Muscular Dystrophies, Osteoporosis, Paget’s, Osteomyelitis & Bone Fractures: Clinical Features, Management & Patient Education

What are the clinical manifestations of muscular dystrophies?

Progressive muscle weakness, enlarged calves (pseudohypertrophy), frequent falls, difficulty running/jumping, Gowers' sign, delayed motor milestones, fatigue, cardiomyopathy, respiratory weakness.

What are common complications of muscular dystrophies?

Respiratory failure, pneumonia, scoliosis, contractures, cardiomyopathy/heart failure, decreased mobility, pressure injuries.

What patient education is essential for muscular dystrophies?

Promote ROM exercises, encourage use of braces, prevent respiratory infections, maintain healthy weight, safety measures for mobility, genetic counseling, pacing activities.

What interdisciplinary team is involved in muscular dystrophy management?

PT/OT, respiratory therapy, cardiology, neurology, pulmonology, orthopedics, dietitian, social work, genetics counseling.

What is the pathophysiology of osteoporosis?

Bone resorption exceeds bone formation → decreased bone density and increased porosity → fragile bones prone to fractures.

What is a pathological fracture?

A fracture occurring from minimal or no trauma due to weakened bone (common in osteoporosis or cancer).

What are clinical manifestations of osteoporosis?

Height loss, kyphosis (Dowager's hump), back pain, fragile bones, fractures (hip, vertebrae, wrist), reduced mobility.

What are complications of osteoporosis?

Fractures (especially hip/vertebrae), chronic pain, disability, loss of independence, respiratory compromise from spinal curvature.

What patient education is essential for osteoporosis?

Weight-bearing exercises, avoid smoking/alcohol, adequate calcium & vitamin D, fall prevention, use assistive devices, home safety modifications.

What medications are used in osteoporosis management?

Calcium supplements: 1200 mg/day, Vitamin D supplements: 800-1000 IU/day, Bisphosphonates (alendronate), Calcitonin, Denosumab, SERMs (raloxifene).

How do you reduce fall and fracture risk in osteoporosis?

Remove rugs/clutter, use grab bars, good lighting, non-slip shoes, avoid sedatives, strength & balance training, assistive devices.

What is the pathophysiology of Paget's disease?

Excessive bone resorption followed by abnormal overgrowth → enlarged, weak, disorganized bone that is prone to deformities and fractures.

What are clinical manifestations of Paget's disease?

Bone pain, bone deformities (bowed legs), enlarged skull (headache/hearing loss), fractures, warmth over affected bones.

What are complications of Paget's disease?

Pathological fractures, osteoarthritis, nerve compression (hearing loss), heart failure (rare), bone tumors (rare).

What is the patient education for Paget's disease?

Take meds as prescribed, calcium/vitamin D intake, fall prevention, weight-bearing exercise, report hearing changes or nerve pain.

What medications are used for Paget's disease?

Bisphosphonates (first line), calcitonin, calcium & vitamin D supplementation for bone health.

What are the risk factors for osteomyelitis?

Open fractures, recent orthopedic surgery, diabetes, poor circulation, IV drug use, pressure injuries, immunosuppression, prosthetic joints.

What is the pathophysiology of osteomyelitis?

Infection enters bone → inflammation → edema → decreased blood flow → bone ischemia → necrosis → formation of sequestrum.

What diagnostic tests confirm osteomyelitis?

Elevated ESR/CRP, leukocytosis, blood cultures, bone biopsy (gold standard), MRI (best imaging), X-ray (late stages), CT, bone scan.

What medications are used to manage osteomyelitis?

Long-term IV antibiotics (4-6 weeks): vancomycin, ceftriaxone. Pain meds, antipyretics. Possible surgical debridement if not responsive.

What patient education is needed for osteomyelitis?

Complete full course of antibiotics, care for PICC line, monitor for infection, perform wound care, avoid weight bearing until cleared, report increased pain or fever.

What are complications of osteomyelitis?

Chronic infection, amputation, sepsis, pathologic fractures, impaired mobility.

What are risk factors for needing joint replacement (osteoarthritis)?

Aging, obesity, joint overuse, previous joint injury, genetics, rheumatoid arthritis.

What patient education is essential for joint replacement surgery?

Pre-op: stop blood thinners, infection prevention. Post-op: use walker, avoid flexing hip > 90° (hip replacement), maintain abduction, follow PT regimen, wound care, signs of infection.

What are major complications of joint replacement?

DVT/PE, infection, dislocation (hip), loosening of implant, neurovascular damage, bleeding.

How do you prevent DVT/PE after joint replacement?

Early ambulation, SCDs, anticoagulants (heparin, enoxaparin), hydration, ankle pumps, avoid crossing legs, maintain mobility.

What is key pain management after joint replacement?

Scheduled analgesics, PCA if ordered, ice, elevation, positioning, early but safe mobilization, non-pharmacologic techniques.

What are clinical manifestations of bone cancer?

Bone pain (worse at night), swelling, palpable mass, pathologic fractures, weight loss, fatigue.

What patient education is needed for bone cancer?

Importance of follow-up, pain management plan, reporting fractures or new pain, medication adherence, nutritional support, coping strategies.

How do you manage complications & treatment of bone cancer?

Chemotherapy/radiation for tumor control, surgical resection or amputation, monitor for complications: fractures, hypercalcemia, infection, neuropathy, support mobility with PT, assistive devices.

How do you manage pain in bone cancer?

Opioids, NSAIDs, nerve blocks, radiation for tumor pain, bisphosphonates for bone strength, non-pharmacologic comfort measures.

What is a strain?

Stretching or tearing of muscle or tendon.

What is a sprain?

Stretching or tearing of a ligament.

What causes strains & sprains?

Overuse, sports injuries, falls, improper lifting, fatigue, poor conditioning.

What diagnostic testing is used for strains & sprains?

Physical exam, X-ray (rule out fracture), MRI/ultrasound for severe tears.

What is RICE treatment?

Rest, Ice 20 min on/off, Compression, Elevation.

What are complications of strains & sprains?

Chronic pain, instability, decreased range of motion, tendon rupture.

What patient education is important for strains & sprains?

Avoid weight-bearing until cleared, use proper body mechanics, pain control, gradual return to activity, continue compression.

What is the process of bone healing?

1. Hematoma formation 2. Granulation tissue 3. Callus formation 4. Ossification 5. Consolidation 6. Remodeling.

What is a pathological fracture?

A fracture caused by weakened bone (osteoporosis, cancer) with minimal trauma.

What are the types of fractures?

Transverse, oblique, spiral, comminuted, greenstick, open/compound, closed, impacted, compression.

What diagnostic tests are used for fractures?

X-ray (primary), CT, MRI (soft tissue), bone scan (stress fractures).

What are non-surgical fracture treatments?

Casting, splinting, traction, immobilization, closed reduction.

What are surgical fracture treatments?

Open reduction, internal fixation (ORIF), external fixation, intramedullary rods.

What are complications of fractures?

Compartment syndrome, fat embolism, infection, DVT/PE, delayed union, nonunion, malunion, neurovascular damage.

What are risk factors for delayed bone healing?

Smoking, diabetes, malnutrition, infection, poor circulation, age, corticosteroids, poor immobilization.

What patient education is important after fractures?

Cast care, keep dry, report numbness/tingling, avoid inserting objects in cast, elevate, ice, use assistive devices.

What is proper positioning after fractures?

Elevate extremity, avoid pressure on casted area, maintain proper alignment, support with pillows.

What are the types of traction?

Skin traction: Buck's traction → short term; Skeletal traction: Pins in bone → long-term alignment; Manual traction: By provider for temporary alignment.

What are risk factors for amputation?

Traumatic: accidents, burns, crush injuries; Ischemic: PAD, diabetes, infection, osteomyelitis, gangrene.

What are complications of amputations?

Infection, hemorrhage, phantom limb pain, contractures, delayed wound healing.

What is nursing management after an amputation?

Pain control, wound care, prevent infection, prevent contractures, maintain alignment, monitor circulation, emotional support.

What is the patient positioning after an amputation?

Avoid prolonged elevation (risk of contractures), lie prone 20-30 min several times/day, no pillow under residual limb.

Why is nutritional support important after an amputation?

Promotes wound healing; protein, vitamin C, zinc, hydration.

How to manage phantom limb pain?

Gabapentin, mirror therapy, opioids, massage, TENS, heat/cold (if not contraindicated).

What is the pathophysiology of carpal tunnel syndrome?

Compression of the median nerve in the wrist due to swollen tendons, overuse, or inflammation.

What are the clinical manifestations of carpal tunnel syndrome?

Numbness/tingling in thumb, index, and middle fingers; night pain; decreased grip strength; positive Phalen's or Tinel's sign.

What diagnostic testing is used for carpal tunnel syndrome?

Nerve conduction studies, EMG, ultrasound, MRI, physical exam (Phalen/Tinel).

What are non-surgical management options for carpal tunnel syndrome?

Wrist splinting (especially at night), NSAIDs, corticosteroid injections, rest, ergonomic modification.

What are surgical management options for carpal tunnel syndrome?

Carpal tunnel release (open or endoscopic).

What are complications of carpal tunnel syndrome?

Persistent numbness, weakness, nerve damage, decreased hand function.