Unit 17 Musculoskeletal Flashcards
ankylosis
fixation or immobility of a joint
arthroplasty
repair of joint problems through an arthroscope or through open joint surgery
atrophy
shrinkage like decrease in size of muscle
contracture
abnormal shortening of muscle or joint or both; fibrosis
osteopenia
bone density is lower than normal
muscle spasm
involuntary contraction of a muscle
osteomalacia
softened, brittle bones
osteomyelitis
infection and inflammation of the bone
osteoporosis
a disorder in which bones lose density and become porous and fragile
herniated nucleus pulposus HPN
herniated of an intervertebral disk through a tear in the surrounding annulus fibrosus
carpal tunnel syndrome
median nerve at the wrist is compressed, caused by repetitive hand and wrist movements.
tendonitis
inflammation of a tendon
crepitus
grating crackling sound or sensation with movement of ends of broken bone or irregular joint surface
radiculopathy
disease of a nerve root
sciatica
inflammation of the sciatic nerve, resulting in pain and tenderness along the nerve through the thigh and leg
Carpal Tunnel Syndrome CTS
- Entrapment neuropathy
- Repetitive movement
- Exposure to extreme cold
- Arthritis
- Hypothyroidism
- Pregnancy
Defining Characteristics CTS
- Pain
- Numbness
- Paresthesia
- Weakness along media nerve
- Night pain
CTS Dx
Tinel’s sign - percuss lightly over median nerve on inner aspect of wrist. if tingling numbness and pain, + Tinel sign
CTS Tx and Interventions
• Focused on cause • Wrist splints • Ergonomic changes • Avoidance of repetitive motion NSAIDs Cortisone injections Yoga Acupuncture Surgery
CTS Pt Teaching
- Hand splint
- Limit hand movement
- ADL assistance
- Recovery: Weeks - months
Osteoporosis
reduction of bone density and change in sructure, become brittle porous and fragile, fracture easily.
Rate of resorption greater than formation. Increase of osteoclasts ,decrease of osteoblasts.
Primary osteo - failure to acheive peak bone mass early in life.
Secondary - malabsorption synd, thyroid diseases, Meds, etc.
Osteoporosi Risk Factors
Small framed nonobese caucasian women Asian women of slight build Deficient Vitamin D and calcium. Immobility Family history Post menopause Men, low testosterone high phospate intake (carbonated) Inadequate calories Caffeine alcohol smoking\ Lack of sunlight exposure Meds: CS, antiseizure, heparin, thyroid hormone. Renal failure
Osteoporosis Dx
- Bone Mineral Density Studies (BMD)
- QUS Scan (Quantitative Ultrasound)
- DEXA Scan (Dual Energy X-Ray Absorptiometry)
- -1 and above = bone density is considered normal.
- Between -1 and -2.5 = osteopenia.
- -2.5 and below = osteoporosis
- Labs: Ca, Phos & ALP
- X-Ray
Osteoporosis Pharma
Goal: Stop the progression and prevent complications
• Bisphosphonates
• alendronate, risedronate, ibandronate
• SE’s: GI, ulcers, jaw necrosis
• Empty stomach
• Sit up, 90 degrees for at least 30-60 minutes
• SERMS (Selective Estrogen Receptor Modulator)
• Raloxifene (Evista)
• SE: Increased risk thromboembolism, allergic reaction, chest
tightness
- Calcitonin: Nasal
- SE’s: Nasal irritation, flushing, GI, urinary frequency
- Alternate nares
Osteoporosis Interventions
Dietary calcium See calcium containing foods in Bb vitamin D–enriched milk, orange juice, steamed broccoli, canned salmon with bones Calcium supplementation Puberty (9-19) = 1,300 mg/day Adults (19-50) = 1000 mg/day 51 + = 1200 mg/day Take with meals or orange juice Split the dose SE – abdominal distension, bloating, renal calculi
• Vitamin D supplementation • Adults: 800-1000 IU daily Weight bearing exercise Sunshine Antacids Prevention of constipation Increased fiber in die
Osteoporosis Pt Teaching
Prevent falls/ Home safety Decrease modifiable risk factors: Smoking Decrease ETOH intake Decrease carbonated sodas Improve bowel function Dietary counseling & supplementation Exercise
Total Hip Replacement Preop Care
• Preoperative care prioritizes patient education about positioning and
assessment for infection
• Donation of autologous blood
• Neurovascular assessment of affected limb
• Postoperative education: abduction
THR Postop Care
• Positioning to prevent dislocation and promote abduction • EARLY ambulation: PT, assistive devices • Monitoring for complications • Monitoring wound drainage • DVT and infection prophylaxsis • Orthopat/cell saver infusion • Pain management • Raided toilet seats and chairs • Maintain HOB below 60 degrees • Assessment for dislocation • 3-6 months
Total Knee Replacement TKR
Postop care
compression bandage • wound drain • continuous passive motion (CPM) device • Early Ambulation – within 24 hours • Pain Management • Knee immobilizer • Weight bearing limitations, assistive device, PT • Pain management
Acute Back pain
may be a result of involvement by muscles and or intervertebral discs
Acute back pain Defining characteristics
- Acute: Lasting < 3 months
- focused history and physical examination
- Sciatic pain or radiculopathy
- Affected
- Gait
- Reflexes
- Leg length
- Leg motor strength
- Sensory perception
• Paravertebral muscle spasm
Back pain Dx
• X-ray of the spine: May demonstrate a fracture, dislocation, infection,
osteoarthritis, or scoliosis
• Bone scan and blood studies: May disclose infections, tumors, and
bone marrow abnormalities
• Computed tomography (CT): Useful in identifying underlying
problems, such as obscure soft tissue lesions adjacent to the
vertebral column and problems of vertebral disks
• Magnetic resonance imaging (MRI): Permits visualization of the
nature and location of spinal pathology
• Electromyogram (EMG) and nerve conduction studies: Used to
evaluate spinal nerve root disorders (radiculopathies)
Acute back pain Interventions
Goal of treatment: Pain relief, return of mobility
• Rest, relaxation & stress reduction
• Pain management
• Patient teaching: sitting, standing, lifting, lying and exercising
• Heat or ice therapy
• Massage therapy
• Physical therapy
• TENS (transcutaneous electrical stimulation)
• Resumption of activity with improvement
Back pain pt teaching
Standing
Advise the patient to adhere to the following guidelines:
Avoid prolonged standing and walking.
When standing for any length of time, rest one foot on a small stool or box to relieve lumbar lordosis.
Avoid forward flexion work positions.
Avoid high heels.
Sitting
Discuss the following strategies with the patient:
Avoid sitting for prolonged periods.
Sit in a straight-back chair with back well supported and arm rests to support some of the body weight; use a footstool to position knees higher than hips if necessary.
Eradicate the hollow of the back by sitting with the buttocks “tucked under.”
Maintain back support; use a soft support at the small of the back.
Avoid knee and hip extension. When driving a car, have the seat pushed forward as far as possible for comfort.
Guard against extension strains—reaching, pushing, sitting with legs straight out.
Alternate periods of sitting with walking.
Lying
Encourage the patient to do the following:
Rest at intervals; fatigue contributes to spasm of the back muscles.
Place a firm bed board under the mattress.
Avoid sleeping in a prone position.
When lying on the side, place a pillow under the head and one between the legs, with the legs flexed at the hips and knees.
When supine, use a pillow under the knees to decrease lordosis.
Lifting
Emphasize the importance of the following strategies:
When lifting, keep the back straight and hold the load as close to the body as possible.
Lift with the large leg muscles, not the back muscles.
Use trunk muscles to stabilize the spine.
Squat while keeping the back straight when it is necessary to pick something off the floor.
Avoid twisting the trunk of the body, lifting above waist level, and reaching up for any length of time.
Exercising
Daily exercise is important in the prevention of back problems.
Walk daily, and gradually increase the distance and pace of walking.
Perform prescribed back exercises twice daily, increasing exercise gradually.
Avoid jumping and jarring activities.
Laminectomy
- Excision of the lamina and spinous processes of a vertebra
- fusion or fixation
- Preoperative:
- Evaluation of extremity movement and strength
- Assessment of bowel & bladder
- Teaching – log rolling postop
Laminectomy Interventions
• Goal of treatment: relieve pain, slow disease progression, and increase the patient’s functional ability • Manage pain and spasm • Log roll Pillows under head and knees • OOB in 1 smooth motion • Assessment: • CSF leak • Urinary retention • Hemorrhage • Strength & Sensation
Osteomyelitis
- Infection of the bone
- Extension of soft tissue infection
- Direct bone contamination
- Hematogenous (blood borne) spread
- May become chronic
- Effects quality of life
Osteomyelitis Risk Factors
- Poor nutrition
- Elderly
- Obesity
- Impaired immune system
- Chronic illness
Osteomyelitis Defining Char
- Sudden
- Signs and symptoms of sepsis
- Localized pain & guarding
- Swelling around bone
- Erythema
- Fever, night sweats, chills
- Purulent drainage
- Lab: Leukocytosis, elevated ESR, anemia
- Pain – constant, pulsating and increases with movement
Osteomyelitis Dx
- X-ray findings
- Radioisotope bone scans
- MRI
- Wound culture
- Blood culture
Osteomyelitis Interventions
Goal: Halt the infectious process, prevention of complications • Antibiotic therapy • Avoid excessive manipulation • Sterile dressing changes • Good body alignment • Activity limitations • IV antibiotics • Pain management • Psychosocial support • Surgery: sequestrectomy
Osteomyelitis Pt Teaching
- Antibiotic therapy
- S&S of worsening infection
- Fall prevention
- Wound care: aseptic
- Physical mobility
- Pain management
- Use of ambulatory aids
