Unit 17 Musculoskeletal Abnormalities Flashcards
What are factors contributing to Carpal Tunnel Syndrome?
- Entrapment movement
- Repetitive movement
- Exposure to extreme cold
- Arthritis
- Hypothyroidism
- Pregnancy
What are the defining characteristics of CTS?
Burning Tingling Pain Numbness Weakness along median nerve
How is CTS Dx?
-Tinel’s sign
tapping on the wrist; the tingling pins feeling is a positive sign
What are the treatments/Interventions for CTS?
- Focused on cause
- Wrist splints
- Ergonomic changes (How you use your body to do things)
- Avoidance of repetitive motions
- NSAIDs (for anti-inflammation and pain)
- Cortisone injection (for severe pain and inflammation)
- Yoga
- Acupuncture
- Surgery
What can we teach the PT regarding CTS?
- Hand splint but never for 24hrs a day
- Limit hand movement
- ADL assistance
- Recovery could take weeks to months
What is Osteoporosis?
A medical condition in which the bones become brittle and fragile typically as a result of hormonal changes, or deficiency of calcium or vitamin D.
Osteoblasts (new bone formation) decreases
Osteoclasts (old bone dissolved and reabsorbed) increases
What are risk factors for osteoporosis?
- Postmenopause
- Low testosterone in men
- Low calcium & vitamin D intake
- Small frame body
- Lack of exercise
- Caffeine, alcohol, smoking
- Lack of sunlight exposure
- Excess corticosteroids or other comorbidities
What are the Diagnostics for Osteoporosis and what is the Gold Standard with values?
>DEXA Scan (Dual energy X-Ray Absorpitiometery) *Gold standard for Dx* -1 and above = Bone density normal Between -1 and -2.5 = Osteopenia -2.5 and below = Osteoporosis
> Bone mineral density studies (BMD)
Labs (Ca, Phos, etc.)
X-Ray
QUS scan (Quantitate Ultrasound)
What are the classes of pharmacological interventions for Osteoporosis?
Bisphosphonates
SERMS (Selective Estrogen Receptor Modulator)
Calcitonin: Nasal
Name and describe Bisphosphonates.
- alendronate
- risedronate
- ibandronate
Work to decrease osteoclast activity
Top choice
SE: GI ulcers, jaw necrosis, GERD
Taken on an empty stomach first thing in the morning
Sit up 90 degrees for at least 30-60 minutes, NO Laying down
What is the goal of Osteoporosis pharmacological intervention?
Stop the progression and prevent complications
Name and describe SERMS.
-raloxifene
Increases osteoblasts, Decreases osteoclasts
SE: increased risk of thromboembolism, allergic reactions, chest tightness
Describe Nasal Calcitonin.
Decrease osteoclasts, increase osteoblasts
SE: Nasal irritation, flushing, GI, urinary frequency
- alternate nares
- taken once a day
What are non-pharmacological interventions for Osteoporosis?
- Increase dietary calcium food intake
- Vitamin D-enriched milk, orange juice, streamed broccoli, canned salmon,
-Vitamin D supplementation (cholecalciferol)
800-1000 IU daily
-calcium supplementation
*take with meals and orange juice
*split the dose
PT’s with renal calculi-decrease dose, drink lots of fluids
SE: abdominal distention, bloating, renal calculi
Name foods high in calcium.
- Milk
- Yogurt
- Green leafy vegetables
- Sardines
- Almonds
- Tofu
What are PT teaching points for Osteoporosis?
- Weight bearing exercise (walking, hiking, jogging, climbing stairs) *3-5 days 30 min
- Sunshine
- Antacids
- Prevention of constipation (increase fiber diet)
- Prevent falls/Home safety
- Decrease modifiable risk factors: smoking, decrease carbonated sodas
What is a Total Hip Replacement and when is it usually done?
Surgical replacement of the hip joint with artificial prosthesis
Done usually for joint disease, deformity, fracture, OA
What is the pre-op care for THR?
- Preoperative care prioritizes PT education about positioning and assessment for infection
- Donation of autologous blood
- Neurovascular assessment of affected limb
- Post-op education: adduction
What is the post-op care for THR?
- Positioning to prevent dislocation and [promote abduction]
- EARLY ambulation: PT assistive device
- Monitoring for complications (hemorrhage)
- Monitoring wound drainage
- DVT and infection prophylaxis
- Orthopat/cell saver infusion
- Maintain HOB below 60 degrees
- Raised toilet seat and chairs
- Assessment for dislocation
- Pain management
- 3-6months
What PT’s usually are candidates for Total Knee Replacement?
PT’s with severe pain and functional disabilities related to destruction of joint surfaces
Chronic bone disease, hemophilia, injury
Prosthesis
What is the post-op care for a total knee replacement?
- Compression bandage
- Wound drain
- Continuous passive motion device
- Early ambulation within 24 hrs
- Pain management
- Knee immobilizer when OOB
- Weight bearing limitations
- DVT/VTE prophylaxis
Describe acute back pain.
- Caused by a variety of musculoskeletal problems
- May be a result of involvement by muscles and/or intervertebral disks
What are the defining characteristics of acute back pain?
-Acute: lasting < 3 months
-Focused H and P
-Sciatic pain or radiculopathy
-What can be affected:
Gait
Reflexes
Leg length
Leg motor strength
Sensory perception
-Paravertebral muscle spasms
What is the goal of treatment for back pain?
Pain relief, return of mobility
What are interventions for acute back pain?
Rest, relaxation, and stress reduction Pain management Heat or ice therapy Physical therapy TENS (electrical stimulation)
Name and define the Surgical intervention for back pain.
Laminectomy: excision of the lamina and spinous process of a vertebra
fusion of fixation
What do you want to do preoperatively for a PT before a Laminectomy Surgical intervention?
- Evaluation of extremity movement, strength, and pain BEFORE Sx to compare with after Sx.
- Assessment of bowel and bladder
- Teaching - log rolling post-op
What is the goal of treatment for a Laminectomy?
relieve pain, slow disease progression, and increase the patient’s functional ability
What are Laminectomy interventions?
Manage pain and spasms
Log roll
Pillows under head and knees
OOB in 1 smooth motion
Assessment:
CSF leak, Urinary retention, Hemorrhage,
Strength and sensatio
What is Osteomyelitis?
*Infection of the bone
Extension of soft tissue infection
Direct bone contamination
Hematogenous spread
May become chronic
What are risk factors for Osteomyelitis?
- Poor nutrition
- Elderly
- Obesity
- Diabetics**
- Impaired immune system
- Chronic illness
- Long term steroid use
What are the defining characteristics of Osteomyelitis?
- Sudden
- Signs and symptoms of SEPSIS
- Localized pain
- Swelling around bone
- Erythema
- Fever, night sweats, chills
- Purulent drainage
- Labs: Leukocytosis, elevated ESR, anemia
- Pain- constant, pulsating, and increases with movement
What are diagnostics for Osteomyelitis?
X-ray findings Radioisotope bone scans MRI Wound culture Blood culture
What is the goal of Osteomyelitis intervention?
Stop the infectious process, prevent complications
What are the Osteomyelitis interventions?
- IV antibiotic therapy (proper PICC care for PT going home)
- Avoid excessive manipulation
- Sterile dressing changes
- Good body alignment
- Activity limitations
- Pain management
- ROM exercises to prevent contractures
What are PT teaching points for Osteomyelitis?
Antibiotic therapy Report signs and symptoms of worsening infection Fall prevention Aseptic wound care Physical mobility Pain management Use of ambulatory aids
In what percentage range of demineralization will osteoporosis show up on an X-ray?
25-40%
