Systemic diseases Flashcards
Fibromyaligia syndrome (FMS)
- idiopathic cause
- etiology may be of peripheral or CNS origin
- functional limitations are a common factor
Signs and symptoms of FMS
- pain
- fatigue
- lowered respiratory function
- reduced joint ROM
- impaired muscle endurance
- impaired muscle strength
- lowered CV fitness levels
- present with at least 11 out of 18 tender points
chronic fatigue syndrome (CFS)
- idiopathic cause- characterized by profound fatigue
- accompanying disorders (neurasthenia, chronic Epstein-Barr virus, myalgic encephalomyelitis)
CFS signs and symptoms
- 25% bedridden or unable to work
- 33% may work part time
- unexplained debilitating fatigue for at least 6 months
- sore throat, tender cervical or axillary lymph nodes, muscular pain, multijoint noninflammatory arthralgia, impairment in memory or concentration
- *up to 70% with CFS present with FMS
multidisciplinary approach
therapeutic exercise intervention for prevention and wellness
- exercise
- pharmacologic
- psychological (education, depression)
therapeutic exercise benefits
1: muscle performance
2: aerobic capacity
3: range of motion
4: posture
5: response to emotional stress
6: pain
early phase exercises for FMS
week 1-on Goal: stress and pain management -relaxation -progressive relaxation -autogenic deep breathing -visualization -deep breathing -stretch
pt response model!!
midphase exercises for FMS
week 2-on
Goal: musculoskeletal balance
-fluoromethane spray and stretch
-self mobilizations
-neuromuscular techniques: hold and relax, contract and relax
-strain-counterstrain
-muscle system balance exercises (Sahrman)
-neutral spine (+-tubing)
-closed chain eccentric exercise
-early aerobic exercise: supine bike, unloading equipment, easy exercises in water
late phase exercises for FMS
Goal: maintenance
- stretch, cont
- musculoskeletal balance, cont
- general strength: resistance tubing, machines, closed chain eccentric exercise
- aerobic exercise: NWB to WB and nonjarring activities (ski machine, seated stationary bike, treadmill) and water exercises (aerobics, flotation belt)
impaired muscle performance and FMS
- Initially: low resistance, low repetition when addressing strength deficits
- exercise can be isometric or dynamic (slow movements)
- calibrate progressions according to pt’s response
impaired aerobic capacity and FMS
- introduce aerobic exercise ASAP
- initial intervention should be limited (2-5 min) with attention to patient response
- gradual increase according to tolerance levels
- by late phase, pts may tolerate elevation of HR to 50-60&
- *education component is so important bc of limited timeframe from payer
impaired ROM and FMS
- hypermobility-stabilization training during agonist strengthening exercises
- graded flexibility exercises. remember, stretching should never be painful
- educate feelings of stretch and tissue damage
impaired posture and FMS
- consider ALL postures (sitting, standing, resting, static/repetitive work postures
- static posture is starting point and end point for return to function
- eccentric control is frequently lost (sitting down, descending stairs- thrown by gravity)
- tai chi chuan, feldenkrais, and low level exercise strategies may help restore muscle balance and function
impaired response to emotional stress- FMS
- exercise with relaxation, deep breathing, stretching
- progressive relaxation, autogenic deep breathing, visualization exercises
- diaphragmatic and lateral costal expansion breathing
FMS-pain
- assess FMS and biomechanical aspects
- eliminate biomechanical origin as part of whole approach
- consider pt’s adherence and the relationship to symptoms
- consider adjunctive (pharmaceutical) and cognitive behavioral approaches
precautions and contraindications for FMS
- adherence to an exercise program may be challenging due to perceived overexertion
- clarity of instruction should be reinforced via checklists and written guidance
- pacing is crucial for those who are chronically fatigued
- exercise applications and dosage should be closely monitored to reduce concerns related to perceived expectations of pain
summary of FMS and CFS
- both have widespread effects and limit functioning
- unclear causes, CFS may have a viral component
- exercise appears to be effective for FMS and possibly for CFS
- exercise rx should be done carefully and tracked continuously
- exercise for both address stress, posture, mobility, muscle performance CV endurance
- exercise interventions should consider pacing, limiting overexertion and overcommitment
- establish mutually acceptable goals to contribute to pt adherence
- aerobic exercise should be low impact and progress slowly
- work w/ other practitioners and consider adjunctive therapies when helping the pt prioritize
- use of agents may be taught as self tx agents to make best use of clinical time
inflammation is characterized by:
- rubor (redness)
- swelling
- calor (heat)
- pain
- diminished function
inflammatory disorders can be further characterized as:
- infectious
- rheumatic
- metabolic
- regional inflammation related to overuse
Infectious inflammatory disorders
1: hematogenous osteomyelitis
2: septic arthritis
hematogenous osteomyelitis
- localized/generalized inflammation of bone due to pyogenic infection spread by the blood stream
- most common in boys
- in children, usually affects the metaphysis of the tibia or femur
- can occur in vertebrae and bones of the feet in diabetics, or at sites penetrated by trauma (open fx) or surgery
osteomyelitis
- can be acute or chronic
- bacteria, once allowed to collect in the minute channels of the bone, may be isolated from both the cellular and chemical elements of host defenses and free to proliferate unimpeded
- microcirculation of bone within these channels is highly vulnerable to bacterial toxins, which may produce local thrombosis of these small vessels leading to the death of bone in the vicinity of infection, which further impedes access by host defenses
- nutrient vessels are quite convoluted in bone, which allows bacteria to be trapped in the metaphysics
joint infection secondary to osteomyelitis..
may occur in shoulder and hip as a result of synovial membrane inserting distally to epiphysis, allowing bacteria to spread directly from metaphysis to the joint space
signs and symptoms of osteomyelitis
- severe/constant pain near the end of the affected long bone with exquisite tenderness to palpation
- may be febrile, report malaise, weight loss
treatment of osteomyelitis
- life threatening condition
- treated with aggressive antibiotic regimen, surgical debridement
- radiographic changes can be evident within 10-14 days in acute cases; initial x-rays are usually normal
- draining sinuses develop if untreated due to increased pressure from accumulation of pus
- lab work reveals elevated leukocyte counts due to infection
septic arthritis
- often secondary to osteomyelitis; often affects children or adults >60
- synovial fluid becomes contaminated with bacteria- nice environment for bacteria to thrive
- the body’s immune response can destroy both bacteria and joint surfaces