Ch. 36 Management of Patients with Musculoskeletal Disorders

hip precautions

- keep operative hip in abduction - don't turn pt onto operative side - maintain limited flexion - when sitting, hips should be higher than the knees - don't cross legs - don't bend at waist past 90 degrees

loose bodies

- occur in a joint space as a result of articular cartilage wear and tear and bone erosion - fragments that can interfere with joint movement - typically removed via arthroscopic surgery

recommended intake vit. d

400-1000 IU daily

herberden's nodes

Bony enlargement of DIP

abduction

Movement away from the midline of the body

adduction

Movement toward the midline of the body

arthroplasty

The surgical replacement of a joint

osteophyte

a bony outgrowth or protuberance; bone spur

contracture

abnormal shortening of muscle or fibrosis of joint structures

corn

area of hyperkeratosis (overgrowth of horny layer of epidermis) produced by internal pressure or external pressure - commonly the 5th toe - soaking and scraping, surgical modification

osteoclastomas (giant cell tumors)

benign for long periods, but can invade local tissue and cause destruction

bouchard's nodes

bony enlargement of PIP

subchondral bone

bony plate that supports the articular cartilage

hallux valgus

bunion, deformity where the great toe deviates laterally - bursa can form - corticosteroid injections, good shoes, surgery in athletes

pes calvus

clawfoot a foot with an abnormally high arch and a fixed equines deformity of the forefoot - exercises, orthotic devices, arthrodesis (fusion) to reshape foot

ganglion

collection of neurological gelatinous material near the tendon sheaths and joints - appear as round, firm, cystic swelling, especially on wrist

enchondroma

common tumor of the hyaline cartilage that develops in the hand, femur, tibia, or humerus - mild ache

hypercalcemia

complication of bone cancer or any process involved with breakdown of bone

sequestrum

dead bone in abscess cavity

avascular necrosis

death of tissue due to insufficient blood supply

osteoporosis

degenerative disease of the bone characterized by reduced mass, deterioration of matrix, and diminished architectural strength

radiculopathy

disease of a spinal nerve root, often resulting in pain and extreme sensitivity to touch

Paget disease

disorder of localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae

DIP

distal interphalangeal joint

hematogenous osteomyelitis

due to bloodborne spread of infection

bone cysts

expanding lesions within the bone

pes planus

flat foot longitudinal arch of the foot's diminished - burning, clumsiness, edema, pain - exercise, foot orthoses

hammer toe

flexion deformity of the interphalangeal joint that may involve several toes - toes are pulled upward, forcing the metatarsal joints (ball of foot) downward - open-toed shoes, exercises, padding, watching for friction points (esp. DB)

contiguous-force osteomyelitis

from contamination from bone surgery

impingement syndrome

impaired movement of the rotator cuff of the shoulder

osteomalacia

inadequate mineralization of bone, softens and weakens bones

PTH

increases with aging, and increases bone turnover and resorption (breakdown)

osteomyelitis

infection of the bone that results in inflammation, necrosis, and formation of new bone

bursitis

inflammation of a fluid-filled sac in a joint

tendonitis

inflammation of muscle tendons

plantar fasciitis

inflammation of the foot-supporting fascia - acute onset of heel pain with first steps in morning - if unresolved, can cause tears

sciatica

inflammation of the sciatic nerve, resulting in pain and tenderness along the nerve through the thigh and leg

onychocryptosis

ingrown toenail - free edge of a nail plate penetrates the surrounding skin - washing 2x daily, warm, wet soaks

estrogen

inhibits bone breakdown, decreases with aging

calcitonin

inhibits bone respiration and promotes bone breakdown, decreases with aging

percutaneous vertebroplasty or kyphoplasty

injection of polymethylmethacrylate bone cement into the fractured vertebrae followed by inflation of a pressurized balloon to restore the shape of the affected vertebrae -relieves pain -improves quality of life

polyostotic

involving multiple bones

septic arthritis

joints that become infected through spread of pathogens from other parts of the body or directly through trauma, injection, or surgical instrumentation - s.aureus most common cause

chronic osteomyelitis: x-ray findings

large, irregular cavities, raised periosteum, sequestrum, or dense bone formation

osteopenia

low bone mineral density

osteolysis

lysis of bone from inflammatory reaction against polyethylene particulate debris

chrondrosarcoma

malignant tumor of the hyaline cartilage

hetertropic ossification

misplaced formation of bone

osteosarcoma

most common and most fatal primary malignant bone tumor

osteochondroma

most common benign bone tumor

involucrum

new bone growth around a sequestrum

osteoarthritis

noninflammatory degenerative disorder of the joints - most common form of joint disease - aka degenerative joint disease

primary osteoporosis

occurs in women after menopause and men later in life

fragility fracture

one that occurs when a person falls from their natural height or with low velocity

osteoid osteoma

painful tumor that occurs in children and young adults

aneurysmal bone cysts

painful, palpable mass found in long or flat bones and vertebrae - seen in young adults

PIP

proximal interphalangeal joint

malignant bone tumors

relatively rare and arise from connective and supportive tissue cells or bone marrow elements

cementless fixation

relies on new bone growing into the surface of the implant by using a press-fit, porous-coated prosthesis

total hip arthroplasty

replacement of a severely damaged hip with an artificial joint

total joint arthroplasty

replacement of all components of an articulating joint

secondary osteoporosis

result of medications or diseases that affect bone metabolism - use of corticosteroids, alcohol, etc. - more common in men

cauda equina syndrome

results from compression of the cauda equina, the bundle of spinal nerves that arise from the lower portion of the spinal cord - urinary/bowel incontinence, neurologic weakness, back pain

Dupuytren's Disease

results in a slowly progressive contracture of the palmar fascia that causes flexion of the fourth, fifth, and sometimes, middle finger - renders these fingers more or less useless

metastatic bone disease

secondary bone tumor, more common than primary - a tumor in the bone causes the normal bone tissue to react by osteolytic response (bone destruction) or osteoblastic response (bone formation)

osteomyelitis with vascular insufficiency

seen most commonly among patients with diabetes and peripheral vascular disease, most commonly affecting the feet

unicameral bone cysts

single cavity bone cysts - mild discomfort, possible fractures of upper humerus and femur

benign bone tumors

slow-growing, well-circumscribed, and encapsulated tumors - few s/s, not a cause of death - more common that malignant primary bone tumors

morton neuroma

swelling near the third (lateral) branch of the median plantar nerve - throbbing, burning pain - rest, massage, surgery (pain and sensation immediately lost)

callus

thickened area of skin that has been exposed to persistent pressure or friction - keratolytic ointment, padding, prevention

cemented fixation

uses a fast-curing bone cement (polymethylmethacrylate [PMMA]) to hold implants in place

carpal tunnel syndrome

when the median nerve at the wrist is compressed by a thickened flexor tendon sheath, skeletal encroachment, edema or a soft tissue mass

acute osteomyelitis: x-ray findings

x ray findings demonstrate soft tissue edema