musculoskeletal MS disorders Flashcards
osteoporosis
Characterized by reduced bone mass- > decreased bone strength.
Consequence: bone fracture
osteoporosis prevention
- Primary osteoporosis
- Low Vit. D level
- To prevent: consume adequate calcium (1,000 – 1,300 mg/day) and Vitamin D
- Engage in weight-bearing exercises
- Lifestyle modification: avoid smoking, alcohol, caffeine, carbonated beverages
- Secondary Osteoporosis- due to medications or diseases that affect bone metabolism.
primary osteoporosis
occurs among women after menopause and men later in life.
Women- decrease in estrogen
Men- decrease in testosterone
secondary osteoporosis
due to medications or diseases that affect bone metabolism
- Use of corticosteroids, excessive alcohol intake
- Specific disease: celiac disease; hypogonadism
- Certain medications: anticonvulsants, thyroid replacements, anti-estrogen, androgen inhibitors, PPI.
osteoporosis management
Diet rich in calcium and Vit D
Regular weight-bearing exercises (20-30 min)
Hormone replacement therapy after menopause
management of osteoporosis pharm
Calcium supplement with Vit. D tablet- take with Vit C/high vit. C drink
Osteoporosis Medications: (page 1207, Table 53.5) look in book for administration/special considerations
vitamin k2
new supplement –> absorption of calcium into bone (from blood to bone)
fracture management
fracture of hip- managed by joint replacement ; or close or open reduction with internal fixation
Compression fracture- treat conservatively
dx for osteoporosis
- Xray- can reveal low bone density and fracture
- DXA (dual x-ray absorptiometry)
- QCT (quantitative computed tomography)
- Peripheral Quantitative Ultrasound
DXA
Usually done in the hips or spine; used to screen early changes in bone density
health teaching: lie flat or stay x-ray table while the scan is going on, pt have to lie still/ follow instruction (ex: not good for people with dementia)
Peripheral Quantitative Ultrasound
This is inexpensive, portable and low-risk method to determine osteoporosis
gerontologic consideration
- Women older than 80- prevalence is 50%
- Men have higher mortality than women after sustaining hip fracture b/c - incidence of living alone in men is higher, men have less compliance
- Older adults absorb dietary calcium less efficiently and excrete more readily via kidneys.
osteoarthritis/ degenerative joint disease
OA is a noninflammatory degenerative disorder of the joints.
- Usually on weight-bearing joints- hips/knees
- Can also be seen in PIP (proximal interphalangeal) joints, DIP joints
osteoarthritis patho
The articular cartilage breaks down- > progressive damage to the underlying bone- > formation of osteophytes (“bone spurs”)(protrude into the joint space)- > joint space is narrowed- > decreased joint movement.
The joint can progressively degenerate!
osteoarthritis risk factors of disease and progression
older age; female gender; obesity; certain occupations; engaging in sports activity; history of previous injuries; genetic predisposition.
s/s of osteoarthritis
S/S: main: pain; morning stiffness; functional impairment (the onset is insidious and progressing over multiple years!), aggravated by movement and relieved by rest
- joints may be enlarged, decrease ROM
tx for morning stiffness
warm bath
management goal
Goal: decrease pain and stiffness; improve joint mobility
how to manage osteoarthritis
Exercise- cardio, aerobic, lower extremity strength training
Weight loss
Complementary, alternative and integrative health therapies
pharmacologic therapy
surgical management: osteotomy, arthroplasty
pharm management osteoarthritis
- Initial: acetaminophen (2 tabs Q 6 hrs – extra strength 500 mg)
- NSAIDs (alieve, ibuprofen, naproxen) - take w/ food
- COX-2 (cyclooxygenase- 2) enzyme blockers (use cautiously!) Celecoxib (Celebrex) common SE is stroke or heart attack so max for 5 days
- Opioid
- Intra-articular corticosteroids (steroid injection)
- Topical analgesics- like capcaisin
- Topical diclofenac sodium gel (Voltaren)- FDA-approved
osteomyelitis
Infection of the bone.
osteomyelitis classification
- Hematogenous osteomyelitis- blood borne
- Contiguous- focus osteomyelitis- contamination from bone surgery, open fracture etc.
- Osteomyelitis with vascular insufficiency– commonly seen among patients with diabetes and PVDs.
most common cause of osteomyelitis
Staphylococcus aureus (can be MRSA!) Surgical ink markers used in surgery have been linked (cross-contamination)!
s/s of osteomyelitis
- Systemic s/s
- Local: infected area: painful, swollen and tender
- Pain description: constant, pulsating that intensifies with movement.
- For chronic osteomyelitis: non-healing ulcer that overlies the infected wound - > intermittently drains pus
dx osteomyelitis
x-ray - bone necrosis
radioisotope bone scan- determine area of infection
MRI
wound and blood culture- not a sensitive indicator
management of osteomyelitis
drugs, surgical, supportive
drugs osteomyelitis management
Note: bone is mostly avascular - > infection is harder to eradicate (no veins)
Antibiotic therapy is longer than for usual infections- 3-6 weeks (mostly IV)
surgical management osteomyelitis
Intended for chronic and those that do not respond to antibiotics
Infected bone-> surgically exposed- > necrotic and purulent materials removed- > irrigated with sterile saline solution
supportive measures for osteomyelitis
diet high in protein (healing), vitamins, correction of anemia, etc.
prevention osteomyelitis
- elective orthopedic surgery - must be postponed if pt has current infection (simple as UTI)
- prompt tx of soft tissue infection (do not wait too long for tx)
- surgical ink (one per pt)
- tattoo sterilitiy
