Musculoskeletal Disorders and Autoimmune Diseases Review

Carpal Tunnel Tests

• Tests are positive if they indicate the presence of carpal tunnel syndrome.
• Phalen's Test: Holding wrists in flexion for 60 seconds to check for numbness and tingling.
• Tinel's Sign: Tapping on the median nerve to check for a response.

Traction

• For patients requiring traction due to a fracture, priority is ensuring the weight hangs freely.
• If weight is on the floor, it's not applying traction.
• Important to check the patient's skin when using both bus and skeletal traction.

Fracture Diagnosis

• Diagnostic order:
  • X-ray
  • CT Scan
  • MRI

Duchenne Muscular Dystrophy

• Priority for children with Duchenne muscular dystrophy is promoting independence.
• Encourage activities like playing with other kids and going to school.

Leg Cast Perthes Disease

• It is an avascular event where the ball of the femur flattens.
• Child is unable to abduct and adduct the leg.
• Treatment is a hip spica cast, worn 24 hours a day.
• Typically affects infants and children.

General Care

• Review cast care, crutch and walker usage, found in closure book.
• Follow the RICE method: Rest, Ice, Compression, Elevation.

Gout Treatment

• Distinguish between allopurinol and colchicine.

Osteomyelitis

• Severe bone infection of bone, bone marrow, and surrounding soft tissue that can spread systemically.
• Leads to irreversible bone ischemia and necrosis.
• Can be acute (less than one month), subacute, or chronic (greater than one month).
• Examples of Patients Affected:
  • Diabetics: Bacteria love sugar, high blood sugar predisposes them.
  • Blunt Trauma, penetrating wound (gunshot).
  • Open wound leads to bacterial invasion then spreads via blood to the bone.

Osteomyelitis Interventions

• Collaborative care.
• Prolonged IV antibiotics via PICC line.
• Surgical debridement to clear dead tissue and improve perfusion.
• Surgical removal of necrotic bone; possibly amputation.
• Hyperbaric Chamber: 100% O_2 to stimulate new cell growth and wound healing.
• Patient education for PICC line care and self-administration of IV antibiotics or home care may be required.
• Avoiding narcotics for chronic cases; exploring other pain management options.

Osteoarthritis

• Most common form of degenerative joint disease; slowly progressive and non-inflammatory.
• New joint tissue forms in response to cartilage destruction.
• Large nodes on fingers and knees.
• Causes sleep disturbances, stiffness, pain, crepitation, and joint deformity.
• Heberden's Nodes: Distal finger joints.
• Bouchard's Nodes: Proximal finger joints.
• Diagnostics: CT scan, X-ray, or MRI; no blood test.
• Treatment:
  • Arthroscopic procedure to remove rough tissue, or joint replacement (knee or hip).

Rheumatoid Arthritis

• Chronic, systemic autoimmune disease with inflammation of connective tissue in synovial joints; remission and exacerbation.
• Signs and Symptoms:
  • Pain, stiffness, limited motion.
  • Inflammation: warmth, redness, swelling.
  • Firm, nontender nodules.
  • Swan neck deformity in fingers (distinct from Heberden's nodes).
  • Cardiopulmonary complications, fatigue, anorexia, weight loss.
• Diagnostic: Increased inflammation in the synovial joint.

Rheumatoid Arthritis Interventions

• NSAIDs for pain and inflammation.
• Non-pharmacological care: Avoid heat on inflamed areas; cold may be soothing.

Osteoarthritis Interventions

• Tylenol for pain relief
• Heat may be used as there is no swelling or inflammation.

Considerations for NSAID Use

• Risk of renal issues and GI bleed.

Systemic Lupus

• Multisystem inflammatory autoimmune disease (Type III) affecting skin, joints, serous membranes, renal, hematologic, and neural systems.
• Exacerbation and remission.
• More common in women of childbearing age.
• Diagnostic: Positive ANA, elevated ESR and CRP.
• Signs and Symptoms:
  • Discoid (butterfly) rash on face.
  • Cardiopulmonary problems: tachypnea, cough.
  • Weight loss, fatigue, fever with infection, arthritis.
  • Emotional issues, hematologic and neurologic issues.
  • Raynaud's phenomenon, pericarditis, pulmonary/cardiac problems.

Lupus Nephritis

• Body rejects kidneys.
• Results in proteinuria and hematuria, potentially leading to kidney failure and dialysis.

Systemic Lupus Interventions

• NSAIDs and corticosteroids (long-term use leads to moon face and buffalo hump).
• Antimalarial drugs (hydroxychloroquine) for fatigue and joint pain.
• Immunosuppressant drugs.
• Patient education: rest, avoid warm environments.

Scleroderma

• Disorder of the connective tissue causing fibrosis or degenerative inflammatory changes in skin, blood vessels, synovium, skeletal muscle, and internal organs.
• Connective tissue around organs becomes stiff, impairing function.
• Stiffening of connective tissue around the mouth can affect eating.
• Onset between 30-50 years; more common in women.
• Two types: crest form (benign) and diffuse form (rapidly progresses to widespread organ involvement).
• Treatment: physical and occupational therapy, drug therapy.

Scleroderma Interventions

• Vasoactive agents and calcium channel blockers early in the disease.
• ACE inhibitors and ARBs to improve circulation.
• Pain relief: NSAIDs, Tylenol, topical medications (lidocaine patches, Aspercreme, Bengay).
• Immunosuppressant drugs.
• If hands are affected: patients can't use their hands.
• If mouth is affected: patients can't eat (may require G-tube).