ORTHO DISORDERS

Degenerative Traumatic Metabolic Autoimmune Infectious Genetic Connective Tissue Structural Elective

BURSA
*fluid-filled sac w/ synovial membrane lining, *all joints contain bursa *gliding surface friction/pressure *between tendon/skin or tendon/bone

FASCIA
*CT; surrounds/binds together muscles, vessels, nerves *uninterrupted from head to toe *superficial (directly under skin) *deep fascia (surrounds/separates muscle groups) *subserous/visceral (surrounds organs)

BONE
-SUPPORT/PROTECT -OSTEOGENESIS/HEMATOPOEISIS -MINERAL STORAGE -MEASURES SOMATIC GROWTH -WOLFFS LAW (bone adapts to wt. bearing) *92% solid 8% water *206 adult, 270 infant

JOINTS
MOVEMENT /MECHANICAL SUPPORT Types -PIVOT (rotation; neck, forearm, head/occipital bone) -CONDYLOID (2plane; shoulder/knee; add/abd, flex/ext) -SADDLE (back and forth, no rotation; ankle, wrist) -BALL AND SOCKET (any direction; hips, shoulders) -GLIDING (sliding movement; foot) -HINGE (knees, elbows) -SUTURE (skull) Function -FIBROUS (no movement/dense collagen; sutures) -CARTILAGINOUS (little movements; spine, ribs) -SYNOVIAL (bursa/articulating caritlage; movable joints) Structure -SYNARTHROSIS (no/minimal movement; sutures) -AMPHIARTHROSIS (slight movement; cartilaginous; spine/ribs) -DIARTHROSIS (moveable; synovial joints)

MUSCLE
-MOVEMENT (motor neurons, Na, action potential ) -HEAT PRODUCTION/METABOLISM -CONTRACTION/EXTENSION -CONDUCTION/ELASTICITY *1% shrinkage per day with no activity

CARTILAGE
-WITHSTAND PRESSURE -CUSHION (long bones, disks, meniscus, pubis) -SHAPE (nasal septum, ears, larynx) -Hyaline= Structure; no nerves/vessels (ears, nose, ribs, trachea) -Elastic= (epiglottis, ear lobes) -Fibrous= between bones (articulating joints) *Smooth, shiny, white, blue tinge *Nonvascular connective tissue *Slow Healing

*ARTHRITIS*
- > 100 different types - group of conditions involving joint/cartilage damage (D/T): autoimmune disease, broken bone, "wear and tear, over use, infection, genetics, lifestyle
(MC): osteoarthritis, rheumatoid, fibromyalgia, gout

LIGAMENTS
FLEXIBILITY/SUPPORT TENSILE STRENGTH SUPPORT TO VISCERAL ORGANS (uterus, bladder) *connects bone to bone * fibrous CT, dense, inelastic, white *forms /stabilizes the joint, limits ROM * desmology(string) =the study of ligaments *transmits muscle contraction to bone = movement *Watershed zone: weakest blood supply, prone to injury Tendonitis/Tendon Rupture Achilles tendon (runners) Rotator cuff (baseball) Posterior tibia Elbow (tennis) (SX): joint pain/swelling, warmth/erythema, ROM, morning stiffness, grinding sound/sensation *everyone presents differently (DX): Xray, H&P, blood tests (r/o AI disease) (TX): depends on cause, affected joint, severity, ADLs, age occupation, underlying health *no curePrevention!

OSTEOARTHRITIS

(Degenerative) -Insidious loss of joint cartilage -50% have no SX d/t slow onset -damage is done by the time they seek care - Idiopathic /secondary -MC = hand, neck, low back, hip, knee (SX): synovitis, joint pain/stiffness, ROM (TX): Acetaminophin NSAIDS (PO and topical) * will probably be taking home NSAIDS * promote adherence to dosage guidelines * Dr. will change meds for ineffective pain relief Selective COX-2 inhibitor (Celebrex) * given if NSAIDs contraindicated/GI bleeds * contraindicated with: >ACE inhibitors, K-sparing diuretics, sulfa allergies Corticosteroid (systemic or injection) * q4-6months; steroids cartilage degeneration Anti-Inflammatory * topical; avoid contact with membranes
of the eyes, mouth, nose, open skin

(PREVENTION): -ERT - contraindicated (DVT, HF, HTN, smoking, HR) - testosterone replacement (esp. HTN) -Diet (Ca) -avoid long-term antacid use (esp Al; Tums/Rolaids) -PPIs (long term GI Ca absorption) -Lifestyle (activity) Daily Intake Ca+(mg) Vit D (units) 19-50yrs 1000 mg & 200 U 51-70yrs 1200 mg & 400 U >70yrs 1200mg & 600 U * divided doses/2-3x daily (to avoid hypercalcemia/stones) (TX): Biophosphates (Fosamax, Boniva, Actinel) *bone resorption/clast activity * take 30 mins before a meal Estrogen replacement SERMs (Tomoxifan, Evista) * selective estrogen receptor modulators * mimics estrogen w/out risk of breast cancer/clots Calcitonin (IM or nasal spray) * must take calcium+Vit D * prevents further post-menopausal loss Patient Teaching -Encourage annual DEXA scans after age 50 (depends on RFs) -Weight bearing/exercise -Pain management (to tolerate exercises) -Smoking cessation -Safety measures (esp. bathroom) -Dietary suggestions (leaky greens, nuts, tofu, fortified foods) -Take Ca pills: sitting up, on an empty stomach, 30mins AC

* causes VASOCONSTRICTION - ISCHEMIA! * dont rub in, apply heat, wrap it Intra-articular hyaluronic acid (HA) * 3-5 injections/week; temporary relief Analgesics * last resort; use tramadol vs opiods * probable long term use = tolerance/addiction Arthroscopy: minimally invasive; to view, diagnose, treat -debridement; shaving off rough articular cartilage Osteotomy: bone segment removed near damaged joint -shifts weight to healthier cartilage Arthroplasty: reconstruction/replacement

DEXA SCAN -Dual Energy X-ray Absorptiometry

-Measures density of bone minerals -scans long bones (spine, hip, femur, forearm, tibia) -better accuracy/cost/less radiation vs Xrays USED FOR: - annual exams age 65 or 50 (osteoporosis) - post menopause - taking >7.5mg of prednisone per day (or >3months) - hyperthyroidism - history of fracture - taking drugs for osteopenia - any other risk factors *Stop all Ca 48hrs Before test *Hold osteopenia drugs day of test *not NPO ***Repeat every 1-5years *** T-score: density compared to healthy 30yr old Normal ( 0 and -1.0) Osteopenia (-1 and -2.5) Osteoporosis ( -2.25+)

OSTEOPOROSIS

(Metabolic)

- Bone mineral density 2.5 standard deviations below average

(MC): women/post-menopausal, White/Asian, endocrine disorders (hyperthyroid, diabetes, Cushings..) (RISK FACTORS): Alcohol - nutritional deficiency Corticosteroids long-term use Calcium low Ca is depleted from bone Estrogen low calcitonin Smoking - circulation to bone Sedentary lifestyle Wolffs Law Lactose Intolerance esp. Blacks (SX): height/spine curvature (Dowagers hump) Low back pain, fractures, subluxation, bone pain

GOUT

(Metabolic) - uric acid = purine metabolite -Rich Mans Disease (alcohol, meats, cheese, seafood, legumes) - hyperuricemia; d/t overproduction or underseretion - crystal deposits (tophi) in joints, tendons, tissues (MC): Men, alcoholics big toe, knees, wrists, fingers (RISK FACTORS): Male, >65 Diet, Obesity, Alcohol, Soft Drinks Long term (aspirin, levadopa, diuretics, excess Vit C) Metabolic Syndrome STAGES: Asymptomatic Hyperuricemia * modify diet, pt. teaching * usually DXd when testing for something else Acute gouty arthritis * single joint affected * usually triggered after holidays, stress, trauma Asymptomatic intervals * remission > exacerbation/flare ups Advanced Gout *untreated or not taking meds *uremic frost (esp. ear helix) (SX): Sever pain, erythema, warth, swelling *Dont touch! * can also deposit in heart, spine, kidneys (TX): Vitamin C NSAIDS (NO ASPIRIN!) Colchicines (PROPHYLAXIS) *UA crystals formation; prevents deposits Allupurinol (MAINTENANCE) * UA production/blood levels Corticosteroids Uricosurics * UA excretion in urine *Low Purine Diet = no beer, sardines, organ meats, aged cheese, legumes (beans/peas) *Monitor for GI upset - caused by gout medications *Take meds with meals to GI upset *Monitor output/Push Fluids - flush to prevent stones *Monitor BUN/Cr - BUN will be high *Monitor Glucose levels corticosteroids BG *Monitor CBC *Monitor Prothrombin time *Vitamin E - inflammation *Amino Acids - kidney excretion of uric acid *Joint positioning pillows underneath, dont touch if painful

BURSITIS
-misdiagnosed as tendonitis/arthiritis d/t similar cause/Sx -Overuse, trauma, RA, advanced gout, infection -Shoulder, knee, elbow, hip, foot, achilles tendon ( SX): Pain/tenderness to touch (painful to walk if in feet) Stiffness/achiness with movement Swelling, warmth, redness, nodule over the joint (DX): Arthrscope (shows fluid excess in bursa) XRAY (vs arthritis which doesnt show up on XRay) (TX): Initial Home TX (Rest, Ice, Time, NSAIDS, avoid overuse) NSAIDS, rest, heat/cold Antibiotics (non-resolving infection) Corticosteroid injections (severe inflammation) Aspiration (non-resolving swelling) Bursectomy (severe/unrelieved)

CARPAL TUNNEL SYNDROME

- MC overuse/occupation disorder - median nerve compression in the carpal tunnel canal (D/T) inflammation, trauma, obesity, AI/endocrine disorders (MC) women/ post-menopausal (osteoporosis narrows canal) (SX): Pain/Parasthesia (palm to lateral ventral side of ring finger) *alleviated by shaking or massaging (circulation to area) Intermittent loss of function / Weak grip (DX): Phalen's (wrists bent perpendicular 30-60s; stop if painful) Tinel's (percussion of carpal nerve illicit pain) EMG (checks muscle and nerve conduction velocity) Nerve Conduction Velocity (illicit hand contraction; time) X-rays (underlying fracture?) (TX): NSAIDS Corticosteroid Injections Immobilizers (keeps canal open during ADLs) Ice 24-48hrs (short term) Heat 4hours (divide application) Resection of carpal ligament (widens canal)

OSTEOPHYTES
- bone that grows around joints to better distribute weight *(compensating for bone/ligament degeneration) -common at weight-bearing joints (D/T): Osteoarthritis, over use, obesity (SX): joint motion, dull radiating pain, parastesia, progressive weakness headaches/vertigo (oseophytes in spine) (TX):Treat the symptoms, PT, surgery (shaven off)

SPINAL STENOSIS
- narrowing of the spinal column/foramina - causes pressure on the spinal cord/nerves (MC): neck, lower back athletes, elderly, moms, spinal tumor/injury (D/T): Aging , Degeneration, Osteoporosis Spinal Tumors/Injuries (SX): Numbness / Cramping / Imbalance Weakness (portion of a leg or arm) Pain (back, butt, thighs, calves, neck, shoulders, arms) * worse when standing * relief when lying down/leaning forward Incontinence/ Headaches (SC sx) * often misdiagnosed as a stroke (TX): Steroid injections Narcotics Antidepressants (good for neuropathic pain) *Analgesics (dont work well for neuropathic pain) Foraminotomy/Laminectomy/Fusion (disk removed) *(relieves compression/ LOG ROLL!) PT/OT

Laminectomy : Decompression Surgery

-removal of disc lamina widens SC canal /decompresses ***-USED FOR: stenosis, herniated disc, impingement*** - 6-8wk recovery - Monitor ICP
(N&V, LOC, double vision/headache/tinnitus, gait, BP/HR)

- Dangle (prevent O.hypotension) **DO THINGS FOR THEM, THEY SHOULD NOT BEND AT ALL!!! - Physical Therapy/Occupational Therapy -PATIENT TEACHING - Stop NSAIDs pre-op - Hospitalized 1-3 days - Pain management (will avoid PT/OT if in pain) - Early ambulation/Weight Bearing (Dangle) - Cushion/Raised Seat, Toilet Extender (shouldnt be low) - Wear corset when out of bed - BODY MECHANICS: - Side-lying or Flat (per MD order)
- No trunk flexion, extension, rotation, side bending
- No heavy lifting (<5lbs)

HERNIATED DISK
-cartilage ruptures, disk herniates, nerve/cord compressed (MC): Men; L1-L5; age 30-50 (manly hobbies/core muscles) (D/T): Trauma (Lifting/Falling/Twisting/Contact Injury) Aging, Degenerative Joint Disease Spinal Disorders, Spontaneous (SX): Pain, numbness, weakness (along nerve) = Sciatica (DX): History, X-ray, MRI/CT (more accurate) (TX): Rest, Heat, Ice, Mobility, Weight Loss (prevents and relieves compression SX) Proper Body Mechanics Pain meds Surgery

Log roll in & out of bed Limit sitting to 15 min Do not bend past 70 degrees at hip joint MAINTAIN NEUTRAL SPINE!!!

MEDIAL TIBIAL STRESS SYNDROME Shin Splints

-Inflammation of CT around tibia (SX): Tibial Pain (dull/aching, front of lower leg) * constant, painful to touch, w/activity * caused by: irritated/swollen muscles stress fractures over-pronation of the foot (drivers, runners) (PREVENTION): Alternate exercises, dont limit to just running Prophylactic use of Ice/NSAIDs/wraps Arch Supports (TX): Rest (up to 3months) Ice Anti inflammatory drugs Neoprene sleeve (shin compression device) Arch supports

SCIATICA
-lumber-sacral Sciatic Nerve damage/pressure -(D/T), DJD, fracture, falls, tumor, Spinal Involvement (stenosis, herniation) Pregnancy, obesity (extra weight) Piriformis Syndrome (inactive gluteal muscles) Over-use (runners, bicyclists) (SX): Unilateral, neuropathic pain + loss of function -AFFECTS: posterior thigh & knee, lower leg, sole of foot *worse = standing, sitting, bending, walking, night, sneeze/cough/laugh (rectal contraction) (TX) underlying cause NSAIDS, corticosteroids Ice, heat, sleep (pillow b/w knees), PT, massage, exercise

TORN ANTERIOR CRUCIATE LIGAMENT

-ACL = main stabilizing ligament of the knee *Partial (heals by primary intention; no surgery needed) *Complete (requires surgery) (D/T): sudden force/change in direction, overuse (DX): X-ray (r/o other injuries) MRI (checks surrounding tissue) Arthroscopy (visualizes tear) (SX): audible pop Knee gives out (will reinjure trying to walk it off) pain/swelling (immediate) strength/ROM (TX) decrease pain/swelling (rest, ice, compress, elevate) NWB, crutch walking, Rehabilitation, PT/OT Surgery dissolvable screws stabilize tibia/femur *partial tear prone to reinjury -- no sports/activity for 3 months

PAGETS DISEASE OSTEITIS DEFORMANS

(Metabolic)

-Localized excessive bone resorption and formation - Results in enlarged and misshapen bone (D/T): unknown? . viral/genetic factors (MC): long bone, spine, pelvis, skull, clavicle (DX): X-ray (bones appear translucent; definitive) Bone Scan Labs (alkaline phosphatase) (SX): New bone is enlarged, weak, and vascular *hard to heal = prone to bleeding Localized deep aching pain (usually just 1 bone) * worse with weight bearing * worse at night (metabolism) Erythema/warmth of overlying skin (d/t vascularity) Bowed legs/osteoarthritis Hip pain (pelvis affected) Fractures (long bones affected) Headache (skull affected) Hearing Loss (ossicles affected) Reduced Height (spine affected) Parasthesia (spine affected) (RISK FOR): Heart Failure *CO = aortic stenosis = LV Hypertrophy = output HF Bone Cancer (sarcoma; abnormal growth) *sudden worsening of pain Renal Insufficiency (hypercalcemia, stones) (TX): Biophosphates (Fosamax, Boniva, Actonel) *Inhibits osteoclast activity *take with water/empty stomach * dont eat or lie down for 30mins Calcitonin (Miacalcin) Calcium+Vit D (separate administration by 2 hours) Surgery (risky; esp. spine/skull; repair/replacement) Pain management Safety Brace/ Corset placement (supports spinal column)

PLANTAR FASCITIS
-Inflamed plantar fasica (connects heel/toes, creates arch) (D/T): genetics, obesity/pregnancy, runners/ flat shoes, occupation/overuse (SX): stiffness-severe pain (intermittent or chronic) *leads to more problems >>> limp/uneven wt. distribution (TX): NSAIDS Rest Exercise (roll an object back and forth under the foot) Splint/Compression (swelling/circulation) Ice Orthopedic Supports

CAVUS FOOT Hollow Foot

-Fixed Plantar flexion of the foot (D/T): heredity neurological, orthopedic, neuromuscular (myotonia) (SX): high arches (gap between floor and foot) pain (heel and ball) callus (heel,ball,side) hammer toes unsteady gait external rotation of ankle ***VERY PRONE TO ANKLE INJURIES!!!*** * unequal wt. distribution >>> knee/hip problems * risk for degenerative orthopedic disorders!!! (TX): Orthopedic Supports/Shoe modification Bracing Surgery

Orthopedic Treatments
Non Weight Bearing no weight on affected leg; CRUTCHES Partial Weight Bearing - % prescribed by PT; WALKER Toe Touch Weight Bearing toes used for balance -- touch down Total Weight Bearing

TOTAL HIP REPLACEMENT

(MC):FEMALE Toe Touch WB (1-3 weeks) Internal rotation to 0 only (1-12 weeks post-op) Adduction to 0 only (1-12 weeks post-op) Hip flexion to 90 only (1-12 weeks post-op) HOSPITAL PRIORITIES -DO NOT FLEX HIP > 45 DEGREES -NO PROLONGED SITTING -MONITOR HGB/HCT (anemia) -ANTICOAGULANT THERAPY (clot risk) -MONITOR DRAINAGE (infection risk) -MONITOR FOR INFECTION -RATE PAIN (compare rating/ADL performance) -PHYSICAL THERAPY (convince them not to refuse PT) -ASSISTIVE DEVICES (keep walker close to bed) -RESPIRATORY PRECAUTIONS (cough/DB, spirometer, fluids, lung sounds) -SEXUAL PRECAUTIONS (avoid for 6 weeks; females higher risk; talk to Dr ) -OCCUPATIONAL HAZARDS (no work/light duty for 6 weeks; no bending/lifting) EMERGENCIES -worsening pain -cant walk/bear weight suddenly or first day -PARESTHESIA (impingement/circulation; check CMS) -LEG LENGTH CHANGE (dislocation) -BULGE OVER HIP (dislocation, cyst, hemorrhage) -INFECTION -DRAINAGE (should be minimal at discharge) -PERSISTENT FEVER = infection POSITIONS TO AVOID -crossed ankles/legs -rocking up to stand (instead, use arm rests to push up) -leaning forward *keep hip flexion 90 *keep objects directly in front of them *dont bear total weight

SKELETON DEVELOPMENT
4wks gestation (cartilage, CT) 15wks gestation (bone formation begins; ossification) *end of first trimester 29wks gestation (skeleton fully formed) BIRTH - flexible skeleton; joints elastic to facilitate birth - back is straight, no lumbar sacral curve - curve develops when infant sits/stands *sit/stand a long-term hospitalized infant INFANCY - ends of long bones are mostly cartilage - gradual ossification of long bone ends - Legs (small short and bowed) - Arms (short and flexed) - Fingers (flexed) - Muscles feel hard (25% of body weight) * grow 1-1.5in/month * should double in length by 10-12 months POSTERIOR FONTANELS = 2-3 months (back of head) ANTERIOR FONTANELS = 12-18 months (top of head)

CRANIOSYNOSTOSIS

(MC):Males

- early suture closure - can interfere with normal skull and brain growth. - Brain compensates (grows parallel to the suture -SAGITTAL SUTURE: middle/top *scaphocephaly = long/narrow head; least complications -FRONTAL SUTURE (METOPIC): forehead * plagiocephaly = asymmetric forehead * trigonocephaly -CORONAL SUTURE = high skull/plagiocephaly-asymmetric -LAMBOID SUTURE = near occipital (RISK FOR) ICP, seizures, visual/cognitive impairments (SX): Early fontanelle closure (absent soft spot) Raised hard ridge along the affected suture Unusual head shape Slow/no increase in the head size over time (DX): head circumference X-ray, CT (TX): Craniotomy prior to 1yr old *Monitor ICP, head circumference * Assess bulging forehead, hydrocephalus * Evaluate Ask questions * Prevent infection, skin breakdown, ICP

TOTAL KNEE REPLACEMENT

(MC):MALE

-same as hip replacement -CPM (2x/day for 2 hrs; uninterrupted; pain meds before) Compression stockings Urinary output/ Foley Assistive devices Sexual Considerations TEACHING -NOTIFY YOUR DR: New onset/severe knee pain; deviation; wt. bearing, length change numbness/tingling, knee appears deformed -NO BATH/SHOWER (3-4wks) keep incision dry -NO DRIVING (6wks minimum) -STRAIGHTEN KNEE (foot on stool) for 30mins 6-10x/day

CONGENITAL TORTICOLLIS Wryneck

- Tight sternocleidomastoid muscle - Associated with hip dysplasia (10-20% of cases) - Only 10% need surgery to lengthen the muscle (MC): 6-8wks old (go to checkups!) (D/T) intrauterine packing (multiples, big baby) (SX): - Head tilts to tightened side ( neck motion) - palpable tumor (lump) of tight muscle - non-painful (TX) Stretching exercises (for 6-8wks at every diaper change) *chin to shoulder, ear to shoulder *evaluate moms aggressiveness Heat, Traction, P/T, Botox, Massage Place toys on opposite side Place involved side towards wall Tummy time TID Stabilizing device (while in carseat) * Treat within first 12 weeks post partum!!!

CONGENITAL HIP DYSPLASIA

-femoral head is not stable in the acetabelum -hip joint ligaments may be loose/stretched (MC): LEFT HIP Girls, first born, breech, Native Americans, hereditary *associated with WRY NECK (PREVENTION): screening at birth and well-child visits (SX): Different leg lengths (affected leg is longer) Uneven skin folds Mobility/flexibility on affected side(abduction) Limping, toe walking, waddling "duck-like" gait Heard/felt clicks with manipulations *usually noticed during diaper changing/bathing (DX): Barlows Maneuver (Adduct) * push knees/thighs together; click Ortolanis Maneuver (Abduct) * push apart; will click back into place XRay/Ultrasound (Confirm Dx) (TX) Replace Femur Head into Acetabelum *different approaches; depending on age;
b/c kids start ambulating at 6-18 months

ACHONDROPLASIA
-Bone growth disorder; MC type of dawrfism. -hereditary but usually spontaneous -abnormal gene from both parents live only a few months -No specific treatment. Related abnormalities should be treated when they cause problems. (PREVENTION): genetic counseling (SX): <5ft tall (check percentile) Normal IQ Space between long and ring fingers Bowed legs Skin folds (risk for skin breakdown) Decreased muscle tone Large head *problem with balance Frontal bossing Short arms and legs (biceps/quadriceps) *problem with walking/crawling Spinal stenosis (prone d/t wt on spine) Kyphosis and Lordosis

NONSURGICAL (0-6months; flexible skeleton) -von Rosen Splint: knee flexion and pronation (0-6wks) -Pavlik Harness: legs externally rotated (like a frog) *soft fabric harness; keeps femur in place SURGICAL (>6months; skeleton no longer flexible) -Bryants Traction: used 2-3weeks before surgery *loosens hip muscles pre-op -Closed Reduction: hip is manipulated into place under general anesthesia *Small incision may be made to loosen adductor tendon -Surgery: if closed reduction doesnt work *>18months/abnormalities -Spica Cast: worn 2-3months after CM & surgery ORTHOTICS PHYSICAL THERAPY/EXERCISES (NIs): SENSORY DEPRIVATION : stimulate mentally/physically HAIR LOSS: prevent by repositioning MUSCLE ATROPHY: stand them up SKIN BREAKDOWN: wash/barrier cream under cast keep dry and clean urine

Von Rosen

Pavlik

Bryants

Spica

TALIPES EQUINOVARUS Clubfoot

-plantar flexion and inversion of the heel, foot, ankle -affects bone, soft tissues, ligaments (MC): Idiopathic; Males; 50% bilateral (TX) Passive correction ineffective! STAT surgery after birth! *50% need surgery before 9 months Cast change every 8-12wks Dennis Brown Splint (less severe cases) = shoe splint Tendon transplant/Ligament release Pin fixation (risk: infection, pain, atrophy, DVT, injury) *before 1 year Corrective shoes (wedges on outside of shoe)

RICKETS
-minerals released form bones > soft/weak bones (D/T): Lack of vitamin D, calcium, phosphate (Esp. poor nations; US foods are fortified) (RFs): Lactose intolerance, Vegetarians Breast fed, NO sun exposure Liver Disorders (site of vitamin D activation) (SX): Bone pain, Muscles cramps Dental deformities, Pigeon chest, Bowed legs (TX): Replace: Calcium, Phosphate, Vitamin D Sunlight exposure Braces, Surgery

OSTEOGENISIS IMPERFECTA
-extremely fragile bones -AUTOSOMAL DOMINANT gene defect (only need 1 bad gene) -type 1 collagen replaces bone tissue (DX): DNA testing (skin biopsy, chorionic villi sampling) (SX): Blue sclera Multiple Fractures Early hearing loss (ossicles affected) Bowed arms/legs (healing of fractures) Kyphosis, Scoliosis Hypermobility (flexible bones) (TX): No cure - may lead a careful life, some die w/n 1 year Bisphosphonates (preserve calcium) Braces/splints/Helmets Surgery (repair fractures, rod implants) (NIs): Dont take BP Dont pick up Transfer on pillow with help Pain management!!!! Education
st

LEGG CALVE PERTHE DISEASE Avascular Osteonecrosis

-Idiopathic; degenerative bone loss disorder >>>> leads to collapse/deformity of hip joint (MC): Males (2-12yrs) *<6yrs have the best prognosis (SX): Dull throbbing hip pain Thigh muscle atrophy Unequal leg length, Irregular gait Referred pain (knee hurts d/t hip problem) (TX): Pain Management NWB non weight bearing Physical Therapy (may use something similar to pavlik harness) ,

SLIPPED FEMORAL CAPITAL EPIPHYSIS

- uncommon disorder of the adolescent hip -NOT activity related: Stable (90%) - limping Unstable (trauma) -immobile - femur head slips backward D/T growth plate weakness (MC) Males; during growth spurts shortly after (8-15) Overweight (DX) H&P Observed gait Xray (TX) In-Situ Fixation

MYOTONIA
-GENETIC/AUTONOMIC DISORDER; (MC) legs (SX) Rigidity (slow relaxation) after voluntary contraction
*aggravated by: cold/inactivity (restaurants, grocery stores, movies) *relieved by: REST (keep active/stay warm)

OSGOOD SCHLATTER DISEASE

-Activity-related -Self-limiting (MC) Males; during growth spurts (SX): Pain, Edema (below patella) Painful lump below the knee cap **Disappears after bone growth stops (TX): NSAIDS & Rest/Ice/Compression/Elevation

(RISK FOR): aspiration, falls (TX) No cure. Muscle relaxants (Baclofen; Baclofen Pumps) Vagus Nerve Stimulation (prevents muscle contraction) PT/OT (home exercises)

MALIGNANT BONE TUMORS

OSTEOGENIC SARCOMA (from connective BONE tissue) EWINGS SARCOMA (from bone marrow) RHABDOMYOSARCOMA (highly malignant; from muscles) * GU, extremities, body wall, and retroperitoneum

SPINAL DEFORMITIES
KYPHOSIS (humpback) osteoporosis; bad posture (tall girls) LORDOSIS (swayback) pregnancy, rickets, congenital SCOLIOSIS (S-shaped) Breathing complications Nerve impingement Slipped Disks, Spine Problems

ACCELERATION NECK INJURY Whiplash : flexion-extension

-Soft Tissue Injury (ligaments, tendons, and muscles) (D/T): MVA, sports, falls, repetitive stress, assault, abuse shaken baby
*may not feel pain for 72hours d/t adrenaline rush

(SX): Pain (spasm/shooting from neck to shoulder) Swelling, Tenderness Limited ROM Weakness, Tingling (arms) Blurred vision, Irritability (TX) NSAIDS Collar (until serious spinal injury is ruled out) Ice (STAT) - swelling/pressure Heat (after 72hrs) PT (move)