MusculoSkeletal Systems

1. MusculoSkeletal Systems

2. Skeletal Review

3. Skeletal review How many bones are in the body? What are the bones in the arm? What are the bones in the leg? How many cervical vertebrae? How many thoracic vertebrae? How many lumbar vertebrae? Name the bones of the pelvis.

4. Bones of the Hand

5. Bones of the feet

6. Muscle Review

7. What muscles make up the rotator cuff? What muscles make up the quadriceps? What muscles make up the hamstrings? What muscles do you use to breathe? What muscles keep your intestines inside your body? What muscles allow you to chew? What is my favorite muscle?

8. What is Origin? What is insertion? What ion is on the outside of the muscle @ rest? What ion is on the inside?

9. What is to move TOWARD the body? What is bending, DECREASING the joint angle between bones?

10. Carpal Tunnel Syndrome Nerve entrapment at the wrist that results in compression of the median nerve in the carpal tunnel. The compression causes sensory & motor changes in the hand (palm & middle finger) Usually 30 – 60 years of age More common in assembly workers, packers Chronic repetitious motion

11. Aggravating factors: sustained grasping, twisting, flexing • Pathology: inflammation of the tendon sheaths that pass through the carpal tunnel causes edema & compression of the median nerve • Related illnesses that can cause CTS: • Pregnancy Acromegaly • RA Colles fractures • Renal failure hypothyroidism • DM TB menopause

12. Symptoms • Numbness • Weakness • Pain in hand (in the thumb, forefinger, middle finger, ½ 4th finger) • Patient can’t clench a fist • Worse at night

13. Testing • Decreased sensation to light touch & pinpricks • Palm muscle atrophy • Positive Tinel’s sign • Phalen’s wrist flexion test • Compression test • Bp cuff inflated above systolic pressure on the are for 1 – 2 minutes provokes pain & paresthesia along the median nerve • EMG • Median nerve conduction delay of more than 5 milliseconds

14. Treatment • Splinting the hand for 1 – 2 weeks • Possible alteration of work environment • NSAIDS (non-steroidal anti-inflammatory drugs) • Steroid injections • Surgical intervention • Decompression of the nerve by resecting the transverse carpal tunnel ligament

15. GOUT • Metabolic disorder marked by red, swollen, & acutely swollen, painful joints • Most common joints are: • Feet • Great toe • Ankle • midfoot

16. Most commonly affects men older than 30 yo & post-menopausal women that take diuretics • Patients may be symptom – free between attacks • Underlying Cause: Primary is Unknown • Pathology: decreased excretion of uric acid by the kidneys ; some patients have an overproduction of uric acid • Secondary gout develops from another disease • Obesity Leukemia bone ca • DM HTN renal disease

17. 4 stages of Untreated Gout Patient develops hyperuricemia with no symptoms Acute gouty arthritis; painful swelling & tenderness. Interictal stage (may last for 6 months) – patient may be asymptomatic or have flare ups Chronic Stage – urate pooling causing tophi (clusters of urate surrounded by inflamed tissue) to develop in cartilage, synovial membranes, tendons, & soft tissues

18. Factors that make it worse • Stress • Trauma • Infection • Hospitalization • Surger • Starvation • Excessive intake of foods with purine • Alcohol • Some medications

19. Purine-Rich Foods According to the American Medical Association, purine-containing foods include: Beer, other alcoholic beverages. Anchovies, sardines in oil, fish roes, herring. Yeast. Organ meat (liver, kidneys, sweetbreads) Legumes (dried beans, peas) Meat extracts, consomme, gravies. Mushrooms, spinach, asparagus, cauliflower. Beneficial Foods Foods which may be beneficial to people with gout include: Dark berries may contain chemicals that lower uric acid and reduce inflammation. Tofu which is made from soybeans may be a better choice than meats. Certain fatty acids found in certain fish such as salmon, flax or olive oil, or nuts may possess some anti-inflammatory benefits. www.health.com

20. Testing • Needle – aspiration of synovial fluid (arthrocentesis)for crystalof sodium urate • Blood & urine analysis (for uric acid levels) • X – rays • Normal in acute gout; joint changes in chronic • Treatment • Dietary changes Acetaminophen • Weight loss Corticosteroids • Cold to inflammation sites • Immobilize joints Colchicine

21. Colchicine Relieves inflammation of acute gout arthritis Side effects: Rash, diarrhea, blood disorders Encourage patient to increase fluid intake to excrete excessive uric acid

22. Allopurinol • Generic name: Zyloprim • Treats chronic Gout • Decreases serum & urine levels of uric acid • Used in chronic management of gout • SE • Rash Allergic reaction N/V • Fever, chills diarrhea drowsiness vertigo • Contraindications – impaired renal function, pregnancy, liver disease, hypersensitivity • Interactions • Alcohol, diuretics, anti-neoplastic drugs

23. Osteoarthritis Most common form of arthritis Equal in males & females Usually over the age of 40 Secondary: usually result from trauma, congenital deformity, obesity Deterioration of the joint cartilage & formation of new bone at margins of joints

24. Symptoms • Stiffness in the morning & after exercise • Aching during weather changes • “grating” sound of joint during movement • Altered gait contractures • Limited movement • Testing • X – ray • Treatment • Acetaminophen NSAIDS steroid injections • Arthroplastyarthrodesis

25. Celebrex • Generic: celecoxib • NSAID – Cox 2 Inhibitor • Selectively inhibits cyclooxygenase – 2 • Anti- inflammatory, analgesic, & antipyretic activity • SE: • GI ulcers/bleeding epigastric pain N & V • Constipation tinnitus HA • Hematuriaalbuminuria • Rash visual disturbances

26. Celebrex cont. • CI: • Asthma HTN Renal disease • Liver dysfunction h/o GI ulcers • Inflammatory Bowel disease Pregnancy • Interactions: • Alcohol anticoagulants • Corticosteroids Aspirin or other NSAIDS

27. Osteomyelitis • Infection in the bone • More common in children (boys) • Lower end of femur • Upper end of tibia • Upper end of humerus • Upper end of radius • Progressive inflammatory bone destruction after new bone is formed • Acute • Trauma • Chronic • Resulting from a hematoma & infection from somewhere else in the body

28. Common “bugs” that cause • Staphylococcus aureus (MOST COMMON) • Streptococcus pyogenes • Pseudomonas aeruginosa • Escherichia coli • Pasteurellamultocida

29. Signs & Symptoms • Acute – rapid onset • sudden pain in affected bone • Tenderness, swelling • Heat, erythema • Chronic – flare ups over years • Drainage of pus • Fever • Dehydration • Irritability or poor feeding in infants

30. Treatment • Acute • IV antibiotics • Nafcillin or oxacillin • Analgesics • Intracavity antibiotics • Surgical drainage of abscess • Chronic • Surgery to remove dead bone • Skin, muscle, bone grafts • Antibiotic beads in bone

31. Nafcillin Semi – synthetic penicillin 500 mg over 7 minutes via IV Metabolized in liver & excreted in bile Indications: for staphylococci bacterial infections CI: hypersensitivity to penicillin (anaphylaxis) Interactions: Tetracycline, decreases effects in warfarin, cyclosporine SE: diarrhea

32. Osteoporosis • Metabolic bone disorder in which bone resorption accelerates & bone formation decellerates • Decrease in bone mass • 4 x more common in women than men • The bones lose: • CA • P • Bones become more porous & brittle making them more prone to fractures

33. Causes – primary is unknown • Contributing factors • Mild but prolonged lack of calcium • Due to diet • Slow absorption • Hormonal imbalance • Faulty metabolism of protein due to estrogen deficiency • Sedentary lifestyle

34. Primary osteoporosis has 3 types: • Type I: Postmenopausal • Women 51 – 75 yo • Due to loss of estrogen • Usually vertebral & wrist fx • Type II: Senile • Wome 70 – 85 yo • Osteoblasts & osteoclasts shrinkage • Fractures of the humerus, tibia, femur, & pelvis • Type III: Premenopausal • Higher estrogen levels • Increase bone resorption due to osteoclasts not responding to the parathyroid hormone

35. Diagnostic tests • X – ray show degeneration of lower vertebrae • Serum Ca, P, & Alkaline phosphatase levels may be WNL • Parathyroid hormone levels may be elevated • Bone biopsy • CT Scan • RULE OUT: other causes for bone disease such as cancer or tumors

36. Treatment • Goals • Control bone loss • Prevent fractures • Control pain

37. Medications • Analgesics for pain • Alendronate, risedronate, or raloxifene • Calcium supplements • Vitamin D supplements • Calcitonin to reduce bone resorption • Etidronate – increases bone density • Teriparatide – injectable human parathyroid hormone

38. Bisphosphonates Actonel (risedronate) Fosamax (alendronate) Inhibit bone resorption & increases bone mineral density Used for both prevention & treatment SE: nausea, dyspepsia, esophagitis, abdominal pain, chest pain CI: Renal insufficiency, hypocalcemia

39. Strains & Sprains What is a strain? What is a sprain? RICE; What does it stand for?

40. Skills Walking with Cane, Walker, Crutches, wheelchair