Week 14: MS/Immobility Flashcards
1
Q
Hemiplegia -Paralysis on ____________ of the body
A
one side
2
Q
Paraplegia -Paralysis of the __________ body half
A
lower
3
Q
Quadriplegia - Paralysis of trunk and ___________________
A
all four limbs
4
Q
Diplegia - _____________ paralysis in any area of the body
A
Symmetrical
5
Q
Inactive muscle
- Loss of strength, endurance, and mass
-Muscle ____________
- Prolonged bed rest may lead to loss of ______ of the muscle strength.
- Correct positioning
- Essential for inactive muscles and joints
A
- Loss of strength, endurance, and mass
-Muscle atrophy - Prolonged bed rest may lead to loss of half of the muscle strength.
- Correct positioning
- Essential for inactive muscles and joints
6
Q
Loss of bone mass
- Lack of weight-bearing activity and ________ action
* Reduces ______________ activity
* Osteoclastic activity continues.
A
- Lack of weight-bearing activity and muscle action
- Reduces osteoblastic activity
- Osteoclastic activity continues.
7
Q
Tendon and ligaments
- Require ________________to maintain structure and function
- Days of __________________ will shorten these connective tissue structures, and density increases.
* Results in limited flexibility and range of motion
A
- Require movement to maintain structure and function
- Days of immobility will shorten these connective tissue structures, and density increases.
8
Q
Factors that promote skin breakdown
- Poor general circulation or ___________
- Edema
- Inadequate subcutaneous tissue in older adults or disabled persons
- Loss of sensation
- Mechanical irritation or friction
-Excessive _____________ from perspiration or urine
-Inadequate personal hygiene
-inadequate nutrition or hydration
-Trauma to the skin
A
- Poor general circulation or anemia
- Edema
- Inadequate subcutaneous tissue in older adults or disabled persons
- Loss of sensation
- Mechanical irritation or friction
-Excessive moisture from perspiration or urine
-Inadequate personal hygiene
-inadequate nutrition or hydration
-Trauma to the skin
9
Q
Cardiovascular Effects of immobility
Full immobilization—initially
- Blood pools in _________
- Venous return may increase.
Prolonged immobility
- Venous return and cardiac output reduced
- Orthostatic __________________ —at change of position
* Short periods of dizziness
* Fainting
* Pallor and sweating
* Rapid pulse
A
Full immobilization—initially
- Blood pools in trunk
- Venous return may increase.
Prolonged immobility
- Venous return and cardiac output reduced
- Orthostatic hypotension—at change of position
* Short periods of dizziness
* Fainting
* Pallor and sweating
* Rapid pulse
10
Q
Patient becomes mobile after long bed rest
- May take _________ for cardiovascular reflex controls to return to normal
A
weeks
11
Q
Blood pooling—stasis
- Increased ____________ pressure and edema
-Promotes thrombus formation in veins
* Particularly in deep leg veins
- Blood clotting in patients with dehydration or cancer
* May be encouraged by increased venous pressure or damage to blood vessels
- Thrombi may break away with ____________ or massage
- Pulmonary embolus
- Venous stasis, hypercoagulability, and blood vessel damage, increase the chance of deep vein thrombosis.
A
- Increased capillary pressure and edema
-Promotes thrombus formation in veins - Particularly in deep leg veins
- Blood clotting in patients with dehydration or cancer
- May be encouraged by increased venous pressure or damage to blood vessels
- Thrombi may break away with movement or massage
- Pulmonary embolus
- Venous stasis, hypercoagulability, and blood vessel damage, increase the chance of deep vein thrombosis.
12
Q
Respiratory Effects of immobility
-Decreased ______________
- Respiration ________ and shallow
-Deep breathing and coughing more difficult
*Drugs
-Sedatives and analgesics
* Depress neuromuscular activity and respiratory control center
*Increased ______________ in the lungs
-Pneumonia
-Atelectasis
A
-Decreased metabolism
- Respiration slow and shallow
-Deep breathing and coughing more difficult
*Drugs
-Sedatives and analgesics
* Depress neuromuscular activity and respiratory control center
*Increased secretions in the lungs
-Pneumonia
-Atelectasis
13
Q
Gastrointestinal Effects of immobility
-____________ dietary intake
-Appetite reduced
- Negative nitrogen imbalance
* Protein deficit
- ______________caused by muscle inactivity and body position
- Reduced food, fiber, fluid intake
- Obesity when prolonged immobility occurs & caloric intake exceeds energy need
A
-Decreased dietary intake
-Appetite reduced
- Negative nitrogen imbalance
* Protein deficit
- Constipation caused by muscle inactivity and body position
- Reduced food, fiber, fluid intake
- Obesity when prolonged immobility occurs & caloric intake exceeds energy need
14
Q
Urinary Effects of immobility
__________ of urine In kidneys or bladder
* Normal drainage by gravity impeded
- Infection
* Stasis of urine and calculi are predisposing factors.
-Renal calculi (stones)
* More likely in people with hypercalcemia
-Bladder infection
* Common if catheters are used
- Increase in diuresis, resulting in dehydration
* Variety of causes
A
Stasis of urine In kidneys or bladder
* Normal drainage by gravity impeded
- Infection
* Stasis of urine and calculi are predisposing factors.
-Renal calculi (stones)
* More likely in people with hypercalcemia
-Bladder infection
* Common if catheters are used
- Increase in diuresis, resulting in dehydration
* Variety of causes
15
Q
Neural and Psychological Effects of immobility
Neural effects
- Continuous pressure on skin and underlying tissue will stimulate mechanoreceptors, pain receptors and others.
- _________ may occur because of nerve damage, and therefore muscle innervation may ensue.
Psychological effects
-Effects of pain and lack of control over the environment
* May cause _____________ and health-related problems
A
Neural effects
- Continuous pressure on skin and underlying tissue will stimulate mechanoreceptors, pain receptors and others.
- Spasms may occur because of nerve damage, and therefore muscle innervation may ensue.
Psychological effects
-Effects of pain and lack of control over the environment
* May cause depression and health-related problems
16
Q
Effects of Immobility on Children
Immobilized for extended period of time
-Normal growth and development often ___________
- Contractures and loss of muscle tone may affect:
* Hips
* Spine
* Hands and feet
Mobility returns.
- ____________ growth possible
A
Immobilized for extended period of time
-Normal growth and development often delayed
- Contractures and loss of muscle tone may affect:
* Hips
* Spine
* Hands and feet
Mobility returns.
- Catch-up growth possible
17
Q
Bone tissue consists of:
- Matrix
-Mature bone cells (osteocytes)
- Bone-producing cells (_____________)
- Bone-resorbing cells (_____________)
A
- Matrix
-Mature bone cells (osteocytes) - Bone-producing cells (osteoblasts)
- Bone-resorbing cells (osteoclasts)
18
Q
Types of bone tissue
- ______________ —outer covering of bone
- Cancellous (____________)—interior of bone
A
- Compact—outer covering of bone
- Cancellous (spongy)—interior of bone
19
Q
Other bone structures
- Periosteum—connective tissue covering ___________________
- Endosteum—osteoblast-rich lining of medullary cavity
A
- Periosteum—connective tissue covering over the bone
- Endosteum—osteoblast-rich lining of medullary cavity
20
Q
Functions of Skeletal Muscle
- Facilitate body ____________.
- Maintain body position.
- __________ joints.
- Produce ______.
A
- Facilitate body movement.
- Maintain body position.
- Stabilize joints.
- Produce heat.
21
Q
Characteristics of Skeletal Muscle
- Usually under ______________ control
- Bundles of protein fibers covered by connective tissue
- Well supplied with nerves and blood vessels
- Stimulation occurs at myoneural junction
- Myoglobin stores _____________ in fibers.
-Glycogen stored for energy - Attachments—directly to periosteum or by tendon
- Cells do not undergo mitosis after birth.
A
- Usually under voluntary control
- Bundles of protein fibers covered by connective tissue
- Well supplied with nerves and blood vessels
- Stimulation occurs at myoneural junction
- Myoglobin stores oxygen in fibers.
-Glycogen stored for energy - Attachments—directly to periosteum or by tendon
- Cells do not undergo mitosis after birth.
22
Q
Connective Tissue Coverings of Skeletal Muscle
Epimysium
- Connective tissue surrounding the _____________
Perimysium
- Connective tissue surrounding ___________________
Endomysium
- Connective tissue around _____________________
A
Epimysium
- Connective tissue surrounding the entire muscle
Perimysium
- Connective tissue surrounding muscle fascicles
Endomysium
- Connective tissue around individual muscle fibers
23
Q
Motor unit
- __________________ in the spinal cord and all muscle fibers innervated by the neurons
A
- Motor neuron in the spinal cord and all muscle fibers innervated by the neurons
24
Q
Neuromuscular junction
- Synapse between the motor neuron nerve fiber and ________________
* Neurotransmitter—acetylcholine (ACh)
* Breakdown of Ach by cholinesterase; anticholinesterases interfere with breakdown of ACh.
A
- Synapse between the motor neuron nerve fiber and muscle fiber
- Neurotransmitter—acetylcholine (ACh)
- Breakdown of Ach by cholinesterase; anticholinesterases interfere with breakdown of ACh.
25
Neuromuscular Transmission and Muscle Contraction steps
- Arrival of the _______________
- Depolarization of the presynaptic terminal
- __________ influx
- Exocytosis of the neurotransmitter (Ach)
- Diffusion of neurotransmitter to postsynaptic receptors—attachment
-Generation of muscle action potential
- Release of calcium from ________________________
- Power stroke—contraction of ___________ fiber
- Arrival of the action potential
- Depolarization of the presynaptic terminal
- Calcium influx
- Exocytosis of the neurotransmitter (Ach)
- Diffusion of neurotransmitter to postsynaptic receptors—attachment
-Generation of muscle action potential
- Release of calcium from sarcoplasmic reticulum
- Power stroke—contraction of muscle fiber
26
Joints are classified by degree of movement:
- Synarthroses—_____________ (e.g., cranial sutures)
- Amphiarthroses—__________ movable (e.g., ribs to sternum)
- Diarthroses (synovial)—____________ movable (e.g.,shoulder)
- Synarthroses—immovable (e.g., cranial sutures)
- Amphiarthroses—slightly movable (e.g., ribs to sternum)
- Diarthroses (synovial)—freely movable (e.g.,shoulder)
27
Structure of Synovial Joint
Articular cartilage—covering over ____________ bones
ends of
28
Structure of Synovial Joint
Synovial membrane—produces _________________ that fills space between ends of bones
synovial fluid
29
Structure of Synovial Joint
-Articular capsule—consists of ____________ membrane, a fibrous capsule
-Ligaments—reinforces capsule, links bones, ____________ joint
-Articular capsule—consists of synovial membrane, a fibrous capsule
-Ligaments—reinforces capsule, links bones, supports joint
30
Structure of Synovial Joint
-Menisci - lateral _______ in some joints to stabilize
- Bursae—____________________ to add extra cushion
-Menisci - lateral pads in some joints to stabilize
- Bursae—fluid-filled sacs to add extra cushion
31
Musculoskeletal Diagnostic Tests
-Bone disorders: radiography, _______ scanning
-Muscular disorders: electromyography (EMG), __________
-Joint disorders: radiography, arthroscopy, magnetic resonance imaging (MRI), examination of synovial fluid
-Bone disorders: radiography, bone scanning
-Muscular disorders: electromyography (EMG), biopsy
-Joint disorders: radiography, arthroscopy, magnetic resonance imaging (MRI), examination of synovial fluid
32
A fracture is a __________ in the integrity of a bone.
- Fractures occur because of trauma, neoplasms, or increased stress on bones.
- Fractures are charted using the ___ sign
- Fractures occur because of trauma, neoplasms, or increased stress on bones.
- Fractures are charted using the # sign
33
Classification of Fractures
Complete: bone broken, forming __________ pieces
Incomplete: bone only __________ broken
Complete: bone broken, forming separate pieces
Incomplete: bone only partially broken
34
Classification of Fractures
Open (compound): skin _________
Closed: skin not broken
broken
35
Classification of Fractures
- Simple: _________ break, maintaining alignment and position
- Comminuted: ___________ fractures and bone fragments
- Compression: bone crushed or collapsed into ________ pieces
- Simple: single break, maintaining alignment and position
- Comminuted: multiple fractures and bone fragments
- Compression: bone crushed or collapsed into small pieces
36
Fractures [other types]
- Impacted—one end forced into adjacent ______
- Pathologic—results from weakness; occurs with little stress
- Stress—fatigue fractures
- Depressed—skull fractured and forced into ________
- Impacted—one end forced into adjacent bone
- Pathologic—results from weakness; occurs with little stress
- Stress—fatigue fractures
- Depressed—skull fractured and forced into brain
37
Fractures initiate an inflammatory response and hemostasis.
-Bleeding
- Edema causes stretching of periosteum (if intact) and swelling of soft tissues → severe pain
- Release of bradykinin and other chemical mediators also contributes to pain
- ______ forms at the fracture site
-Systemic signs of _____________ may occur
-Bleeding
- Edema causes stretching of periosteum (if intact) and swelling of soft tissues → severe pain
- Release of bradykinin and other chemical mediators also contributes to pain
- Clot forms at fracture site
-Systemic signs of inflammation may occur
38
Healing of Bone Fracture
-________________ —fibrin network is formed.
-Phagocytic cells remove debris.
- _______________ lay down new collagen fibers.
- _______________form new cartilage.
- Formation of procallus (fibrous collar).
- ________________ generate new bone.
- Procallus is replaced by bony callus.
- Remodeling of bone, with return to use
-Hematoma—fibrin network is formed.
-Phagocytic cells remove debris.
- Fibroblasts lay down new collagen fibers.
- Chondroblasts form new cartilage.
- Formation of procallus (fibrous collar).
- Osteoblasts generate new bone.
- Procallus is replaced by bony callus.
- Remodeling of bone, with return to use
39
Factors Affecting Bone Healing
-Amount of local ____________
- Proximity of bone ends
-Presence of foreign material or infection
- _________ supply to fracture site
- Systemic factors, such as age, nutrition, anemia
-Amount of local damage
- Proximity of bone ends
-Presence of foreign material or infection
- Blood supply to fracture site
- Systemic factors, such as age, nutrition, anemia
40
Treatments of Fractures
- Closed reduction—_____________ to restore bone position
-Open reduction— ______________to align and/or Insert pins, screw rods, or plates to align
- Closed reduction—pressure to restore bone position
-Open reduction—surgery to align and/or Insert pins, screw rods, or plates to align
41
Compartment Syndrome
- _________ within one area of compartment of limb that is between layers of dense CT (fascia)
- Ischemia and infarction of tissue may occur because of compression of arterial blood supply.
- Dead tissue may become gangrenous, requiring ______________ .
- A tight ______ can cause compartment syndrome!
- Edema within one area of compartment of limb that is between layers of dense CT (fascia)
- Ischemia and infarction of tissue may occur because of compression of arterial blood supply.
- Dead tissue may become gangrenous, requiring amputation.
- A tight cast can cause compartment syndrome!
42
Dislocations
-Separation of two ________ at a joint, with loss of contact between articulating surfaces
- Usually accompanied by significant soft tissue damage to ligaments and tendons
- Distortion of joint usually evident
- May recur repeatedly, requiring surgery
-Separation of two bones at a joint, with loss of contact between articulating surfaces
- Usually accompanied by significant soft tissue damage to ligaments and tendons
- Distortion of joint usually evident
- May recur repeatedly, requiring surgery
43
Sprains and Strains
-Sprain—a tear in a ____________
- Strain—a tear in a ___________
- Avulsion—ligaments or tendons completely separated from bony attachments
- Immobilization often used to prevent tissue damage and promote healing
-Sprain—a tear in a ligament
- Strain—a tear in a tendon
- Avulsion—ligaments or tendons completely separated from bony attachments
- Immobilization often used to prevent tissue damage and promote healing
44
Other Joint Injuries
Overuse injuries
- _________ tears
_____________ strain injuries—injuries that develop over a period of time in which the same movement is repeated
- Scaling
- Massage
- Keyboard, mouse use
- Running or jogging
Overuse injuries
- Muscle tears
Repetitive strain injuries—injuries that develop over a period of time in which the same movement is repeated
- Scaling
- Massage
- Keyboard, mouse use
- Running or jogging
45
Muscle Tear can occur as a result of a trauma or overextension or _____________ of the muscle
-Repeated injuries will result in __________ scar tissue replacing normal structures.
Muscle Tear can occur as a result of a trauma or overextension or overstressing of the muscle
-Repeated injuries will result in fibrous scar tissue replacing normal structures.
46
Three degrees of muscle tears:
First degree
* Involves only a _______________ of muscle fibers
Second degree
* Involves ________ of the muscle but is not a complete tear
Third degree
* A ___________ tear across the width of the muscle
First degree
* Involves only a small percentage of muscle fibers
Second degree
* Involves much of the muscle but is not a complete tear
Third degree
* A complete tear across the width of the muscle
47
Treatment of Joint Injuries
_______
-Rest, Immobilization, Compression, Elevation
-Nonsteroidal anti-inflammatory drugs (NSAIDs)
-Physiotherapy
-______________ of surrounding tissue
RICE
-Rest, Immobilization, Compression, Elevation
-Nonsteroidal anti-inflammatory drugs (NSAIDs)
-Physiotherapy
-Massage of surrounding tissue
48
Bone Disorders—Osteoporosis
-Decrease in bone _______ and density
-Occurs in two forms:
Primary
* Idiopathic
* Age 50+ years
* Decreased sex hormones
* Decreased ___________ intake
Secondary
* As a complication of ______________
-Decrease in bone mass and density
-Occurs in two forms:
Primary
* Idiopathic
* Age 50+ years
* Decreased sex hormones
* Decreased calcium intake
Secondary
* As a complication of another disorder
49
Osteoporosis Pathophysiology
- Bone ____________ exceeds formation.
- Results in loss of ___________ bone
- Diagnosed with bone density scans
- Can cause compression fractures of vertebrae, wrist, or hip
- Can lead to kyphosis and scoliosis
- Bone resorption exceeds formation.
- Results in loss of compact bone
- Diagnosed with bone density scans
- Can cause compression fractures of vertebrae, wrist, or hip
- Can lead to kyphosis and scoliosis
50
Osteoporosis predisposing factors
-Age ___ + years
- Decreased mobility or ____________ lifestyle
-Hormonal factors
* Excess corticosteroids or parathyroid hormone (PTH)
* Deficit of estrogen or testosterone
- Deficits of calcium, vitamin D, or protein
- Cigarette smoking
- __________ BMI
- Asian or European ancestry
- Excessive caffeine intake
-Age 50+ years
- Decreased mobility or sedentary lifestyle
-Hormonal factors
* Excess corticosteroids or parathyroid hormone (PTH)
* Deficit of estrogen or testosterone
- Deficits of calcium, vitamin D, or protein
- Cigarette smoking
- Lower BMI
- Asian or European ancestry
- Excessive caffeine intake
51
Osteoporosis Treatment
- ___________ supplements
- Weight-bearing exercise
- Physiotherapy to reduce pain and maintain function
- Bisphosphonates
- Calcitonin
- Human _____________ hormone
-Dietary supplements
- Weight-bearing exercise
- Physiotherapy to reduce pain and maintain function
- Bisphosphonates
- Calcitonin
- Human parathyroid hormone
52
Rickets and Osteomalacia
Result from deficit of vitamin ___ and phosphates
- Causes—dietary deficits, malabsorption, intake of phenobarbital, lack of sun exposure
- In children, leads to weak ______ and other skeletal deformities
- In adults, may lead to soft _______, resulting in compression fractures
Result from deficit of vitamin D and phosphates
- Causes—dietary deficits, malabsorption, intake of phenobarbital, lack of sun exposure
- In children, leads to weak bones and other skeletal deformities
- In adults, may lead to soft bones, resulting in compression fractures
53
Paget’s Disease
- Occurs in adults older than ___ years
- Exact cause has not yet been established.
- Bone destruction replaced by fibrous ________
- Pathologic fractures are common.
- In vertebrae—can result in compression fractures and kyphosis
- In skull—increased pressure > headaches & compression of cranial nerves → severe pain
- Occurs in adults older than 40 years
- Exact cause has not yet been established.
- Bone destruction replaced by fibrous tissue
- Pathologic fractures are common.
- In vertebrae—can result in compression fractures and kyphosis
- In skull—increased pressure > headaches & compression of cranial nerves → severe pain
54
Osteomyelitis
- Bone ___________ caused by bacteria or fungi
Signs and symptoms
- Local inflammation and bone pain
- Fever, sweating, Chills, malaise
Treatment
- Antibiotics
- ___________ may be required.
- Bone infection caused by bacteria or fungi
Signs and symptoms
- Local inflammation and bone pain
- Fever, sweating, Chills, malaise
Treatment
- Antibiotics
- Surgery may be required.
55
Abnormal Curvatures of the Spine
Lordosis
- Swayback—curving inward at the ________ back
Kyphosis
-Hunchback or humpback—abnormally rounded _________ back
Scoliosis
-___________ -shaped—sideways curve to the spine
Lordosis
- Swayback—curving inward at the lower back
Kyphosis
-Hunchback or humpback—abnormally rounded upper back
Scoliosis
-S- or C-shaped—sideways curve to the spine
56
Osteosarcoma—most common primary _____________ of bone
- Occurs in the shaft of long bones of the _____
- Common in children, adolescents, and young adults
- Bone pain at rest is a warning sign for this cancer!
Osteosarcoma—most common primary neoplasm of bone
- Occurs in the shaft of long bones of the leg
- Common in children, adolescents, and young adults
- Bone pain at rest is a warning sign for this cancer!
57
Chondrosarcomas—arise from _______________ cells; more common in adults
- Ewing’s sarcoma is common in adolescents and usually occurs in the shaft of long bones.
Chondrosarcomas—arise from cartilage cells; more common in adults
- Ewing’s sarcoma is common in adolescents and usually occurs in the shaft of long bones.
58
Bone Tumors
- Tumors metastasize to ________ early in the course of the disease.
Treatment
-Excision of tumor if possible
- Surgical amputation if excision is not feasible
- Chemotherapy to reduce metastasis
Bone Tumors
- Tumors metastasize to lungs early in the course of the disease.
Treatment
-Excision of tumor if possible
- Surgical amputation if excision is not feasible
- Chemotherapy to reduce metastasis
59
Muscular Dystrophy (MD)
- Group of autosomal recessive disorders
- Degeneration of __________ __________ over time
-Duchenne’s MD or pseudohypertrophic MD most common type; affects young boys
- Group of autosomal recessive disorders
- Degeneration of skeletal muscle over time
-Duchenne’s MD or pseudohypertrophic MD most common type; affects young boys
60
Muscular Dystrophy Signs and symptoms
-With Duchenne’s MD—early _________ weakness
-Weakness in pelvic girdle—waddling gait, difficulty climbing stairs
- Gower maneuver—pushing up to erect position
- Tendon reflexes reduced
- Deformities develop, such as kyphoscoliosis
-Respiratory infections common
- Cardiac myopathy occurs commonly.
-With Duchenne’s MD—early motor weakness
-Weakness in pelvic girdle—waddling gait, difficulty climbing stairs
- Gower maneuver—pushing up to erect position
- Tendon reflexes reduced
- Deformities develop, such as kyphoscoliosis
-Respiratory infections common
- Cardiac myopathy occurs commonly.
61
Muscular Dystrophy Treatment
-No ____________ treatment available
- Moderate ______________ to maintain motor function
- Supportive appliances
- Physiotherapy and occupational therapy to maximize function and adaptation
- Massage—reduces pain and stiffness
- Ventilator—in case of respiratory failure
- Research being done on genetic therapies
-No curative treatment available
- Moderate exercise to maintain motor function
- Supportive appliances
- Physiotherapy and occupational therapy to maximize function and adaptation
- Massage—reduces pain and stiffness
- Ventilator—in case of respiratory failure
- Research being done on genetic therapies
62
Fibromyalgia
Syndrome characterized by:
-_______ in soft tissues
- Stiffness affecting muscles, tendons, and soft tissue
- No obvious inflammation or atrophy
- Sleep disturbance and severe ___________
- Anxiety and/or depression may be present.
Cause is not known but hypothesized to be imbalance in _____________ and other neurotransmitters or increased production of substance P
Syndrome characterized by:
-Pain in soft tissues
- Stiffness affecting muscles, tendons, and soft tissue
- No obvious inflammation or atrophy
- Sleep disturbance and severe fatigue
- Anxiety and/or depression may be present.
Cause is not known but hypothesized to be imbalance in serotonin and other neurotransmitters or increased production of substance P
63
Fibromyalgia Predisposing and aggravating factors
- Onset is higher in women age ____ to 50 years.
- History of physical or psychological _________ or chronic pain
- Sleep deprivation
- Stress
- Fatigue
- Onset is higher in women age 20 to 50 years.
- History of physical or psychological trauma or chronic pain
- Sleep deprivation
- Stress
- Fatigue
64
Fibromyalgia Treatment
- _________ avoidance or reduction
- Regular ______________ in the morning
- Pace activity and rest as needed.
- Applications of heat or massage
- Analgesic drugs
- Low doses of antidepressants
- NSAIDs
- New drugs—pregabalin (Lyrica)
- Stress avoidance or reduction
- Regular exercise in the morning
- Pace activity and rest as needed.
- Applications of heat or massage
- Analgesic drugs
- Low doses of antidepressants
- NSAIDs
- New drugs—pregabalin (Lyrica)
65
Osteoarthritis
- Degenerative—wear and tear joint disease
-May be the result of increased weight-bearing or lifting
- Incidence increasing
-Genetic component identified in research with mice
- Degenerative—wear and tear joint disease
-May be the result of increased weight-bearing or lifting
- Incidence increasing
-Genetic component identified in research with mice
66
Osteoarthritis Pathophysiology
- Articular cartilage is damaged.
- Surface of cartilage becomes rough and worn
- Tissue damage causes release of _____________, accelerating disintegration of cartilage.
- Subchondral bone may be exposed.
- Cysts, osteophytes, or new bone spurs develop.
- Osteophytes and cartilage break off.
- Joint space becomes ______________.
- Secondary inflammation of surrounding tissue
- Loss of normal range of joint motion
- Pain with weight-bearing and use
- Articular cartilage is damaged.
- Surface of cartilage becomes rough and worn
- Tissue damage causes release of enzymes, accelerating disintegration of cartilage.
- Subchondral bone may be exposed.
- Cysts, osteophytes, or new bone spurs develop.
- Osteophytes and cartilage break off.
- Joint space becomes narrower.
- Secondary inflammation of surrounding tissue
- Loss of normal range of joint motion
- Pain with weight-bearing and use
67
Osteoarthritis Causes
- Primary form—weight-bearing, _________, aging
- Secondary form—follows ________ or repetitive use
- Genetic factors thought to play a role
- Weight-bearing joints most frequently affected but __________ joints also involved
- Primary form—weight-bearing, obesity, aging
- Secondary form—follows trauma or repetitive use
- Genetic factors thought to play a role
- Weight-bearing joints most frequently affected but finger joints also involved
68
Osteoarthritis Signs and symptoms
- __________ pain with weight-bearing and movement
- _________ movement is limited.
- Recreational and social activities become limited because of pain.
-Walking is difficult.
- Predisposition to falls
- In temporomandibular joint (TMJ) syndrome, mastication and speaking are difficult.
- Bony enlargement of distal interphalangeal joints
- Aching pain with weight-bearing and movement
- Joint movement is limited.
- Recreational and social activities become limited because of pain.
-Walking is difficult.
- Predisposition to falls
- In temporomandibular joint (TMJ) syndrome, mastication and speaking are difficult.
- Bony enlargement of distal interphalangeal joints
69
Osteoarthritis Treatment
-Stress on joint minimized by use of adaptive devices such as a _______
- Pacing activity
- Mild ____________ program to maintain fitness and joint function
- Supports such as hand brace to facilitate movement
- Orthotic Inserts in shoes
- Massage therapy
- Physiotherapy
- Acupuncture
- Occupational therapy
- Glucosamine chondroitin supplements
- Injection of synthetic synovial fluid (hyaluronic acid)
- NSAIDs
- Analgesics
- Arthrotomy to stabilize joint
- Surgical joint replacement
-Stress on joint minimized by use of adaptive devices such as a cane
- Pacing activity
- Mild exercise program to maintain fitness and joint function
- Supports such as hand brace to facilitate movement
- Orthotic Inserts in shoes
- Massage therapy
- Physiotherapy
- Acupuncture
- Occupational therapy
- Glucosamine chondroitin supplements
- Injection of synthetic synovial fluid (hyaluronic acid)
- NSAIDs
- Analgesics
- Arthrotomy to stabilize joint
- Surgical joint replacement
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Rheumatoid Arthritis
- Considered an _________ disorder
- Causes chronic systemic inflammatory disease
-Higher incidence in ___________________
- Affects all age groups
- Considered an autoimmune disorder
- Causes chronic systemic inflammatory disease
-Higher incidence in women than in men
- Affects all age groups
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Rheumatoid Arthritis Pathophysiology
- Synovitis—marked _______________ , cell proliferation
- Pannus formation—granulation tissue spreads.
- ___________ erosion—creates unstable joint
- Fibrosis—calcifies and obliterates joint space
- Ankylosis—joint fixation and deformity develop if untreated.
- Synovitis—marked inflammation, cell proliferation
- Pannus formation—granulation tissue spreads.
- Cartilage erosion—creates unstable joint
- Fibrosis—calcifies and obliterates joint space
- Ankylosis—joint fixation and deformity develop if untreated.
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Joint Disorders: Rheumatoid Arthritis Systemic effects
- Marked ____________
- Depression
- Malaise
- Anorexia
- Low-grade fever
- Iron deficiency anemia that is _____________ to iron therapy
- Marked fatigue
- Depression
- Malaise
- Anorexia
- Low-grade fever
- Iron deficiency anemia that is resistant to iron therapy
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Rheumatoid Arthritis Cause
- Exact __________ not known
- ___________ factor is present.
- Familial predisposition
- Some links to viral infections
- Exact cause not known
- Genetic factor is present.
- Familial predisposition
- Some links to viral infections
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Rheumatoid Arthritis Signs and Symptoms
- Affected joints are extremely __________.
- Stiffness of joints
- Redness and swelling of joints
- Joint involvement includes small joints and is often bilateral.
- Joint ___________ impaired
- Eventually, the joint becomes fixed and deformed
- Affected joints are extremely painful.
- Stiffness of joints
- Redness and swelling of joints
- Joint involvement includes small joints and is often bilateral.
- Joint movement impaired
- Eventually, the joint becomes fixed and deformed
75
Rheumatoid Arthritis Treatment
- Balance between rest and moderate activity
- _______ and cold applications
- Physical and occupational therapy
- NSAIDs
- _________________ for severe inflammation
- Analgesia for pain
- Disease-modifying antirheumatic drugs, such as gold salts, methotrexate, hydroxychloroquine
- ____________ response–modifying agents, such as infliximab, rituximab, anakinra
- Balance between rest and moderate activity
- Heat and cold applications
- Physical and occupational therapy
- NSAIDs
- Glucocorticoids for severe inflammation
- Analgesia for pain
- Disease-modifying antirheumatic drugs, such as gold salts, methotrexate, hydroxychloroquine
- Biological response–modifying agents, such as infliximab, rituximab, anakinra
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Juvenile Rheumatoid Arthritis (JRA)
- Several different types
- Onset more _________ than adult form
- _________ joints frequently affected
- Several different types
- Onset more acute than adult form
- Large joints frequently affected
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Juvenile Rheumatoid Arthritis (JRA)
- Still’s disease (___________ form)—fever, rash, lymphadenopathy, hepatomegaly, joint involvement
- Second form of JRA causes polyarticular _______________
- Third form of JRA involves four or fewer joints but causes : _____________________________________
- Still’s disease (systemic form)—fever, rash, lymphadenopathy, hepatomegaly, joint involvement
- Second form of JRA causes polyarticular inflammation
- Third form of JRA involves four or fewer joints but causes uveitis (inflammation of iris, ciliary body, and choroid of eye)
78
Infectious Arthritis AKA septic arthritis
- Develops in ________ joint
- Joint is red, swollen, painful, with decreased movement
Causes
- Direct introduction of __________ into joint, such as trauma, nonsterile injection, surgery
- Secondary infection because of bacteremia
Treatment with _______________ over sustained period; often requires IV administration
- Develops in single joint
- Joint is red, swollen, painful, with decreased movement
Causes
- Direct introduction of bacteria into joint, such as trauma, nonsterile injection, surgery
- Secondary infection because of bacteremia
Treatment with antimicrobials over sustained period; often requires IV administration
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Gout - Also known as gouty arthritis
- Results from deposits of ___________________ in the joint, causing inflammation
- Formation of tophus—large hard nodule of urate crystals
- Tophi cause local inflammation and occur after the first attack of gout.
- Results from deposits of uric acid and crystals in the joint, causing inflammation
- Formation of tophus—large hard nodule of urate crystals
- Tophi cause local inflammation and occur after the first attack of gout.
80
Gout (Cont.)
-Uric acid and crystals form because of inadequate _______________, chemotherapy, metabolic abnormality, and/or genetic factors.
- Inflammation causes redness, swelling, and pain.
- Treated by reducing _____________ levels with drugs and dietary changes
-Diagnosed by examination of synovial fluid and blood tests
- NOTE: Use of NSAIDs prior to blood tests will cause a false-negative result.
-Uric acid and crystals form because of inadequate renal excretion, chemotherapy, metabolic abnormality, and/or genetic factors.
- Inflammation causes redness, swelling, and pain.
- Treated by reducing uric acid levels with drugs and dietary changes
-Diagnosed by examination of synovial fluid and blood tests
- NOTE: Use of NSAIDs prior to blood tests will cause a false-negative result.
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Ankylosing Spondylitis
- Chronic, progressive, inflammatory condition
- Affects sacroiliac _________, intervertebral spaces, costovertebral joints
- More common in _______ age 20 to 40 years
- Cause has not yet been determined—thought to be an ______________ disorder with a genetic basis
- Chronic, progressive, inflammatory condition
- Affects sacroiliac joints, intervertebral spaces, costovertebral joints
- More common in men age 20 to 40 years
- Cause has not yet been determined—thought to be an autoimmune disorder with a genetic basis
82
Ankylosing Spondylitis (Cont.)
- Signs—______________ pain, morning stiffness, pain when lying down, spine becomes rigid
- Systemic signs—fatigue, fever, weight loss, uveitis
- Treated by drugs to relieve _______ , daily exercise, physiotherapy, occupational therapy
- Signs—lower back pain, morning stiffness, pain when lying down, spine becomes rigid
- Systemic signs—fatigue, fever, weight loss, uveitis
- Treated by drugs to relieve pain, daily exercise, physiotherapy, occupational therapy
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Bursitis
- Inflammation of the ________ associated with bones, muscles, tendons, and ligaments of various joints
- Most common cause- Repetitive __________ on a particular joint
Diagnosis
- Physical examination
- Ultrasound and/or MRI
Treatment options
- Rest
- Anti-inflammatory drugs
- Inflammation of the bursae associated with bones, muscles, tendons, and ligaments of various joints
- Most common cause- Repetitive motion on a particular joint
Diagnosis
- Physical examination
- Ultrasound and/or MRI
Treatment options
- Rest
- Anti-inflammatory drugs
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Synovitis
- Inflammation of the ___________________
- Movement of joint is restricted and painful
Diagnosis
- Swollen, red, and warm joint
- Analyzing synovial _______ (for signs of infections)
Treatment
- Anti-inflammatory drugs
- Identification and treatment of underlying cause
- Inflammation of the synovial membrane
- Movement of joint is restricted and painful
Diagnosis
- Swollen, red, and warm joint
- Analyzing synovial fluid (for signs of infections)
Treatment
- Anti-inflammatory drugs
- Identification and treatment of underlying cause
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Tendinitis
- Irritation or inflammation of the _________
- Manifestation- Dull ache and mild ____________
Cause- Single trauma or repetitive motion
Diagnosis
- Made by physical examination
Treatment
- Rest, application of ice
- Pain relievers—maybe anti-inflammatory drugs
- Physical therapy
- Irritation or inflammation of the tendon
- Manifestation- Dull ache and mild swelling
Cause- Single trauma or repetitive motion
Diagnosis
- Made by physical examination
Treatment
- Rest, application of ice
- Pain relievers—maybe anti-inflammatory drugs
- Physical therapy
