Osteoarthritis & Other Orthopedic Disorders PDF

 Osteoarthritis: inflammation of the bones and joints o Osteo- vs rheumatoid arthritis  Osteoarthritis is primarily a wear and tear condition involving cartilage  Rheumatoid is autoimmune; synovial membrane is attacked; starts as synovitis o Used to be called degenerative joint disease o The cha...

 Osteoarthritis: inflammation of the bones and joints o Osteo- vs rheumatoid arthritis  Osteoarthritis is primarily a wear and tear condition involving cartilage  Rheumatoid is autoimmune; synovial membrane is attacked; starts as synovitis o Used to be called degenerative joint disease o The change in anatomy can result in joint mobility issues  Bone spurs or overgrowth of bone that occurs from inflammation o Joints most affected: the ones carrying the most weight and the most repetitive action  Neck  Lumbar vertebrae  Hip  Hand  Knee  Foot o Etiology: joint space narrowing  Characteristic finding on x-ray  Present due to loss and thinning of cartilage o Etiology: subchondral bone erosion  Bone immediately below the cartilage  When joint space is narrow, as the cartilage thins, that erosion can also progression down into the bone o Implications of bone spurs  osteophytes  Osteoarthritis causes break down of joint cartilage, inflammation and irregular growth of new bone  Painful when they grind on other bones or sensory nerves  May restrict joint range of motion o Stages of osteoarthritis  In early stages, the cartilage swells, which reflects an effort by the cartilage to try and repair itself.  Later on in the disease, the cartilage loses its elasticity and it thins resulting in flaking or shredding of the cartilage to the point where you may have bone on bone grinding o Osteoarthritis tends to begin in the knee medially, then progresses up, over and then lateral  Inflammation causes the swelling, pain, and stiffness o Muscle atrophy in later stages of osteoarthritis  Individuals with OA involving the hips and knees may have atrophy of the leg on the affected side and it’s related to changes in weight bearing (disuse muscle atrophy) o Persons at risk for secondary OA  History  Mechanical injury  Repeated joint stress  Wear and tear This study source was downloaded by 100000780651383 from CourseHero.com on 10-09-2023 15:30:58 GMT -05:00 https://www.coursehero.com/file/130102312/orthopedic-disordersdocx/ o o o o o o o  Overweight/obese  Athletes or individuals who do a lot of running Persons at risk for primary OA  Age  can decrease the cartilage volume and the cartilage thins, which makes it easier for it to crack  decrease vascular supply to cartilage, so tissue don’t receive the nutrients they require  decrease in proteoglycans, which is a compound that holds water in the cartilage, so the cartilage is able to “give”  age alone is not enough to result in OA  age + another factor = OA  Ex. Weight Other risk factors for OA  Genetics  twice as likely in first degree relatives Chief complaint of persons with OA is worsening chronic pain  Aggravating factors: activity  Relieved by rest (at least initially) Etiology: gel phenomenon and crepitus  Stiffness = gel phenomenon  related to the thickening of the synovial fluid from inactivity; lasting less than 30 minutes  Crunching sound = crepitus  bone grinding on bone Physical exam  Find impaired physical mobility related to loss of muscle mass, muscle tone and strength associated with abnormal weight bearing and disuse  Range of motion evaluated  OA can decrease ROM Treatment  Weight control to take the stress off the joints  Analgesia  “cushioning” the knee o Joints can be lubricated using medications, such as, hyaluronic acid.  Platelet rich plasma  Spin down person’s blood to concentrate the platelets  inject into the knee  activates growth factors, stem cells that may help repair tissue  may help with early onset OA symptoms and decrease inflammation  Knee replacement/arthroplasty  Purpose is to correct the altered anatomy to increase mobility  After knee replacement, synovial tissues will reform OA: Hip  Issues are still the same as with the knee  Decreased joint space due to worn, thinned, and cracked cartilage  Bone spurs  Decreased ROM This study source was downloaded by 100000780651383 from CourseHero.com on 10-09-2023 15:30:58 GMT -05:00 https://www.coursehero.com/file/130102312/orthopedic-disordersdocx/    Pain Treatment  Hip replacement o Total hip arthroplasty Osteoporosis o Bones demineralize o Etiology  Underlying problem is that the osteoclasts are more active than the osteoblasts; bones are being broken down more quickly than they can be rebuilt o Highest risk group  Post-menopausal women  Due to low estrogen  When estrogen levels fall, the osteoclasts absorb bone and osteoblasts (the cells which build bone) are not as active  Overall effect: bone demineralization o What puts men at risk  1 in 4 men over the age of 50 have or at risk for osteoporosis  Thin white males over age 65 are at highest risk  Pathological fracture related to osteoporosis  related concern  Visceral obesity may increase risk for osteoporosis in men  Visceral fat weakens bones because this type of fat secrets adipokines, which weaken bones o Adipokines promote inflammation o Inflammation may promote osteoclasts activity  Seen less often in men than in women  Men generally have a greater bone mass than women  Bone loss in men begins later in life and advance more slowly o Fractures are a related concern  Causes by thinning/demineralization of the bone matrix; primarily in the areas of spongy bone o S/S occur late  Fractures  Vertebrae  Wrists  Hip (may occur as first indication) o Fractures occur in area of spongy bone o Etiology: stooped posture and loss of height  Stooped posture = kyphosis  Demineralization of the vertebral bodies  results in fractures and collapse of the vertebral bodies resulting in a change of contour and loss of height o Low back and neck pain o Routine screening of bone density  Recommended for all women over age 65 This study source was downloaded by 100000780651383 from CourseHero.com on 10-09-2023 15:30:58 GMT -05:00 https://www.coursehero.com/file/130102312/orthopedic-disordersdocx/ Post-menopausal women under 65 if they have risk factors indicating they could experience a fracture within the next 10 years o Bone mineral density screening  Low dose x-ray notes signs of mineral loss and bone demineralization  Interpreting the report: T scores  Diagnosis both osteopenia (less severe bone loss) and osteoporosis o Screening for men  For all men 70 and older  Men 50-69 with risk factors o Reduce risk for osteoporosis  Resistance builds bone  Resistance exercises  things that make the muscle pull on the bone  Because the muscle is pulling on the bone against resistance more density is required to prevent fracture and more density is developed  Skeletal muscle pulls on bone and stimulates increase in bone density  Diet  calcium and vitamin D o Treatment  Calcium  Vitamin D  Resistance exercises  build bone  Drugs that decrease osteoclast activity  allow the blasts to rebuild the bone  Alendronate Bone demineralization (special cases) o Renal disease  Decreased activation of vitamin D and increased serum phosphorus results in a low calcium  related concern would be fracture   o  Persons on long term high dose Glucocorticoids have a related concern of bone demineralization and osteoporosis o Roux en Y  risk for osteoporosis  Malabsorption of calcium and vitamin D Fracture: when stress on the bone is more than the bone can absorb o Etiology: trauma; sudden injury o Stress fracture: constant pounding against a bone (walking, jogging, etc.) can cause a splintering fracture o Pathological fracture: as a result of disease o S/S  Pain  Tenderness  Swelling  Loss of function o Fractures can be classified by location  Proximal  Midshaft This study source was downloaded by 100000780651383 from CourseHero.com on 10-09-2023 15:30:58 GMT -05:00 https://www.coursehero.com/file/130102312/orthopedic-disordersdocx/   Distal o Fractures can also be classified by the direction or pattern  Transverse  straight across  Oblique  at angle  Spiral  like the bone was twisted  Comminuted  many fragments  Segmental  1 fragment  Impacted o Open vs closed fractures  Closed: skin was not broken  Open: skin broken; osteomyelitis (infection) is a related concern o Impacted vs compression fracture  Impacted: telescoping fracture  Compression: vertebral disk collapse o Treatment  Immobilize  limit soft tissue injury and injury to blood vessels and nerves; fat emboli  Reduce  to pull into anatomical alignment o Fractures in the elderly  Reduced ability to withstand stress on the bones o Compartment syndrome  A neurovascular complication of certain orthopedic conditions  Volume and pressure pathophysiology  Increased volume  increased pressure  compression of blood vessels and nerves  potential loss of tissues  S/S  Early s/s suggestive for compartment syndrome o Pain with passive muscle movement  Later signs o Pale cool skin  Definitive diagnostic test  Measure the compartment pressure  Treatment  Split the cast  Remove an occlusive dressing  Fasciotomy  Goal: s/s compartment syndrome monitored and managed as evidence by no complaints of: o Pain on passive movement or stretch o Paresthesia  Numbness, “pins and needles”  Burning or tingling Osteomyelitis: inflammation in the bone and bone marrow related to infection o Late manifestations of s/s This study source was downloaded by 100000780651383 from CourseHero.com on 10-09-2023 15:30:58 GMT -05:00 https://www.coursehero.com/file/130102312/orthopedic-disordersdocx/ Increased temperature Increased WBC count  Increased number in % neutrophils  Pain  Swelling  Skin color might be red  Skin temperature might be warm o Inflammatory markers: nonspecific, but do tell you the degree of inflammatory  Erythrocyte sedimentation rate: increases  C-Reactive protein: increases o Clinical features  No s/s for days  weeks  Pain, fever, malaise  Unable to bear weight  Bone tender to palpation  Reduced joint movement  Late: soft tissue swelling o Definitive diagnostic test = biopsy bone  50% of persons have positive bone cultures o Treatment  Antibiotics  Based on the specific organism  Antibiotic to which organism is sensitive  Local debridement  Removal of infection tissue  Surgical treatment  Limited amputation often necessary with osteomyelitis in the foot in adults Paget’s Disease o In Paget’s Disease the normal process of bone turnover is altered. Remodeling is another word that means bone turnover. In Paget’s Disease the bone turns over more quickly. Osteoclasts (the demolition cells or the cells that chew up bone) are more active. When the bone grows back, bone building cells called osteoblasts are activated, bone formation is increased but the bone is abnormal. Bone formation in Paget’s Disease results in bone that is soft which can result in bone that bends and is prone to fracture. o What causes Paget’s Disease? Genetic and environmental influences are suspected. Viral etiology is probably associated with Paget’s. Paget’s (osteitis deformans) is the second most common bone disease after osteoporosis.    o Signs and Symptoms  Many persons are asymptomatic. Only mild pain and tenderness may be present. Paget’s Disease might be suspected during routine lab studies when an increase in alkaline phosphatase is noted. This could indicate an increase in This study source was downloaded by 100000780651383 from CourseHero.com on 10-09-2023 15:30:58 GMT -05:00 https://www.coursehero.com/file/130102312/orthopedic-disordersdocx/   osteocalst activty. A bone scan can be performed to detect rapid bone turnover. However, it would not be possible to distinguish Paget’s Disease from osteosarcoma or osteomyelitis. Bone biopsy would have to be done to confirm the diagnosis of Paget’s Disease o Treatment  Pain control may be achieved using NSAIDs (non steroidal anti inflammatory drugs). Drugs can also be given that decrease osteoclast activity. Persons with Paget’s Disease should also get adequate calcium and vitamin D in the diet. Fractures o Delayed union: failure of a fracture to unite within the normal period  Contributing factors  Large, displaced fracture  Inadequate immobilization  Large hematoma  Infection at fracture site  Excessive loss of bone  Inadequate circulation o Malunion: healing with deformity, angulation, or rotation that is visible on x-ray films  Contributing factors  Inadequate reduction  Malalignment of fracture at time of immobilization o Nonunion: failure to produce union and cessation of the process of bone repair  Contributing factors  Inadequate reduction  Mobility at fracture site  Severe trauma  Bone fragment separation  Soft tissue between bone fragments  Infection  Extensive loss of bone  Inadequate circulation  Malignancy  Bone necrosis  Noncompliance with restrictions Fat emboli o Common o Often asymptomatic or mild and undiagnosed o Fat Emboli related to long bone, pelvis or rib fracture secondary to movement of unstable bone fragments o Fat emboli related to increased pressure within intramedullary canal secondary to placement of prosthetic device (total hip or hemiarthroplasty) o Fat emboli syndrome This study source was downloaded by 100000780651383 from CourseHero.com on 10-09-2023 15:30:58 GMT -05:00 https://www.coursehero.com/file/130102312/orthopedic-disordersdocx/      Fracture unstable, ends move … or a prosthetic devise is pushed into intramedullary canal release yellow marrow, bone marrow fat  into torn veins  clogging circulation in brain and around alveoli…fat emboli syndrome Not common…suggested by confusion, restlessness, hypoxia (oxygen saturation less than 90%), tachypnea, tachycardia; non blanching petechiae on chest axillae, neck and shoulders Triad  Cerebral Symptoms: confusion  Integumentary Sx: petechiae  Pulmonary Sx: hypoxia (low pulse oximetry)  tachypnea, tachycardia Prevention  Early immobilization of fracture Treatment  Support respiratory system o Oxygen o Ventilation could be needed  Steroids to suppress inflammation  Provide fluids in the event of shock This study source was downloaded by 100000780651383 from CourseHero.com on 10-09-2023 15:30:58 GMT -05:00 https://www.coursehero.com/file/130102312/orthopedic-disordersdocx/ Powered by TCPDF (www.tcpdf.org)