Connective Tissue Disorders PDF

SYS Connective tissue Disorders CT disorders - Have air-ups and remission states RA = Most common Scleroderma Lupus Scleroderma - Sclero = hardening, with loss of elasticity - Der...

SYS Connective tissue Disorders CT disorders - Have air-ups and remission states RA = Most common Scleroderma Lupus Scleroderma - Sclero = hardening, with loss of elasticity - Derma = skin - Scleroderma — systemic disorder a ecting collagen characterized by slowly spreading brosis throughout body - 2 forms: - 1) Localized — A ecting skin, fascia, mm, sometimes bone --> brotic lesions, hard, oval patches on the skin’s surface possibly extending deep into mm + bones - ↓ROM in a ected joints - Joint Ⓟ - 2) Generalized — A ects multiple systems. Skin, capillaries and viscera. - Limited Generalized: skin is a ected 1st, followed by contractures of digits + dilated super cial skin capillaries. Develops over 5-10 years. - Di use Generalized: skin a ected 1st, followed by exion contractures, CTS. Mm weakness,↓ROM. Everything is slowly failing More serious symptoms: - esophageal and intestinal narrowing. Congestive heart failure, lung disease, malignant hypertension and renal failure. - No treatment can stop the overgrowth of collagen —> but we can help stabilize how much is produced History onset, diagnosis general health a ected areas treatment, meds ADL’s progression ff ff fl ff ff ff ff ff fi ff fl fi fi Tx Goals stress management relaxing, sedating intent Ⓟ reduction maintain ROM, ↑where possible TrP’s, compensatory structures maintain & promote tissue health Precautions/ Contraindications Tx duration + intensity meds position for comfort presentation + severity is pt dependent other health issues or compounding factors Lupus - Systemic Lupus Erythematosus — Chronic auto immune in ammatory disease with periods of acute attack + remission. unknown cause, possible genetic + environmental triggers, possible hormonal link SSX: 1st sign of lupus = Butter y rash on face fatigue joint + mm Ⓟ fever HA anemia - ↓RBC’s — ↑risk of blood clots loss of appetite nausea, abdominal Ⓟ skin rash — butter y sun sensitivity bruising easily Flair ups — with high estrogen More Serious SSX: hypertension pericarditis fl fl fl  pleuritis —> chest cavity in ammation renal dysfunction —> most leading cause of death from lupus CNS involvement - Change in vision - Strokes/seizures History onset, diagnosis signs + symptoms are ups (FID’s) treatment medications ADL’s Tx Goals ↓Ⓟ maintain joint health & function address compensatory structures Pt education Precautions/ CI’s during acute are up * no hydro * no tx local or distal to a ected joints * no PROM to a ected joints fever open lesions medications duration Fibromyalgia - Fibromyalgia — A painful, chronic, non-articular condition of at least 3 months. Characterized by widespread mm Ⓟ Generalized Ⓟ - Diagnosis involves ruling out other conditions with blood tests, x-rays, scans. 18 diagnostic points — must have at least 11 of them to be diagnosed 11-18 speci c diagnostic tender points are also palpated + elicit Ⓟ bilaterally fl fi fl ff ff fl  - High sensitivity to Ⓟ Diagnostic points: Posterior 1,2 — suboccipital mm insertion, just inferior to occiput 3,4 — upper traps, midpoint, upper border 5,6 — supraspinatus origin, med border 7,8 — gluteus medius, anterior portion 9,10 — greater trochanter, 2 cm post Diagnostic points: Anterior 11,12 — anterior aspect of TVP’s C5-C7 13,14 — Rib #2, costochondral junction 15,16 — 2cm distal to lateral epicondyle 17,18 — MCL, proximal to joint line - These points rule out conditions: Chronic fatigue syndrome myofacial pain syndrome arthritis lupus Control sites - These areas should NOT be tender… Forehead Deltoid muscle insertion Muscle belly of nger exors Lateral epicondyle SSX generalized Ⓟ = most common symptom ~ a ecting ADL’s fatigue, poor sleep sti joints HA’s depression IBS anxiety f fi fl ff  dysmenorrhea NTW History Onset Diagnosis - What were there tender points / how many? SSX Treatment Medications Massage history ADL’s, activity level - Flair-ups? - ↑Ⓟ after certain activities? Sleep quality Tx Goals Sedating intent Ⓟ management Pt education Encourage healthy lifestyle Diaphragmatic breathing, postural awareness Maintain tissue/joint health + ROM Tx precautions/ CI’s Duration Depth of pressure Medications (for depression/anxiety, sleep) Positioning? Hydro tolerance Remedial exercise - mild —> moderate exercise at times of least discomfort/most energy include stretching, strengthening, aerobic - Referral for movement therapies such as: Feldenkrais, Alexander Technique, Yoga Therapy, Tai Chi - Referral to a naturopath to support immune system, etc  Myalgic Encephalomyelitis (CFS) - Myalgic Encephalomyelitis (ME/CFS) — persistent fatigue does not resolve + severely reduces activity levels for at least 6 months - “Chronic fatigue syndrome” often misdiagnosed ~ u, infection, depression cause is not well known De ciency of T-lymphocytes (killer T-cells) - potential genetic and/or viral links - over 1/2 a million Canadians currently living with ME (CIHR) SSX: - May be chronic or recurrent - Disabling fatigue = primary symptom - aching mm, joints - spasm, weakness - fever, sore throat - appetite, intestinal problems - memory loss, inability to concentrate, confusion - anxiety, depression, mood swings - sensitivity to light/heat - sleep disturbances - persistent daily HA or migraine ~ in up to 90% of pts 3x more common in women generally btwn ages 20 -> 40 fi fl