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Osteoporosis Etiology
- Oseteopenia: low bone mass precursor to osteoporosis
- Involoves reduction in bone mass/volume
- Brittle Bones results in invrease resk of frature
- Can be primary: presence of risk factors
- Can be secondary to other metabolic disorders such as DM, hypersthyroidism, RA, cushings disease
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Osteoporosis Risk Factors
- Age: over 50 female,
- Race: caucasion,
- Post menopausal
- Small body frame
- Family history
- Long periods of immobility, lack of WB
- Long term use of heparin, corticosteroids, antacids, laxatives, anticonvulsants
- Excessive use of alcohol, caffine, tobacco
- Dietary deficiencies of calcium, vit D
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Osteoporosis Diagnosis
- x-ray
- CT scan
- MRI
- Bone mineral density test: normal >833 mg/cm2 Osteopenia 648-833 Osteoposis <648
- Blood tests: Blood Ca, Vit D
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Osteoporosis S&S
- may be asymphomatic until well advanced
- Pain esp. back pain
- Loss of height, postural changes
- bone loss in mandible can change appearance
- suseptible to fracture
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Osteoporosis Medical Management
- Hormone therapy: estrogen, androgens
- Meds: calcium, Citamin D, Calcitonin, Biphoshonates, Fluoirde
- Modify risk factors: limit use of alcohol, tabacco, caffine
- Adequate dietary intake of calcium and Vit D
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Osteoporosis Prevention
- Keep active & stay strong
- Regular exercise that includes weight bearing activities
- Flexibility, strengtheing and balance ex.
- Safety and fall prevention programds
- Home assessment for hazards
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Osteoporosis Rehab Management
- Joint protection: bracing, splints
- Weight bearign exercise
- Fall prevention strategies: use of assistive deives, balance strategies, home assessment
- Use caution with any assessment or treatment technigue that involves forces being transmitted though bones
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Rickets/Osteomalacia
- Diseases that involve improper ossification of bone: soft bones
- Causes by vitamin D deficiency and an inability to absorb calcium properly
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etiology of Rickets/ Osteomalacia
- Insufficient intestinal absorption
- Increased renal phosphorus loss
- often related to other metabolic disorders of liver, gall bladder, pancreas, small intestine or kidney
- Incidence is higher in cold regoins
- Sunlight - vit D - Increases Ca absorb
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Rickets/ Osteomalacia S&S, medical menagement and Rehab
- S&S: diffue, general aching and fatigue. Deformation of WB bones, decreased height
- Medical Management: Rx of primary metabolic problem, increased calcium. increased Vit D, Increased Sunlight
- Rehab: maintain strength, WB, Preserve joints
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Bone Tumors
- Etiology: primary or secondary
- Signs and Symptoms: bone painm, worse at night
- Medical Management: surgical amputation, chemo, radiation
- Rehab: same as other cancers, pain limits function and ability to participate
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Osteomyelitis
- Etiology: Inflammation cuase by bacterial infection in the bone, usually related to surgery or Trama
- S&S: exudate - pressure within bone- pressure on nerves- pain
- Swelling redness, warmth at site
- Fever, luekocytosis, malaise, irritablility
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Osteomyelitis Medical Management
- Aggressive antibiotics
- if chronic may need surgery to remove necrotic bone tissue
- when inflamed amintain ROM, strength, function of rest of body, protect affected area, limit WB
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Paget's Disease Etioloyg and S&S
- Cause not establish, possibly a slow virus, genetics
- S&S: excessvie bone destruction and replacement with fibrous tissue and abnormal bone growth
- Structural abnormalities, bone thickening, can have pathological fratures
- Sometimes asymptomatic
- with skull involvement: HA, CN symptoms
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Pagets Medical Management
- reduce risk of fracture & deformity
- NSAID manage pain
- Calcitonin
- Surgery
- Rehab: fragile Pt may be involved with pain control, stregthening to support abnormal bone
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Muscular Dystrophy types
- Duchennes: most rapidly progressive
- FSH
- Myotonic
- Limb Girdle
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Duchennes Muscular Dystrophy Etiology
- Sex linked recessive inherited
- Reuslts in a metabolic dfect in the muscle cell that leads to degeneration and necrosis of muscle
- Muscle cells are replaced by fat or fibrous tissue
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Duchennes S&S, Diagnosis, Complications
- S&S degeneration of skeletal ms proximal first
- waddling gait, problems climbing stairs gowers sign
- Diagnosis: eclevated CPK, EMG, muscle biopsy
- Complications: scoliosis, limb deformites (anke and foot) Cardiac and respirtory problems
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Duchennes Medical Management
- Treatment of symptoms
- Goal: maintain function as long as possible
- Rehab: maintain ambulation and fuction
- moderate ex and supportice divices
- once WC bout medical complications increase
- Train Family
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Carpal Tunnel Syndrome
- Formed by carpal bones and transverse carpal ligament
- Contains 9 flexor tendons and media nerve
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Carpal Tunnel Syndrome Management
- Conservative: resting, splint at night, functional splint at work, adapt environment
- Corticosteroid injections
- Surgical: sever the flexor retinaculum (transverse carpal lin) relieve the compression forces, open or endoscopic
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Carpal Tunnel Role of Rehab
- Prevention: ergonomic assesment
- Conserative: splintin, ROM, strengthening, Fuct activites, Help adapt workplace? schedule
- Post-op: scar massage, stretching, elbow and schoulder strengthening
- ergonomic analysis, adapt to work recurrence
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Thoracic Outlet Syndrome
- Condition wiht insidous onset related to compression of bracial plexus and subclavian arterly
- often related to ms tension, poor postsure, or sleeping witha rms in elevated, ER postion
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Thoracic Outlet Syndrome Etiology and S&S
- muscle tension, poor posture, awkward positions
- S&S: pain parathesia, vasomotor symptoms weakness,& wasting of small ms of hand
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Thoracic Outlet Syndrome Medical Management
- Discountinue damaging activity, ice anit-inflammatory meds
- Rehab: correct posture/ positioning
- stretch/ strenghening as neededd, functional activites
- modify environment
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Dequervains Syndrome
- Overuse of thumb inflammation of thumb abductor tendons
- S&S: pain
- Management: ice, rest, splinting, ROM, strengthening, functional activities
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Define Impingement
- Structures are pinched between bony surfaces- inflammation - pain
- Treatment: anti-inflammatory meds, phono, ionto, steroid injections
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Impingement Examples
- Rotator cuff: impingement of rotator cuff between its insertion on humerus and ingerior acromion
- Patella: pinching or lat/ inf. ct soft tissues in knee cause= patellar malalignment
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Fibromyalgia
- a group of disorders characterized by pain and stiffness affecting muscles, tendons, and soft tissue joints.
- 18 specific trigger points
- Typical onset= females 20-50 years old with history of trauma or osteoarthritis
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Fibromyalgia S&S
- generalized aching, non-restorative sleep
- fatigue poor work tolerance, weakness
- AM stiffness, HA, irritable colon, anxiety depression
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Fibromyalgia Medical Management
- Stress reducaion, Anti-depressand meds, NSAID
- Rehab: regular exercise, rest, heat, massage, aquatic therapy, modalities, flexibility, strengtheing, posture, functional activites
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