ORTHOPEDIC NURSING

ANATOMY AND PHYSIOLOGY MUSCLES

→ It initiates movement
BONES → Serves as the body’s contour
→ Acts as “framework of the body” → Thin and thick filaments pulls together to contract and
→ Storage of calcium relax
• 8.6-10.1 of it is found in the blood • Thin - actin
• Majority is of which found in the bones • Thick - myosin
• Hypercalcemia → inc cal in the blood → bone • Requirements for muscle contraction:
becomes brittle 1. ATP- for energy
→ Serves as protection: 2. Acetylcholine - neurotransmitter
• Brain - skull 3. Calcium - ca is in the muscles too
• Heart and Lungs - ribcage ▪ Calcium in the heart → stimulating
• Spinal cord - vertebrae contraction → catalyst for myosin and
→ Axial actin
• With connection with the SC ▪ Blood vessels → CA out from muscle →
• Skull, ribs and vertebrae hypercalcemia → weakness of the
o Center of gravity / weight would bear down muscles (no catalyst, Ca should be found
(there is a normal curvature of the spine when INSIDE the muscle)
viewed to the side and straight when viewed at
the front and back; it is a problem/abnormality
if the curvature is still present when viewed at
the front and back)
▪ Weight is not scattered
o Vertebrae
▪ Cervical - C1-C7
▪ Thoracic - T1-T12
▪ Lumbar - L1-L5
▪ Sacrum - S1-S5 SCOLIOSIS
▪ Coccyx - C1
o C1-L5 - articulating
▪ Vertebras in between have intervals -
intervertebral disc/IVD
▪ Nucleus Pulposus: shock absorber - jelly
like substance; to prevent friction rub in
every intervertebral disc
o S1-C1 - fused (magkakadikit)
▪ Newborn - open skull (open fontanelles)
❖ With tumor → (X) ICP d/t open
fontanelle → CSF will leak instead of → Lateral curvature of the spine
increasing the pressure → → Pain will manifest because there are nerves in the
hydrocephalus spine and lateral curvature will cause compression and
➢ r/t monro-kellie hypothesis pain
❖ Should close after 18 months
➢ Sutures closes fontanelles making Manifestations
them immovable joints → Shoulder asymmetry
❖ Gas formation → increased pressure → Rib asymmetry
→ opened (X monro kellie) → Flank asymmetry
▪ Monro kellie - skull is an enclosed space → → Pelvic bone asymmetry
intracranial pressure
→ Appendicular Diagnostic Procedure
• w/o connection to SC → X-ray is the best diagnostic test
• Shoulder, extremities, pelvic bone → Best screening test- Adam’s test
o Shoulder - rotator cuff
o Extremities - there are 4
▪ Longest extremity - femur
o Pelvic bone
▪ Acetabulum - the socket of the hipbone,
into which the head of the femur fits.
❖ Hip injury → hip dislocation

→ If a patient turns out positive on Adam’s screening test it

does not automatically mean that the patient has
scoliosis
→ The purpose is to determine if there is a need to
perform the diagnostic test
→ Instruct the patient to bend over with their hands
hanging freely
→ Knees should be straight and not flexed
→ Negative Adam’s test: straight curvature
→ Positive Adam’s test: “S” curvature
Management
→ Apply braces
• Braces will not be able to treat the patient this will
only prevent further curvature
• Never wear it with a shirt inside as it may impair
skin integrity and cause skin breakdown d/t
wrinkles of clothes
→ Tight so it has to be worn underneath the clothes
→ Worn 16-23 hours/ day
• 16: You have the liberty to remove braces every 8
hours especially when sleeping
• 23: Remove braces at least an hour especially for
taking a bath
• The longer the braces is worn, the better, choose
23 hours
→ Braces should be kept dry
• If wet - medium for bacteria to grow
→ No lotions o Manifestations of MAS:
→ No powder ▪ Decreased peristaltic movement and
• Lotions and powders can lead to wounds as it hypoactive bowel sounds
smoothens the skin ▪ Increased pressure→ regurgitation of
→ Inspect the skin underneath the braces chyme→ vomiting
• Check for skin breakdown (redness) ▪ Constipation
→ Wear comfortable clothes
• Loose clothes are more comfortable All patients who have undergone spinal cord surgeries
→ Refer the patient to a physical therapist should be flat on the bed, never place pillows!
• Exercises that will maintain the alignment of the
spine Mesenteric Artery
→ Surgery: spinal fusion (Laminectomy and Disc → The major artery that supplies blood to the abdominal
organs- liver, stomach, intestines, colon
Surgery)
• Done when physical therapy no longer works
For patients who have undergone spinal fusion can still
• Pedicle screws will be placed in the vertebrae to undergo x-ray because the pedicles do not absorb
maintain alignment radiation (medical metallic objects)

FEMUR
→ Bone Marrow - found inside the bone
• Red - living marrow → to produce RBCs in
response to Erythropoietin produced by kidneys
• Yellow - dead marrow → high in fats

• A highly invasive procedure

• Should be flat on the bed to prevent complication
o Complication: spinal cord injury
▪ Twisting (flex or hyperextend) of the
vertebrae
• Reposition the client q2h to prevent decubitus
ulcers
o Using the log roll technique
o Gently turn the patient rolling like a log—head,
shoulders, spine, hips, and knees turning
simultaneously.
o Support back, buttocks, and legs with pillows
to maintain a side-lying position.
o Minimum of 2 nurses should move the patient
depending on the weight
o Protect the head while turning to protect it by
virtue of gravity
• WOF mesenteric artery syndrome
o The mesenteric artery causes obstruction
against the duodenum
▪ Mesenteric Artery - meant to provide
tissue perfusion into the abdominal
organs
o A digestive condition that occurs when the
duodenum is compressed between two
arteries (the aorta and the superior
mesenteric artery). This compression causes
partial or complete blockage of the
duodenum.
CONNECTIVE TISSUES: (TLC) • Support extremity above and below injury
o To maintain immobilization of the affected site
and lessen the pain
• Assess for LMP (to know for possibility of
pregnancy)
o X ray is teratogenic (harmful to the baby)

Electromyography (EMG)
→ Myo - muscle
→ Measures electrical conduction in the muscle
→ “Action potential”
→ Use of needles
→ Tendons - connects muscles to bones → Not painful but an uncomfortable procedure
• Milder than pain
→ Ligaments - connects bone to bone
→ Cartilages - connects bone to joints → Nursing responsibilities:
• Instruct client to remain still
JOINTS • Bruises are NORMAL after procedure

Myelography
→ myElo - Epidural space
→ Administration of a dye in the epidural space
→ To assess presence of neural tube defect
• Lack of folic acid → spina bifida
• Sac - cystica type
o Myelolomenigocele: CSF + SC
o Meningocele: CSF
• Occulta - smaller type

→ Functional unit
→ Allow movement
→ Cushioned and lubricated by Synovial Fluid
→ Types of joints
• Amphiarthrosis - slightly moving joints
o E.g., rise and fall of the ribs
• Condyloid - freely moving (angular)
o E.g., finger, knees
→ Nursing responsibilities:
• Diarthrosis - most movable (ball and socket)
→ Asses for allergies (dye - iodine)
o E.g., basis on the angles, shoulder joints, hip
• If the mother is not allergic, the baby is not allergic
joint
as well
• Synarthrosis - immovable (closure of fontanelles)
• If the baby is allergic, administer antihistamines
o E.g., sutures
• Types of dyes: (depending on the physicians
prescription)
DIAGNOSTIC PROCEDURES: For Orthopedic Disorders
o Air - flowing
X Ray ▪ Should be in trendelenburg; head lower
than heart
→ Most common diagnostic test for orthopedic disorders
o Water - falling
→ To rule out presence of fracture
▪ Should be head higher than heart
→ Nursing responsibilities:
o Oil - flat
• Advise patient to remove all metallic objects,
▪ Should be flat on bed; head at the level of
pacemakers
the heart
o Metallic objects absorbs radiation → risk for
→ Increase OFI to promote the exit of the dye from the
cancer
body
• Radiation is minimal and not harmful
• Instruct client to remain still for accurate imagery
TRIO ARTHRO
• Administer analgesics as ordered
o If patient is in pain → to prevent movement
and inaccuracy of the image

ARTHROCENTESIS ARTHROGRAPHY ARTHROSCOPY

→ aspiration → dye → direct visualization

→ 3rd most painful → 2nd most painful d/t injection of dye directly
→ Manage pain: to the joints (synovial membrane)
corticosteroids → If the dye did not circulate in the joint →
inflammation → possible of RA
• GSCS might be needed
→ Manage pain: local anesthesia
→ Most painful d/t the scope is inserted
directly in the joint
→ Manage pain:
• General anesthesia - arthroscopy of
the shoulder
• Spinal anesthesia - arthroscopy of the
knee (joint beneath the waist level)

NURSING RESPONSIBILITIES

Remain still Assess for allergies (in shellfish,seafood,dye) NPO for 6-8 hours
General or spinal anesthesia
 Rest the affected joint to
lessen the pain
Ice compress → to lessen pain
→ PRN and or up until 2 days only
Elastic compression bandage → to promote immobilization of the affected
extremity
Pain lasts for 2 days
Refer to the physician
→ If there is sign of infection (fever)
→ If there is pain >2 days
CRUTCHES
→ Assistive devices
→ Parts:
• Axillary Pad
o Do not bear weight
here because this
might cause brachial
plexus nerve damage
▪ Numbness
▪ Tingling sensation
(Paresthesia)
• Handle
NON-WEIGHT BEARING
Move crutch (6in) →
unaffected → affected leg
(nakalutang/nakataas)
2 POINT GAIT
Remain still, except if instructed to do Range Of Ice compress → to lessen pain
Motion (ROM) → PRN and up until 3-4 days because it is the
→ If ROM is already performed and dye did not most painful
circulate → possibility of obstruction →
infection or inflammation
→ Normal: the dye circulates
Elastic compression bandage (3-4 days) → to
promote immobilization of the affected
extremity
Crutches:
→ For 4-6 weeks
→ 3 point gait
Pain lasts for 3 days
Refer to the physician
→ If there is sign of infection
→ If there is pain >3 days
o Bare weight on handle
• Rubber Tip
o Most important part
o Can be removed
→ Crutch mechanics:
• Move 6 inches forward
• Move 6 inches sideward
• Bare weight on handle
• Feet apart
3 POINT GAIT (w/ affected side) PARTIAL-WEIGHT BEARING
Use with affected side
Affected leg (nakasayad)
With non-weight bearing and partial weight bearing
Move crutch (6in) together with
affected leg (tripod gait) → followed
Device should be placed first
by unaffected leg
2 & 4 POINT GAIT 4 POINT GAIT
(w/o affected side;
contralateral,
weakness)
 Swaying left hand,
AKA Army Walk Device should move first
right foot walking

Left crutch together with the right leg → right crutch

Weakness - should Left crutch → followed by right leg → right crutch
together with the left leg
have assistance → followed by left leg
→ Any of the side will do

More difficult because both crutches and leg moves

together

SWING TO SWING THROUGH

Swinging towards the crutch Swinging through the crutch (covers longer distances)

Used in patients with paraplegia

(Paralysis from the waist down)

Used when the abdominal muscles have strength already

GOING UP STAIRS Management

→ Good leg goes to heaven → R- rest
• Unaffected/GOOD leg first → affected leg • To be able to facilitate the healing process
together with crutches → I- ice compress
• For pain and inflammation
• No warm compress within 24 hours, COLD
COMPRESS ONLY!
o Warmth results in vasodilation→ exacerbate
→ Bad leg goes to hell injury (excessive bleeding)
• Affected/BAD leg together with the crutches → • You may alternate warm and cold compress after
unaffected leg 24 hours
• Cold- 15 minutes
• Warm- 20 minutes
• If time is not followed rebound phenomenon will
occur
→ C- compression bandage
INJURIES • Promote immobilization
→ Overstretching of connective tissues (tendons, → E- elevate
ligaments, and muscles) • To prevent edema from occurring
• Bones, joints, and cartilages cannot be
overstretched FRACTURES
→ Tendons- muscle to bones
• STrain- overstretching of tendons and muscles Causes
• If tendons are overstretched muscles will follow → Trauma
→ Ligaments- bone to bone • Falls
• Sprain- overstretching of the ligaments • Accidents
→ Cartilages- bone to joints • Sports
→ Either sprain or strain can both be painful depending → Bone density disorders
on the extent of overstretching • Osteoporosis
 • Bone cancer
• Paget’s
→ Overuse
Manifestations:
→ Pain (most obvious)
→ Swelling (inflammation of the muscles)
• Skin and fats → fascia (inelastic layer; does not
expand) → deep seated arteries → bone
• Bone fracture injury → damages skin, fats, and
arteries → fascia is inelastic and therefore the
muscle will constrict → compresses the bone and
blood vessel → compartment syndrome
→ Bruising and discoloration (d/t pressure in the arteries)
→ Inability to use injured part (d/t pressure in the arteries)
→ Numbness (distal area d/t poor tissue perfusion)
Types
3. Immobilize
• Immobilize the patient the way you see the patient,
never move!
• Exception: Pull the patient in a SAFE environment
(especially when in a railway/expressway)
4. Call for help but never leave the patient
• To prevent anxiety
• Once you see the client, state your name and
inform that you are the rescuer (never say good
morning/afternoon) to establish good rapport
• Ask the bystanders to call for help
Hospital Management
Surgery
1. Reduction
• Done to reduce the angle of the fracture which will
promote bone healing
Stages of Bone Healing
→ Bone formation- osteoblasts are responsible (b- build)
• A thin bone will form to connect the two fractured
bones
→ Callus formation
• Serves as additional support for the healing bone
→ Remodeling- osteoclasts are responsible (c- cut)
• Removes the excessive callus that has formed to
smoothen the surface of the bone
• Open- with surgery, invasive
o Plates and screws are used
o This will maintain the alignment of the bone

→ Open
• Osteomyelitis (infection to the bone)
→ Closed
→ Complete- through and through
→ Incomplete
→ Comminuted- splintered into smaller fragments;
slowest healing rate
→ Greenstick- common in children; flexible bone; easiest • Closed- without surgery, non-invasuve
to heal d/t rapid growth and development of children; o Manual manipulation only
incomplete fracture for children o Followed by immobilization using a cast
→ Impacted- one bone has been driven to another bone
→ Compressed- two adjacent bones (e.g., tibia & fibula,
radius & ulna); breakage of the other bone puts
pressure on the artery, therefore, decreasing tissue
perfusion in the adjacent bone that could lead to
avascular necrosis
→ Depressed- a fracture of the skull in which the
fragment is depressed below the normal surface
→ Transverse- through and through; straight 2. Fixation
across/horizontal; less likely to result in open fracture • Internal- plates and screws inside the body
d/t blunt edge but possible if the impact is too strong o Done together with open reduction (ORIF-
→ Oblique- through and through; diagonal; more likely to open reduction with internal fixation)
result in open fracture d/t pointed edge (penetrating) o Higher risk for infection because plates and
→ Spiral- occurs when a long bone is broken by a screws are foreign bodies, a larger incision
twisting force (uzumaki hehe) o Easy mobility
→ Pathological- secondary to a disease process • External- plates and screws outside the body
o Lesser risk for infection in comparison to
“fractures can happen in any bone in the body, but it internal fixation
usually affects your extremities” ▪ Pin care q1 or q2-4
o Prolonged hospitalization
Other common sites
→ Head
→ Face
→ Ribs
→ Spine

Management
Scene management
→ If you see a victim, always anticipate a fracture
• Do not move the patient, as it may further
complicate the fracture
→ Initial action: always follow the nursing process
1. Assess the environment
• Priority is the nurse’s/ rescuer’s safety
2. Assess the patient’s ABCD (airway, breathing,
circulation, and disability)
TRACTIONS
TYPES OF TRACTION

Buck’s traction
→ Pulling down
→ Tibia, fibula and femur
→ Overhead trapeze- used for repositioning to prevent
decubitus ulcers
→ Countertraction is the body weight of the patient
→ Place a footboard for the footplate to avoid foot drop
(position of the foot should be flexed) especially when
the patient will be sleeping (placed intermittently, not all
the time)

Russel’s Traction
→ 1 traction weight and 2 applied forces (pataas at
pababa)
→ More effective
→ Multiple lines and multiple pulley
→ The downward pull is used to decrease muscle spasms
→ Place a footboard to avoid foot drop (position should be
flexed)

Pelvic Traction
→ More complicated
→ Pelvic girdle connected to waist → connected to a
pulley with a weight
→ Tension is applied in the lumbar area although the
pelvic is being pulled downwards

Head Halter Traction / Cervical Traction

→ Leather patch on the head and nape → lines meet on 1
midpoint → extending below with weight
→ To apply tension on the cervical area

Principles of Traction • If there's weight → foot extends

1. To decrease muscle spasm (relaxing the muscles) • If weight is removed → foot is maintained at an
2. To promote immobilization extended position
3. Countertraction • To avoid foot drop:
▪ Most important principle o Proper positioning - instruct the client to flex
▪ Provision of counter weight AT TIMES to maintain the foot
stability o Provide footboard - attached at the bed frame
▪ The client's body weight will serve as the to maintain flexed position and no extension of
countertraction the foot
▪ (X) elevation of bed because the countertraction
will go down CASTING
→ Wet cast- takes 2-3 days (48-72 hours) to dry up
→ Dry cast- dries for 20-30 minutes (synthetic/
fiberglass)

4. Never remove, adjust unless there is a doctor’s order
5. Weight should be FREELY hanging
6. Check the line - if there are knots
• There should be NO knots
7. Check pulleys - make sure they are EFFECTIVE
• Umiikot, should have no resistance
8. Avoid occurrence of foot drop
Nursing Management
→ Facilitate drying of cast
• Never dry it in front of the aircon as it may moist
which is a good medium for bacterial growth
• Use a hair dryer, turn it to the coolest setting
• The warmest setting is not used as it may cause
burns→ bivalving will be done to prevent burns
→ Maintain the dryness of the cast to prevent bacterial
growth
→ Place adhesive tapes and place them on the edges of
the cast to prevent irritation of the skin
• Petalling of the cast- decreases irritation from the
rough edges
→ Instruct the patient to elevate the casted extremity to adequate tissue perfusion on the distal parts),
prevent edema (1-2 days, 24-48 hours) after weakness, fever (101F) → osteomyelitis
application of the cast • Aggressive intravascular antibiotic therapy
• There is third spacing d/t injury • Subject the client to hyperbaric oxygenation
• Prevents compartment syndrome o To improve the immune system of the patient
→ Instruct the patient exercises- isometric o The more O2 = more immune system
• Exercises without range of motions– contraction of response (ISR)
muscles in a specific part → Avascular necrosis
→ Instruct the client to avoid inserting objects inside the • D/t a compressed fracture→ decreased tissue
cast→ can cause pressure ulcers and wounds d/t perfusion to adjacent bones→ necrosis→ scrape
friction from the object the dead bone→ bone grafting
• To address itching, an antihistamine may be
prescribed by the doctor (antipruritic effect) HIP DISLOCATION
→ WOF signs of infection
• Fever*
• Altered levels of pain d/t wounds that may serve
as a portal of entry
• Hotspots- subjective data
o Hapdi
o This may also indicate a wound
• Foul smell- indicates the presence of pus

COMPLICATIONS
→ Fat embolism
• The most fatal complication of fractures
• Comes from the bone marrow from the long bones
→ The acetabulum is a hollow socket
(femur, tibia, fibula)
→ Types: anterior and posterior hip dislocation
• Fat will travel the arteries which may cause
pulmonary embolisms or even CVA
• Hemoptysis may present because of the
increased pressure in the capillaries d/t the
embolism that may cause movement of blood to
the alveoli
• Dyspnea
• A petechial rash over the chest and neck
• Heparin may be given to prevent further clotting
• O2 (2-3 L/min) will be given d/t dyspnea (safest;
not to kill hypoxic drive)
→ Compartment syndrome
• Compression of the blood vessels d/t edema of
the muscles (fascia cannot extend)→ cutting off of
perfusion from the affected area to the areas
below it
• Assess for the 6 Ps
o Pulselessness
o Paresthesia- earliest sign
o Poikilothermia
o Paralysis
o Pain
o Pallor
• Bivalving will be done to open the cast
o Fascia will be cut open to decompress the
content (promote tissue perfusion) → → The head of the femur will be the basis of the type of
fasciotomy dislocation
• Loosen tight clothing
Causes
→ Large force trauma
→ Sports accident
→ High impact falls

Posterior Hip Dislocation

→ More common
→ Adducted
→ Flexed
→ Internally rotated

Anterior Hip Dislocation

→ Rare
• The acetabulum lies naturally
at the back, it takes a larger
force or trauma to disposition
→ Osteomyelitis the head to the front
• Begins with open fractures → introduction of → Abducted
microorganisms → bone infection → pain in the → Extended
area → tachycardia (compensation to provide → Externally rotated
 Manifestations are the same with hip fracture
• Female
• Aging
→ Diet low in calcium (milk, cheese)
Common Manifestations → Malabsorption
→ Pain because of the trauma and nerve compression → Immobility (weight-bearing improves bone mass)
• In the lumbar area down to the left and right • If there is no weight bearing → bones will not
posterior thighs is where the sciatic nerve runs→ thickened → calcium will go out of the bone →
head of the femur will compress the sciatic hypercalcemia
nerve→ sciatica → Prolonged corticosteroid therapy (increased resorption
→ One leg appears to be (c), decreased formation (b))
shorter than the other → Propylthiouracil (thyroid reducing medication)-
• The affected leg will reduces thyroid function; calcitonin moves calcium
be shorter into the bones
→ Waddling gait → Alcohol and smoking (decrease calcium absorption)

Management Manifestations (PAIN KILLER)

→ Promote abduction position (wide base stance, feet → Pain with heavy lifting
apart) for both anterior and posterior hip dislocation → Pain with weight-bearing (standing for a long time)
• The head of the femur will be driven further into → Pain with palpation
the acetabulum • Areas: wrist, vertebrae, pelvic bone
→ Avoid adduction position (feet and legs together) → Kyphosis d/t weak spinal bones (pathognomonic sign)
• The head of the femur will further go out of the → Increased calcium in the blood
acetabulum → Low calcium in the bones (brittle/fragile)
• Avoid cross-legging → Low height d/t kyphosis
→ Avoid extreme hip flexion → Easily fractured (pathological fracture)
• Extreme flexing will cause further dislocation → Renal calculi (the kidneys attempt to excrete excessive
• Use high-seated chairs calcium; they clump together and form calcium
• Elevated toilet seats oxalate)
→ Low-heeled shoes to prevent further injuries
→ Take small steps Medications
• The larger the steps the more the head of the → Estrogen therapy- to decrease resorption and increase
femur moves→ further dislocation the formation
→ Calcium gluconate- if the cause is malabsorption;
Medications increase calcium absorption
→ Analgesics → Injectable Vitamin D- facilitates absorption of calium
→ NSAIDs → Calcitonin (Miacalcin)- moves calcium inside the
• Also blocks the cyclooxygenase that is required bones
for the synthesis of the prostaglandins that are
responsible for the inflammatory response Nursing Management
→ Safety precaution: modify the environment (prone to
Procedures accidents d/t fragile bones)
→ Noninvasive- manual manipulation • Carpeted floors
(closed reduction) • Rubber mattings
→ Invasive- total hip replacement (moore • Safety handrails (accident-prone areas and
prosthesis) bathroom)
• Unobstruct the walkways of the client (remove
OSTEOPOROSIS clutters)
→ Use proper body mechanics
• Bend with the knees
• Carry objects close to the body
• stand straight with the feet apart and one leg
slightly forward to maintain optimum balance
→ Increase calcium and vitamin D in the diet
• Good source of Vitamin D: fish
• Absence of vitamin D- 16% calcium absorption
only
• Best time: 8-10 am, 3-5 pm
→ Porous bones → Weight-bearing exercises- improves bone mass; stop
→ Fragile, brittle bones exercises with the onset of pain
→ Decreased calcium in the bones → Increase OFI- address renal calculi (3-4 L/day)
→ Increased calcium in the blood • Dilute calcium and flush calculi in the kidneys
→ Painful Diagnostic Tests
→ Xray
SPONGY DENSE
(Cancellous) (Compact) → CT scan
→ Bone Density Scan
Trabecular Cortical • Obtain consent
• Remove all metallic objects (has radiation)
Weaker Stronger • Remain still (for the procedure to be properly
executed)
Inner Outer • Duration- 10-30 minutes
With open spaces Without open spaces

Causes
→ Decreased estrogen- increased resorption (c),
decreased formation (b)
JOINT DISORDER
Rheumatoid Arthritis
Inflammatory joint disorder
But inflammation is greater
in rheumatoid
The autoimmune disorder of
the joint→ inflammation→
increases pressure in the
joints
Systemic (antibodies run
through the blood)
Symmetrical
Inflammation (inflammation
will be surrounding the joint)
Signs and Symptoms:
NSAIDS
→ Negative/limited ROM
→ Stiffness in the morning
(more than 30 minutes)
→ Anemia - inhibition of
RBC production in the
bone marrow
→ Inflammation
→ Destruction of synovial
membrane (SM)
• Permanent
dislocation
• Weakness
• Deformity (swan
neck)
→ Significant Increase in
RF and ESR →
autoimmune → attacks
the RBCs suspended in
the blood → increased
sedimentation can be
seen at the bottom of
the test tube
• nonR - 0-39
• weaklyR - 40-79
• R - 80/more
• Would be relieved
Osteoarthritis by rest
Degenerative joint disorder 20-40 years old* Athletes, obese (weight will
(overuse) be compressing the joints),
Morning stiffness that is >30 Joint pain upon activity, and
minutes in duration is relieved by rest
Wear-and-tear
Management: Management:
→ Promote rest! → Promote rest: especially
• To prevent increase on acute attacks
pressure in the joint • Joint pain relieved
Unilateral → Diet: high iron, high FA by rest
→ ROME: passive or active → Maintain weight within
• Depending on what normal limits
Asymmetrical the patient is → Exercise: Non weight
capable of bearing-Swimming
Little or no inflammation → Alternating warm → Avoid flexion
(inflammation will be in (longer) and cold contractures
between the bones) (short) • Position should be
• Observe for extended
rebound → Avoid exposure to
phenomenon extreme temperatures
→ Avoid flexion → Administer direct
contractures injections of
• When in prolonged corticosteroids (Intra-
position, maintain articular injections)
extended position
(functional position)
→ Administer NSAIDs
→ Administer DMARDS
(Disease modifying Anti
Rheumatic Drugs)
No perfusion in between the • Methotrexate
joints, therefore, direct • Hydroxychloroquine
injection of corticosteroids • Imuran
will be given to address pain
(intraosseous)
For osteoporosis, weight-bearing exercises should be
Signs and Symptoms:
done to slow the mineral loss and degeneration of the bones
DIRECT INJ
→ Difficulty getting up
from sitting position
• Overweight, obesity
are greatest factors
→ Inflammation (-/limited)
→ Radiating pain
• If there is nerve
involvement →
compression of
spine
→ Eliciting flexion
contractures
→ Compression of spine
→ Temperature change
causes aggravation of
symptoms
• Avoid exposure to
extreme
temperature
→ Inability to do ADLs
• Highly debilitating
therefore modify
activities
→ Nodes
• Heberden’s (distal)
and Bouchard’s
(proximal) nodes
• Mas una ang B sa
alphabet→
bouchard/s will be
the inflammation of
the proximal
interphalangeal
node
→ Joint pain