Dinah Hernandez MSN, PHN, RN

Common Medical Treatments for MSApplication of hot and coldHot, cold compress or paraffinPhysical Therapy Tx (PROM, AROM)External Immobilization

Braces, corsets, splints, casts, tractionSurgical Treatment

Joint- replacement surgery/ arthroplasty Amputation

Data CollectionSkeletal deformity

posture, coordination, body build assymetry, deformity

Muscle mass, swelling, deformity, tendernessAssess musculoskeletal function

muscle strength, balance, gaitAssessment of immobilization device

pressure, infection, hemorrhage Complications: neurovascular compromise

Complications of pressureWound infectionInfection to the boneHemorrhage

Diminished color Tachycardia Hypotension Rapid respiration Anxiety/panic/confusion Diaphoresis Oliguria

Planning and implementationPreventing disorders of immobility

Skin breakdown Contractures Constipation Thromboembolism

Providing comfortable positioningProviding skin careAdequate nutritionExercise

Evaluation

Musculoskeletal Disorders◦ Amputation – the absence or removal of all part or limb/

body organ w/c can be congenital or as a result from an injury/ surgery

◦ Reasons for surgical treatment: Malignancy Trauma Gangrene

Amputation of any extremety is performed at the most distal part to preserve joint and maximize limb length; prosthesis fitting is easier.

Amputation is classified1.According to the affected limb2.According to the level of amputation

Levels of Amputation◦ Below elbow amputation◦ Above elbow amputation◦ Below knee amputation◦ Above knee amputation

◦ Phantom limb pain is an after effect of amputation. It refers to the sensation of pressure, itching that occurs to the areas of amputation, and the feeling as if the absent body part is still present. The sensation is common and results from damage to the nerves in the stump

Prosthesis – artificial device that replaces part or all necessary extremity.Clients are fitted w/ prosthesis asap after

surgeryNursing consideration:

Wound dressing twice daily Preventing complication Client teaching Provide emotional support Assisting in exercises

Replantation – is the re-attachment of a completely severed body part back to the body.

Chronic back painContributing factors

Combination of prolonged muscular and ligament strain, pressure on the lumbosacral vertebrae, aging process

Causes: Abnormal spinal column curvatures Poor posture Congenital disease Malignancy Compression fracture Osteoarthritis Rickets Rheumatoid arthritis aging

Intervertebral Disk (IVD) results when a small pad or disk or cartilage ( nuclues pulposus) between two vertebrae presses against the spinal nerve that radiate out from the spinal cord.Also known as herniated nucleus pulposus

(HNP)Also know as sciatica

Diagnostic Tests:MRICT Scan combine with myelography/Diskography

Medical Treatment of IVDPhysical therapyAntispasmodic/analgesicUltrasound/intermittent traction. TENS therapySurgical Treatment

Surgical TreatmentLumbosacral decompressionLaminectomyDiskectomyMicrodiskectomySpinal fusionInterbody fusion

Nursing considerationProvide postoperative care Assist with pain managementWound careWatch for s/s of bleeding, drainageEvaluate pt for neurologic functionFollow physician’s orders

Lumbar DecompressionObserve for clients sensation/mobilityObserve for complications of spinal nerve damage/cord Immediately report complaints of tingling, numbness or

difficulty moving legsCheck for edema due to traumaEncourage pt to move to prevent respiratory

complication

Postlumbar decompression concernsNerve damageEdemaChanges in level of consciousnessMuscle spasmThrombophlebitisAdditional injuryInfection

Cervical decompressionDifficulty/changes in sensation in armsDifficulty in moving armsDifficulty in breathing

Nursing consideration◦ Log roll◦ Pain medicine (PCA)◦ Use of thoracic-lumbar-sacral orthosis (TLSO)◦ Use of fracture bed; advice pt not to reach/stretch for

articles◦ Application of antiembolism stocking & pneumatic

compression devices◦ Use of cervical collar ( cervical diskectomy)◦ Teach pt to keep his neck in neutral pos’n & aligned pos’n◦ Teach pt for cervical collar care◦ Assist pt with sitting by supporting pt’s neck & shoulder

Temporomandibular Joint (TMJ) – painful, aching disorder involving facial bones/ muscles around the joint between mandible & temporal bones.

Causes: ◦ Stress◦ Malocclusion of the upper and lower jaw◦ Poorly fitting dentures◦ Rheumatoid arthritis◦ Neoplasm

s/s: clicking sound during chewing Tinnitus DeafnessTreatment:Identify the causative etiologyPhysical therapyAnti-inflammatoryBraces/surgery

Muscular Dystropathies -chronic degenerative dse of the skeletal muscle often inherited; progressive weakening and wasting of muscles.

Cause: unknownTreatment:

Focus on supportExercise programsSplints to prevent deformitiesBraces to permit ambulation Inform pt need to prevent respiratory infection,Maintain ideal weightStrive for general good health

Osteoporosis- bone mass decrease, common to postmenopausal womenRisk Factors

Advanced age Family history Early menopause Low intake of dietary calcium Excessive alcohol/caffeine intake Sedentary life Smoking

Treatment Calcium supplements Hormones (estrogen, progesterone) Fosamax

Repetitive strain injuries-“overuse disorders”, occurs in workplace because of the necessity of performing certain motions repeatedly in some occupations.

Carpal Tunnel Syndrome – compression neuropathy of the median nerve in the wrist.◦ S/S:

Weak grip Paresthesia Pain of the thumb & 1st 3 fingers (Tinel’s sign)

◦ Causes: Repetitive movements Arthritis Trauma Gout Tumor

Treatment: Wrist splinting NSAIDS Rest Corticosteroid injection Surgery

Lateral Epicondylitis – repeated forceful wrist and finger movements that stress the origins of muscles.

S/S:Pain along the outer aspect of elbow radiating to forearmPain increases on stretching & on resisted wrist and hand

flexion

TreatmentSplintingAnalgesicsRestCorticosteroid injections

Rotator cuff injury Injury to the rotator cuff in the shoulders due to the

repetitive injury or sudden traumaS/S

PainWeaknessLoss of shoulder movement

Treatment:Physical Therapy to increase ROM arm muscle

strengthSurgical intervention

Inflammatory DisordersBursitis – inflm of bursa due to mechanical

irritation, bacterial infection, trauma, goutTreatment : heating and resting affected part Inflammatory agentCorticosteroid injection/aspiration of fluidSurgical drainage – infectious bursitisExcision of bursa

Tenosynovitis – inflammation of tendon sheath that may result from irritation or infection, typically affects the wrist/ankle◦ S/S : pain and tenderness◦ Causes: non-infectious: strains blows prolonged use of tendons

◦ Treatment: Resting Application of ice 1-2 days NSAIDS Surgery Antibiotic Elimination of activities

Arthritis – joint inflammationTypes of arthritis

Rheumatoid arthritisOsteoarthritis, DJD, hypertrophic arthritisAnkylosing spondylitis, rheumatoid spondylitis,

rheumatoid arthritis of the spineGouty arthritisSystemic lupus erythematosus (SLE)Scleroderma, progressive systemic sclerosisMonoarticular arthritis – one jointPolyarticular asrthritis- multiplt joints

Factors causing arthritis:◦ Infection by virus/microorganism◦ Direct injury to a joint ( traumatic arthritis)◦ DJD ( degeneration/deterioration of joint)◦ Metabolic disorder (gout)

◦ Cause: unknown◦ Monocyclic arthritis: 35% cases◦ Polycyclic arthritis: 50% cases◦ Progressive arthritis: 15% cases

Clinical features of arthritis◦ Persistent pain/stiffness◦ Pain & tenderness of joints◦ Swelling in the joints◦ Recurrence of symptoms◦ Obvious redness and warmth in joint◦ Unexplained wt loss, fever, muscle weakness with

joint pain◦ Bouchard’s nodes ( enlargement of proximal

interphalangeal joints)◦ Heberden’s nodes (grows in the terminal phalengeal

joints) with DJD

Rheumatoid arthritis –most painful & crippling., 3x common in womenCause: possibly virus that causes immune

system to become overactive genetic predispositionS/S: fatigue weakness wt loss general body aches painful/tender joints stiff, swollen joints

Tendons/ligaments shorten- joint deformities such as hyperextension, contractures, sublaxation (dislocation)

Medical Treatment of Rheumatoid arthritisGoal: maintain functionReduce inflammation before joints are

permanently damageMultidisciplinary ( nursing, PT, OT)Drug therapyPatient education

OsteoarthritisBelieved to have a genetic cause or

predisposition, caused by wear & tear on a joint.

Treatment:SynovectomyArthroscopic surgeryTotal arthroplasty

Ankylosis spondylitis Rheumatoid arthritis of the spine primarily affects the

facet joints & stabilizing ligaments of the spinal columnS/S:Hip & lower back pain or stiffnessWt lossFatigueFeverConjunctivitisHip contracture & flexion of neck & backBreathing impairedOsteoporotic spine increases spinal fxSpinal stiffeningHumpbackChest curvatureNeck stiffness

Treatment of ankylosis spondylitisPhenylbutazoneTeach pt to refrain from lying on one side to

prevent excess sideways spinal curvatureLight exerciseBrace