musculoskeletal problems

• chronic metabolic disease in which bone loss causes decreased density and possible fracture
• usually silent and often the first sign is hip fracture

• a part of osteporosis
• low bone mass
• occurs when osteoclastic activity is greater than osteoblastic activity - bone remodeling is constant

• - women after menopause with decreased estrogen levels
• - thin, lean women of European or Asian descent
• - no exercise
• - diet lacking calcium and vitamin D
• - excessive caffeine intake
• - protein deficiency or excess
• - excessive alcohol or tobacco use
• - excessive exercise
• - anorexia
• - bulimia

• - generalized/primary = occurs mostly in postmenopausal women and men in their 60s and 70s
• - secondary = results from an associated medical condition (hyperparathyroidism, corticosteroids, long-term immobility)
• - regional = when a limb is immobilized

• teaching should begin with young women at 30 years of age
• take vitamin D and calcium
• decrease modifiable risk factors
• avoid sedentary lifestyle
• weight-bearing exercises

• fall risk
• height and weight
• back pain
• painful joint
• psychosocial
• labs - bone specific alkaline phosphatase; osteocalcin; pyridinium; N-teleopeptide; C-teleopeptide
• DXA - best tool - dual x-ray absorptiometry
• QCT and QUS

• healthy diet with calcium and vitamin D
• walking 30 minutes 3-5 times a week is the single most effective treatment for prevention
• drug therapy
• surgery - vertebroplasty or kyphoplasty

• supplements (take in divided doses because you only absorb about 500 mg at a time)
• estrogen or hormone therapy (low doses/short duration)
• bisphosphonates (slow bone reabsorption; take on empty stomach with full glass of water first thing in the morning and remain upright for 30 min after taking)
• selective estrogen receptor modulators (mimic estrogen in some parts of the body and block it in other parts)
• calcitonin (decreases bone loss)
• androgens (men)

• loss of bone related to vitamin D deficiency
• bone softens because of inadequate deposits of calcium and phosphorus in the bone matrix
• not common in US
• known as Rickets in children

• nutrition history
• age
• skin pigmentation
• ability to be exposed to sunlight to build vitamin D
• history of chronic GI distress r/t trouble of absorbing vitamin D

Vitamin D

• chronic metabolic disorder in which bone is excessively broken down and reformed
• bones are structurally disorganized, weak with increased risk of bowing of long bones and fractures

• possibly genetic - autosomal dominant inheritance pattern
• could be caused by viral respiratory infection

• history of bone fractures
• scoliosis
• kyphosis
• enlarged skull
• predisposed to kidney stones and gout
• diagnostic - increased alkaline phosphatase; radionucleotide bone scan

• analgesics - pain
• decrease bone resorption
• selected bisphosphonates
• calcitonin
• plicamycin (only if they don't respond to other meds)
• diet - increased calcium
• heat
• strength bearing
• massage
• ROM
• relaxation

• tibial osteotomy
• partial or total joint replacement
• decompression and stabilization of spine

• infection in bony tissue from bacteria/virus/fungi/cut on outside of body/from other area of infection in the body
• very rare in US
• seen more commonly in 3rd world countries
• very hard to treat
• labs
• - high ESR, c-reactive protein, WBC

• fever
• swelling
• erythema
• tenderness in effected area
• localized pain that intensifies with movement

• skin ulceration
• drainage
• sinus tract formation
• localized pain

• antibiotic therapy - IV followed by long course of oral
• hyperbaric oxygen therapy
• sequestrectomy - debride infected bone
• microvascular bone transfers

often asymptomatic and may be discovered on routine x-rays or as a cause of pathologic fracture - pain is biggest manifestation

• chrondogenic - from cartilage
• osteogenic - from bone
• fibrogenic - from fibrous tissue - most commonly found in children

• heat/cold
• analgesics/NSAIDs
• curettage
• joint replacement
• arthrodesis

• primary tumors - site where cancer starts to grow; affects 10-30 year olds; most common site is distal femur
• metastatic lesions - cancer from one place starts growing in the bone

occurs more often in males and people that had radiation treatment and benign bone lesions, prostate cancer, breast cancer, kidney, thyroid or lung metastasis

• pain
• local swelling
• palpate mass
• treatment aimed at reducing size/removing tumor

• chemotherapy
• radiation - only palliative if it has metastasized

• pressure dressing
• wound suction
• hemorrhage risk
• monitor circulation, movement, sensory, infection
• muscle strength, ROM, PT, CPM
• assess psychosocial

• slowly progressive contracture of the palmar fascia resulting in flexion of the fourth or fifth digit of the hand
• very common in European men, families
• can be bilateral
• surgery to release contracture

• round benign cyst often found on wrist or foot joint/tendon
• usually painless on palpation
• can cause joint discomfort
• rubbing/friction
• sometimes they are aspirated
• tendon sheath deteriorates and becomes weak/distended

• bunion
• more common in women

usually 2nd toes

• plantar digital neuritis
• tumor at end of foot
• needs to be removed

very similar to carpal tunnel syndrome

• inflammation of plantar fascia located in arch of foot
• treated with NSAIDs and shoe orthodics

• changes in muscles and ligaments on the concave side of the spinal column
• more common in females
• congenital in embryonic development
• screened in middle school/physicals
• sometimes leg lengths will be different
• treatment - bracing, casting, surgery, stabilize the spine (50% of adults)