Osteoarthritis and other musculoskeletal disorders

Question 1

List common musculoskeletal disorders

Answer 1

• Osteoporosis
• Osteoarthritis
• Septic arthritis
• Osteomyelitis
• Prosthetic joints
• Carpal tunnel syndrome
• Muscular dystrophies
• Myasthenia gravis

Question 2

State causes, signs/symptoms, treatment and prevention of

Osteoporosis

Answer 2

Causes
• Occurs when bones lose minerals, such as calcium, more quickly than the body can replace them, causinga loss of bone thickness (bone density or mass)
• Thinner/ less dense bone = increased fracture
• Common fracture sites: hip, spine and wrist

Signs and symptoms
• Back pain, caused by a fractured or collapsed vertebra
• Loss of height over time
• A stooped posture
• A bone that breaks much more easily than expected

Treatment
• Bisphosphonates: encourage bone density by slowing osteoclast actions
• Parathyroid hormone (PTH)– regulates the amounts of calcium, phosphorus and magnesium in the bones and blood. Parathyroid hormone therapy stimulates new bone formation and can increase bone density and strength

Prevention
• Have a healthy and varied diet with plenty of fresh fruit, vegetables and whole grains
• Eat calcium-rich foods
Absorb enoughvitamin D
• Avoidsmoking
• Limitalcoholconsumption
• Limitcaffeine
• Do regular weight-bearing and strength-training activities

Question 3

State causes, signs/symptoms, treatment and prevention of

Osteoarthritis

Answer 3

Causes
• Breakdown of articular cartilage
• This results in the bones rubbing together, causing pain, swelling and loss of motion
• Chronic joint trauma: Repetitive overloading of joints
• Obesity: major risk factor – loading and cytokine effects – especially knee

Signs and symptoms
• Pain: Usually only one or a few joints painful
• Restricted joint movement - due to capslar thickening and osteophytes
• Crepitus (creaking/crackling) due to rough articular surfaces
• Bony ‘swelling’ around joint margins – feels bony and hard
• Muscle weakness/wasting due to reduced activity

Treatment
• Treatment aimed at reducing symptoms 
• Supervised walking program for mild-moderate
• Weight loss important 
• Pharmacologic: paracetamol, NSAIDS 
• Surgery – eg hip and knee replacement

Prevention
• Watch your weight
• Healthy diet
• Exercise
• Adequate sleep
• Support body, e.g. wear running shoes to reduce impact

Question 4

State causes, signs/symptoms, treatment and prevention of

Septic arthritis

Answer 4

Causes
• Caused by bacteria entering the joint through the bloodstream
• Organisms: S aureus, various streptococci common

Signs and symptoms
• Fever
• Acute monoarthritis (only in one joint)
• Swelling and dysfunction

Treatment
• IV antibiotics (hospitalisation)
• Joint aspiration
• Physiotherapy

Prevention
• Avoiding infection
• Avoid puncture wounds
• Avoid damage to the skin

Question 5

State causes, signs/symptoms, treatment and prevention of

Osteomyelitis

Answer 5

Causes
• Osteomyelitis means an infection of bone. Bacteria are the usual infectious agents

Signs and symptoms
• Fever
• Pain & movement limitation in adjacent joint
• Bone pain/tenderness

Treatment
• IV antibiotics for 2 weeks
• 4 weeks oral antibiotics
• Amputation in severe cases

Prevention
• Be clean
• Flush wounds
• Sterile bandages

Question 6

State causes and treatment of

Prosthetic joints

Answer 6

Causes
• Bacterial infections

Treatments
• Antibiotic prophylaxis given to patients with prosthetic joint/s undergoing dental treatments

Question 7

State causes, signs/symptoms, treatment and prevention of

Carpal tunnel syndrome

Answer 7

Causes
• The median nerve (which runs from your forearm down into the palm of your hand) is compressed or squeezed as it passes through the carpal tunnel

Signs and symptoms
• Tingling and numbness in the fingers and palm
• Pain in your wrist or hand
• The pain and discomfort can often be relieved by shaking out the hands
• A sensation that your fingers are swollen, even if they look normal in size
• A feeling of weakness in your hands or a loss of grip strength

Treatment
• Rest
• A cool pack
• Splinting
• Elevation
• Anti-inflammatory medicines
• Corticosteroids

Prevention
• Warming up fingers, wrists and forearms with stretching exercises before work;
• Taking regular breaks;
• Wearing a splint or a hand brace to keep wrists straight;
• Making sure desk or work area is correctly adjusted to maintain a natural wrist position
• Rotating repetitive jobs among workers

Question 8

State causes, signs/symptoms, treatment and prevention of

Muscular dystrophies

Answer 8

Causes
• Muscle damage and weakness due to the lack of a protein calleddystrophin, which is necessary for normalmusclefunction

Signs and symptoms
• Trouble walking
• Scrawny frame
• Difficulty standing
• Muscle weakness
• Bone thinning

Treatment
• Corticosteroids:This type of medication can help increase muscle strength and slow progression, but long-term use can weaken bones and increase weight gain
• Heart medications:If the condition impacts the heart,beta blockersand angiotensin-converting enzyme (ACE) inhibitors may help
• General exercises:Standard low-impact aerobic exercises such as walking and swimming can also help slow the disease’s progression.
• Breathing assistance: use of devices to help improve oxygen delivery through the night.
• Mobility aids:Canes, wheelchairs, and walkers can help the person stay mobile.
• Braces:These keep muscles and tendons stretched and help slow their shortening. They also give added support to the user when moving

Prevention
• Genetic basis: cannot be prevented

Question 9

State causes, signs/symptoms, treatment and prevention of

Myasthenia gravis

Answer 9

Causes
• An autoimmune disease where antibodies are produced that interfere with motor nerve conduction

Signs and symptoms
• Drooping of one or both eyelids (ptosis)
• Blurred or double vision (diplopia) due to weakness of eye muscles
• Change in facial expression
• Difficulty swallowing
• Shortness of breath
• Impaired speech (dysarthria)
• Weakness in the arms, hands, fingers, legs, and neck

Treatment
• Thymectomy:Removal of the thymus gland (which often is abnormal in individuals with myasthenia gravis) can reduce symptoms and may cure some people
• Anticholinesterase medications: Anticholinesterases like pyridostigmine slow the breakdown of acetylcholine at the neuromuscular junction, thereby improving neuromuscular transmission
• Immunosuppressive drugs.These drugs improve muscle strength by suppressing the production of abnormal antibodies
• Plasmapheresis and intravenous immunoglobulin. These treatments remove the destructive antibodies
• Plasmapheresisis a procedure using a machine to remove harmful antibodies in plasma and replace them with good plasma or a plasma substitute.
• Intravenous immunoglobulinis a highly concentrated injection of antibodies pooled from many healthy donors that temporarily changes the way the immune system operates. It works by binding to the antibodies that cause myasthenia gravis and removing them from circulation.

Prevention
Myasthenia gravis cannot be prevented, but avoiding the following triggers may help patients prevent exacerbation:
• Emotional stress
• Exposure to extreme temperatures
• Fever
• Illness (e.g., respiratory infection, pneumonia, tooth abscess)
• Low levels of potassium in the blood (hypokalemia; caused by diuretics, frequent vomiting)
• Medications (e.g., muscle relaxants, anticonvulsants, certain antibiotics)
• Overexertion