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rheumatic disease
any disease or condition involving the musculoskeletal system
autoimmune disorders-antibodies attack healthy normal cells and tissues
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arthritis
inflammation of one or more joints
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osteoarthritis and rheumatoid arthritis
oa-noninflammatory, localized, not systemic, not an autoimmune disease
ra-systemic, inflammation
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osteoarthritis
progressive deterioration and loss of cartilage in one or more joints (articular cartilage)-60-80% water
osteophytes-bone spurs occur
the bodys repair process can not overcome the rapid process of degeneration
crepitus-when pieces of bone float in diseased joint and make a grating sound caused by loosened joint and cartilage
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primary OA
aging, genetics, obesity, smoking,
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secondary OA
can happen from other musculoskeletal conditions such as rheumatoid arthritis, manual occupations, trauma to joints
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OA VS. RA
OA- chronic joint pain and stiffness, pain diminishes with rest, worsens after activity, inflammation with OA indicates secondary synovitis
- heberdens nodes (distal interphalangeal joints)
- bouchards nodes (proximal)
- infrapatellar notch (area directly below the knee)
- suprapatellar area (directly above knee)
CONSTANT PAIN, INTERFERE WITH LIFE AND ADLS
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labs for OA
erythrocyte sedimentation rate and high sensitivity c reactive protein may be elevated in secondary synovitis
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if acetaminophen and topical agents do not help OA what do you give?
NSAIDS
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capsaicin
hot peppers-WEAR GLOVES
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glucosamine
decrease inflammation
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chrondroitin
strengthens cartilage
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total joint arthroplasty/total joint replacement
surgical creation of a joint
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osteonecrosis
bony necrosis secondary to lack of blood flow usually from trauma or chronic steriod therapy
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primary arthroplasty
first time a pt receives a total joint arthroplasty
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revision arthroplasty
fix implant
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when are clotting meds discontinued before surg?
1 week
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neuroaxial
epidural or spinal
reduces blood loss and incidence of dvt
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subluxation
partial dislocation
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major problem with post op THA
partial or total hip dislocation
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most important life threatening complication of THA is?
VTE and pulmonary embolism
anti coags
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thrombocytopenia
decreased platelets
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drainage=?
less than 50 ml/8 hr
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when do you get out of bed from a joint surgery?
the night of
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what degree should the hips not be flexed past
90
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length of stay
traditional surg=3 days
MI=2nd post op day or day of surg.
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adlea
refined capsaisin products placed directly into the surgical joint
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peripheral nerve blockade
anestesiologist injects femoral or sciatic nerve with local anestetic by portable pump
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articulations
joint surfaces
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hemiarthroplasty
replacement of part of the joint
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Rheumatoid arthritis
common connective tissue disease that can be the most destructive to the joints, chronic, progressive, systemic inflammatory autoimmune disease, affects primarily the synovial joints
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systemic
means that it affects the body system affecting many joints and other tissues
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pannus
vascular granulation tissue composed of inflammatory cells, it erodes the articular cartilage and eventually destroys bone
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vascultitis
blood vessel involvement
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bone biopsy
extract a specimen of bone tissue for microscopic examination
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techniques for bone biopsy
1) needle (closed)
2) incisional (open)
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muscle biopsy
done for diagnostic and inflammation
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EMG
electromyography
used to evaluate diffuse or localized muscle weakness
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arthroscopy
fiberoptic tube inserted into a joint for direct visualization of the ligaments, menisci, and articular surfaces of the joint
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WHAT MUST YOU BE ABLE TO DO BEFORE A KNEE ARTHROSCOPY??
flex the knee at least 40 degrees
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open reduction with internal fixation
reducing and immobilizing a fracture
open reduction-allows the surgeon to see the fracture site
internal fixation-metal pins, screws, rods, plates or prostheses to immobilize the fracture during healing
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external fixation with closed reduction
for patients with soft tissue injury (open fracture)
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external fixation
system in which pins or wires are inserted through the skin and affected bone and then connected to a rigid external frame
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electrical bone stimulation
delivers small continuous electrical charge directed toward the non healed bone
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low intensity pulsed ultrasound
used for slow healing fractures or for new fractures
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iontophoresis
method for absorbing dexamethasone through the skin near the painful area to decrease inflammation and edema
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compartment syndrome
can begin 6-8 hours after injury, can take up to 2 days to appear
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intracapsular
within the joint capsule
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extracapsular
outside the joint capsule
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kyphoplasty
inserting a balloon into the vertebra space to restore height to vertebra
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synovectomy
removal of excess synovium
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rice
rest, ice, compression, elevation
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tendon transplant
tendon reconstruction
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