Tests that help determine whether a disorder is inflammatory or non-inflammatory

CBC looking for WBC

ESR increase ESR levels as condition worsens
RA
Rheumatoid Arthritis: Chronic, systemic progressive Inflammatory disease. Can occur at
any age but most often women of childbearing age (20-50). Thought to be an
autoimmune disorder.
S/S: Malaise, Muscle weakness, loss of appetite, aching or stiffness after resting, morning
stiffness lasting > 1H, activity decreases pain and stiffness. Redness, inflammation,
warmth, stiffness.
Hands:

Ulnar shift
Boutonniers deformity
Swan-neck deformity

Medical Management: Salicylates (asprin), NSAIDS (reduce inflammation and pain),

DMARDS(liver toxicity)
Side Effect of Corticosteroids: GI Bleed
RA Tx Goals: Control disease, provide pain relief, reduce symptoms, prolonged joint
function, slow progression.
Blood salvage unit may be used to collect blood, it is filtered and returned back to PT.
Position Pt on nonoperative side.
Synovectomy: remove synovial membrane

Most serious
Autoimmune
Increase in women
Childbearing age
Symmetrical joints
OA

Osteoarthritis: Noninflammatory, shock-absorbing protection lost (weight bearing joints)

No systemic symptoms
2 froms of OA: Primary cause is unknown. Secondary trauma, infection, RA
Effecs only 1 or 2 joints, more common in women. Crepitus.
1

Tx: lose weight, keep active, heat, rest, Canes

Heberdens nodes distal joints
Bouchards nodes proximal joints

Most common
Degenerative
Equal sexes
> 40 age
nonsymmetrical
Ankylosing Spondylitis: ligaments become ossified.

Chronic CT disorder of spine and surrounding area

Lower back and hips
Vertebrae fuse and stiffen
Lumbar curve will flatten after fuse
Unknown cause
NI: firm mattress without pillow, lie on abdomen, turn q2h
Gout
Metabolic disorder accumulation of uric acid in the blood
Caused by purine, sweetbreads
Usually in feet and elbow
Tophi: uric acid deposits that accumulate in the body (rim of the ear and uric acid kidney
stones)
Medical Management: Colchicine usually po (acute) Allopurinal zyloprim (chronic)
NI: when taking colchicines increase fluid intake 2000mL, Avoid alcohol.
Osteoporosis
Metabolic bone disorder w reduction in bone mass. Pathological fractures.
Dowagers hump
Small framed white euro-asian nonobese menpause smoker
Medical Management: Calcium-Men 1000mg, Women 1500mg, VitD needed for proper
absorption of calcium. Weight bearing exercise: walking 30M 3x per wk

NI: calcium and VitD begin at an early age. D is necessary for Ca absorption.
Osteomyelitis
Bacterial infection of the bone
Painful, edema, limited mobility, high fever, increased WBC
NI: gentle movements, bedrest, diet high in cal, pro, vita.
Fibromyalgia Syndrome
Unknown cause
Soft tissue tenderness
Achiness
Poor sleep paternt
IBS
H/A
Numbness of upper extremities
Forgetfulness
Needs to move
Medical Management: Elavil, Flexeril, No caffeine, no alcohol, decrease stress, take your
ass to bed.
Surgical intervention for TKR or THR
Synovectomy: remove lining of joint
Osteotomy: cutting of bone
Arthrodesis: fusion of joint
Arthroplasty: joint replacement
Total Knee 3 compartment: Femoral, Tibial, Patellar
Use a CPM=Continuous Passive Motion exercise
Fractures of the Hip
Intracap Avascular necrosis: thigh edematous
Extracap occurs outside the hip joint: external rotated.
Use abduction pillow for 7-10 days
3

NI: maintain proper alignment, maintain leg abduction, HOB 45 max, DO NOT cross
legs.
Types:

Spiral: Child abuse

Green stick
Impacted
Comminuted: crushed
Fractures of Vertebrae

Log Roll
Use Stryker or Foster bed
HOB no > 30
S/S: pain, partial or complete loss of sensation or mobility below the level of injury,
urinary retention complications.
Pelvic Fracture
Affected foot will be externally rotated
Watch urine for blood
Assess abdomen bowel sounds/distention
Assess for fat embolism:

Tachypnea
Dyspnea
Hypoxemia
Auditory crackles and wheezes
S/S of shock BP - HR

NI: Monitor for signs of shock, measure abdominal girth

Complications:

Compartment syndrome increase of pressure in muscle

Shock
Fat embolism
Gas gangrene
Thromboembolism
Delayed fracture healing

Volkmanns contracture: Permanent contraction in hand or wrist

Shock
Can occue due to fractured bone, severed blood vessels, pain and fever
Tx: IV Fluid, Warmth, Elevate lower extremities, Replace fluid volume
Fat Embolism
Most serious complication of long bone and pelvic fractures fat breaks off and goes into
lung.
NI: monitor ABG, O2, Petechiae red dots that don't blanch
Gas Gangrene
Severe infection of the skeletal muscle
Moist leaving a tourniquet on too long.
Gas dirty lacerated wounds, infected by anaerobic bacteria. C Dif
RBC breakdown: thromb or Clot
Cuts off circulation to main organ
Tx: Debridement and amputation
Thromboembolism
Earlist sign is altered mental status
Blood vessel accluded by an embolis
Doppler is used to find blood clot
Homan Sign: pain in the calf on forceful and abrupt dorsiflexion of foot at the ankle
while the knee is extended. DVT
Contusions: bruise
Carpal Tunnel
Compression on the median nerve
S/S: tingling, numbness, Hypoesthesia decrease sensation
Nonsurgical immobilizer, elevate, ROM
Surgical elevate x 24H, ROM, circulation checks q1-2H x 24H. Can come back
Herniation of intervertebral Disk
Pain

H/A
Voiding difficulty
Bowel
Bladder
Respiratory
Look for CSF

Osteogenic sarcoma long bones, malignant

Osteochrondroma benign

Femur
Humorus
Tibia
Pain with weight bearing
Pathological fracture

Tx: Radiation and Amputation