Recording-2025-01-21T17:05:18.389Z

Osteoarthritis (OA)

• Functional Limitations: OA leads to difficulty with mobility, affecting tasks such as getting out of a car or walking.

• Chronic Nature: It is a chronic disease causing significant functional loss over time.

• Non-inflammatory: Defined as a non-inflammatory condition that does not involve systemic inflammation.

• Primary vs. Secondary OA:

  • Primary OA occurs typically after age 40, often referred to as wear and tear.

  • Secondary OA can be caused by infections, rheumatoid arthritis, metabolic disorders like gout, and endocrine issues such as diabetes.

Diagnosis of OA

• Lab Findings: No specific laboratory tests indicate OA. Diagnosis is primarily based on clinical and radiological findings.

• Clinical Findings: Includes joint pain, particularly after periods of inactivity.

• Radiological Findings: X-rays may show narrowing of joint space and the formation of bone spurs (osteophytes).

Osteoporosis

• Definition: A chronic metabolic disorder characterized by decreased bone density and increased fragility.

• Pathophysiology: Osteoporosis involves the activity of osteoclasts that resorb bone faster than new bone is formed.

• Calcium Levels: Low blood calcium levels stimulate osteoclast activity, leading to osteopenia.

• Risk Factors: Includes prolonged immobility, which can exacerbate bone loss.

• Assessment: Health history and a bone mineral density scan (BMD) are crucial for diagnosis.

Fractures

• Types of Fractures:

  • Closed Non-displaced Fracture: Bone is broken but does not penetrate the skin.

  • Open Compound Fracture: Breaks through the skin, increasing risks of infection.

  • Displaced Fracture: Bone fragments are displaced from their normal alignment.

  • Spiral Fracture: Caused by a twisting force and may indicate abuse, especially in children.

  • Greenstick Fracture: Partial fracture, common in children due to softer bones.

• Signs and Symptoms: Swelling, pain, and loss of function in the affected area.

Treatment Approaches

• Initial Treatments: Includes rest, compression, elevation, and immobilization.

• Medications: Calcium and vitamin D are essential; hormone therapy may be indicated for some patients.

• Specific Drugs:

  • Osmax (Alendronate): Bisphosphonate used to prevent bone loss; must be taken in the morning on an empty stomach with water.

• Surgical Interventions: Open reduction and internal fixation (ORIF) for severe fractures; joint replacement for advanced OA.

Total Joint Replacement Precautions

• Hip Replacement Precautions: Avoid crossing legs, limit hip flexion beyond 90 degrees; maintain proper positions to prevent dislocation.

• Postoperative Care: Includes monitoring for signs of infection, managing pain, and encouraging mobility to prevent complications like blood clots.

Pain Management and Complications from Amputation

• Complications: Include hemorrhage, infection, and phantom limb pain.

• Pain Assessment: Pain perception is subjective and should be treated regardless of underlying conditions.

• Rehabilitation: Involves physical and occupational therapy to promote recovery and adaptation to changes post-amputation.

Rheumatoid Arthritis (RA)

• Overview: A chronic systemic inflammatory disorder affecting joints and other organs.

• Symptoms: Joint pain, swelling, and stiffness, particularly in the hands and feet, with potential systemic effects.

• Treatment Strategies: Include non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs, e.g., methotrexate), and biologics.

Gout

• Pathophysiology: Caused by elevated uric acid levels leading to urate crystal deposition in joints.

• Dietary Management: Emphasis on hydration; avoidance of purine-rich foods like red meat and alcohol.

• Acute Attack Treatments: NSAIDs and corticosteroids to manage inflammation during flare-ups.

Miscellaneous Complications

• Compartment Syndrome: Can occur post-fracture or cast application; characterized by severe pain, pallor, and paralysis.

• Rhabdomyolysis: A condition arising from muscle injury that can lead to kidney damage if untreated; involves monitoring for myoglobin in urine.