid therapy
- antiepileptic medications
- heparin therapy
- thyroid medications
- disease processes
Acronym for Osteoporosis Risk Factors
A- alcohol use C- corticosteroid use C- calcium low E- estrogen low S- smoking S- sedentary lifestyle
Are there symptoms used to identify osteoporosis?
NO there are generally NO warning signs
When is a diagnosis typically made for osteoporosis?
often after a fracture occurs
Where do fractures typically occur in patients with osteoporosis?
spine, hip, and distal radius
Vertebral Collapse
vertebrae collapse on one another causing a reduction in height
Kyphosis or Dowager’s Hump
hump in the upper back (spine deformity) from compressed vertebrae
Diagnostic test for osteoporosis
Bone Density Scan/DEXA scan
-results in a T-score
Fracture Risk Assessment Tool (FRAX)
T-Score
- Normal < 1
- Low Bone Mass 1-2.5
- Osteoporosis > 2.5
FRAX
Assesses the patient for a 10 year risk for the development of fractures using clinical risk factors
Treatment for Osteoporosis
- Weight loss, avoid smoking/alcohol, improve diet
- Muscle strengthening, calcium/vitamin D
- Appropriate diagnosis, meds
Medications for Osteoporosis
- Oral Biophosphates (Fosamax, Actonel)
- Calcitonin
- Estrogen
What MUST you do for biophosphates?
- Take on an empty stomach first thing in the morning w/ a full glass of water
- Remain upright for 30-60 minutes after
- side effects: diarrhea, nausea, heartburn, renal toxicity
Calcitonin
- may be given IM or Sub Q
- Nasal spray if going home: alternate nares w/ each dose once a day
Estrogen
- Lowest dose for the shortest amount of time
- Risk of stroke, DVT, breast cancer
Paget’s Disease
Bone is rebuilt at an accelerated rate, resulting in structural abnormalities of the bone
-Usually asymptomatic
What bones are most commonly affected by Paget’s Disease?
skull, femur, tibia, pelvic bones, and spine
When is a diagnosis made for Pagett’s?
after a fracture
What S/S may occur w/ severe pain and visible deformities?
- bow legged
- knock kneed
- headaches/increase in head size
- pain/warmth over affected bone
Complications of Pagett’s Disease
- Enlarged skull: dental probs, deafness, neuro probs
- Weakened bones
- Bone tumors (osteosarcoma)
- Affected bones have extra blood vessels requiring additional blood flow (cardiac issues)
What is used to diagnose Pagett’s?
- previous fractures in common areas
- pain
- deformities
- familial history
- lab work
What lab work is done for Pagett’s?
- Elevated serum alkaline phosphate levels w/ normal calcium levels
- Bone scan
- X-rays/CT Scan
Treatment for Pagett’s
- NSAID’s (ibuprofen)
- Opioids (Percocet, Dilaudid)
- Calcitonin
- Oral Biophosphates (Fosamax, Actonel)
- IV Biophosphates (Reclast)
Fosamax
can be taken 6 months on and 6 months off
Actonel
2 months on and 2 months off
Reclast
- 1 time and last for 6 years
- side effects: hypocalcemia and renal toxicity
Osteomyelitis
Infection of the bone
- Endogenous- spread from one area of the body to the bone via blood
- Exogenous- result of open fracture or other bone trauma
Acute S/S of Osteomyelitis
- pain over affected bone
- swelling
- warmth/tenderness
- fever/chills
- nausea
- NOT “feeling well”
Chronic S/S of Osteomyelitis?
- constant pain
- Warmth, swelling, tenderness at site
Complications of Osteomyelitis
- Sepsis
- Amputation
- Death
What lab tests are used for Osteomyelitis?
- CBC- elevated WBC
- ESR (SED rate)- inflammatory response
- CRP (C-reactive proteins)- inflammatory response in acute phase
- Blood Cultures
What diagnostic tests are used for osteomyelitis?
- X-ray
- Bone biopsy
- Bone Scan
- MRI
- CT Scan
How can you prevent Osteomyelitis?
- postpone elective orthopedic surgeries if infection is present or has been present in the last 4 weeks
- Prophylactic antibiotic use
- Controlling outside factors
Treatment for Osteomyelitis
- IV antibiotics sensitive to bacteria causing infection (4-6 weeks)
- Pain meds
- High protein diet
- Nutritional Supplements
When would surgery be required for Osteomyelitis?
Antibiotic therapy is unsuccessful/soft tissue involvement
-Infected orthopedic hardware
What surgeries may be used for Osteomyelitis?
- Surgical Debridement
- Amputation
Septic Arthritis
Infection of a joint
- inappropriate treatment may lead to death or permanent damage
- Result of secondary infection, trauma, or surgery
S/S of Septic Arthritis
- warm, painful, swollen joint
- decrease ROM
- chills/fever
- increased WBC’s
How is Septic Arthritis Diagnosed?
- S/S
- Lab Work: cultures, CBC, ESR/C-Reactive
- Diagnostic Exams: Aspiration of fluid, CT/MRI
Treatment for Septic Arthritis
- Broad spectrum antibiotics
- Removal of excess fluid
- Immobilize
- Limit weight bearing
- ROM exercise
