⮚ DIAGNOSTICS:

We MUSCULOSKELETAL DISORDERS 1) X-RAY (Checks deformities & fractures)

2) DEXA (Dual Energy X-Ray Absorption)
BONE ✔ Checks the decreased bone mass
⮚ 99% calcium are inside the bone (To make the ✔ CONFIRMATORY TEST for
bone strong) Osteoporosis
⮚ 1% calcium are in the blood ⮚ MANAGEMENT:
1) AVOID Smoking
CALCIUM RESPORPTION (Bone-Blood) 2) DECREASED alcohol consumption
⮚ The calcium goes out from the bone to the 3) Increase Ca Intake
blood. a) Milk products
⮚ PROBLEM: the bone will be weak b) Green-leafy vegetables
4) Calcium supplementation
CALCIUM REABSORPTION (Blood-Bone) ✔ S/E: Constipation
⮚ The calcium goes back from the blood to the ✔ EXAMPLES:
bone a) Caltrate
5) Regular Exercise (Weight-bearing
OSTEOPOROSIS exercises)
⮚ Increased Calcium Resorption making the ✔ Stresses the bone to promote
bones weak. calcium absorption
⮚ CAUSES: ✔ E.g. walking, cycling,
1) AGE (>40 y.o.) 6) MEDICATION:
2) SEX (Common in FEMALES) a) BISPHOSPHONATE
✔ Postmenopausal women (d/t − MOA: Prevents Ca Resorption
decreased estrogen levels) − E.g. Alendronate (Fosamax)
3) LIFESTYLE (Sedentary) − S/E: Esophageal ulcer
4) DIET (Low calcium intake) (regurgitation of acids)
5) DECREASED VITAMIN D INTAKE (for − POSITION: High Fowler’s
Calcium Absorption) − Given EARLY MORNING
6) SMOKING (Increased Ca Resporption) b) ESTROGEN REPLACEMENT
7) ALCOHOLISM (Increased Ca Resporption) THERAPY (for FEMALES)
⮚ S/SX: − LAST option (can cause
1) INITIALLY: ASYMPTOMATIC breast cancer)
2) Deformity: KYPHOSIS (Dowager’s Hump) − S/E: Breast Cancer
✔ If a kyphotic patient is having a 7) BEDSIDE: Donut Pillow
cardiac arrest:
a) Position: SUPINE GOUTY ARTHRITIS
b) Place a donut pillow at the ⮚ Metabolic disorder that causes inflammation
back of the patient of the joints d/t increased uric acid in the
c) Then Start CPR blood.
✔ If at the beach, a kyphotic person is ⮚ CAUSES:
having a cardiac arrest: 1) AGE (>30 y.o.)
a) Position: SUPINE 2) SEX (Common in MALES)
b) Place an inflatable donut at 3) DIET (Increased PURINE diet)
the back. ✔ E.g. organ meats, beans, anchovies
c) Start CPR (dilis), alcohol intake
d) If no inflatable donut, dig a ⮚ PATHOPHYSIOLOGY:
small hole that fits the hump 1) Increased Purine diet
of the patient. 2) It increases Uric Acid
e) Start CPR. 3) Uric Acid travels in the blood
3) DECREASED HEIGHT 4) It can cause HYPERURICEMIA
✔ Measuring for Height: TAPE MEASURE 5) It travels to the synovial joints
4) LOWER BACK PAIN 6) It causes inflammation of joints
5) VERTEBRAL COLLAPSE (Risk for (arthritis)
fractures)
 ⮚ S/SX: 3)
Unilateral localized
1) Joint inflammation (arthritis) 4)
Asymmetrical
2) Joint Pains (arthralgia) 5)
Joint pain
3) Tophi (pathognomic sign of Gouty 6)
Joint stiffness (less than 30 minutes)
arthritis) 7)
Crepitus heard on the affected joints
✔ Large, visible bump made of urate 8)
DEFORMITIES:
crystals that form in joints, bone a) HEBERDEN’S NODE (Distal)
and cartilages (in the ear). − Bony bumps on the finger joints
4) Podagra (Big Toe enlargement) closest to the fingernails
✔ FIRST joint to be affected! b) BOUCHARD NODE (Proximal)
✔ Enlargement of the big toe − Bony bumps on the middle
containing urate crystals joints of the fingers
5) Pruritus (itching) ⮚ DIAGNOSTICS
✔ The urate crystals precipitate, 1) X-RAY (Visualization of narrowed joint
causing itching. spaces)
6) Risk for Renal calculi (made of urate ⮚ MANAGEMENT
crystals) 1) Relieve Pain:
⮚ DIAGNOSTICS: a) Rest & Exercise
1) X-RAY (visualization of uric deposits b) Warm & Cold Compress
–WHITE color) − Put Warm Compress in joint
2) SERUM URIC ACID (Increased uric acid) stiffness
3) ARTHROCENTESIS (aspiration of synovial − Put Cold Compress in joint
fluid of joints) inflammation
✔ CONFIRMATORY TEST for Gouty 2) Maintain joint mobility
Arthritis a) ROM
⮚ MANAGEMENT: b) Non-weight bearing exercises
1) LOW PURINE diet (Swimming)
2) Increase oral fluid intake 3) MEDICATIONS
3) MEDICATIONS: CAP a) NSAIDs (pain relief)
a) COLCHICIN b) Corticosteroids
− For pain
b) ALLOPURINOL RHEUMATOID ARTHRITIS (RA)
− Prevents formation of uric acids ⮚ CAUSE:
c) PROBENECID 1) AUTOIMMUNE (produces antibodies that
− Excretion of uric acids destroys the joints)
⮚ RISK FACTORS:
OSTEOARTHRITIS 1) Common in FEMALES
⮚ Inflammation of the bones and joints ⮚ PATHOPHYSIOLOGY
⮚ RISK FACTORS: 1) Antibodies are produced
1) Degenerative (slowly progresses) 2) Antibodies attacks the joints
2) Idiopathic (unknown cause) 3) Resulting inflammation of joints
3) Repetitive use of joints ⮚ S/SX:
4) Trauma 1) Inflammatory
5) Common in FEMALES 2) Small joints
⮚ PATHOPHYSIOLOGY 3) Bilateral systemic
1) Repetitive use of joints 4) Symmetrical
2) Frequent friction of two separate joints, 5) Joint pain
resulting wearing out of joints 6) Joint stiffness (more than 30 minutes)
3) It can now affect the bones d/t the worn 7) Fever
out joints, 8) DEFORMITIES:
4) Friction of bones then occurs, resulting a) Swan-neck
pain − Flexion of the base of the
⮚ S/SX: finger.
1) Non-inflammatory
2) Weight-bearing joints
 b) Ulnar deviation
− A hand condition where
the fingers bend
abnormally towards the
little finger
⮚ DIAGNOSTICS:
1) ERYTHROCYTE SEDIMENTATION RATE
(detects systemic inflammation)
2) ANTINUCLEAR ANTIBODIES
✔ Detects (+) RA
3) RHEUMATOID FACTOR TITER
✔ Detects (+) RA
⮚ MANAGEMENT
1) Relieve Pain:
a) Rest & Exercise
b) Warm & Cold Compress
− Put Warm Compress in joint
stiffness
− Put Cold Compress in joint
inflammation
2) Maintain joint mobility
a) ROM
b) Non-weight bearing exercises
(Swimming)
3) MEDICATIONS
a) NSAIDs (pain relief)
b) Corticosteroids
c) DMARDS (Disease Modifying
Anti-Rheumatoid Drugs)
− Decreases the antibodies of RA
− SLOW acting (the therapeutic
effect will show 3-6 months)
− Examples:
1. GOLD SALTS
2. HYDROXYCHLOROQUINE
(anti-malarial)
3. IMURAN (most EFFECTIVE)