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Interventions for Clients with
Musculoskeletal Problems
Metabolic disease, in which bone
demineralization results in decreased density and
subsequent fractures
Osteopenia (low bone mass), which occurs when
there is a disruption in the bone remodeling
Classification of Osteoporosis
Primary osteoporosis occurs most commonly in
postmenopausal women and men in their 60s and 70s.
Secondary osteoporosis results from an associated medical
condition such as hyperparathyroidism, long-term drug
therapy, long-term immobility.
Regional osteoporosis occurs when a limb is immobilized.
Health Promotion/Illness
Ensure adequate calcium intake.
Avoid sedentary life style.
Continue program of weight-bearing exercises.
Drug Therapy
Hormone replacement therapy
 Parathyroid hormone
 Calcium and vitamin D
 Bisphosphonates
 Selective estrogen receptor
 Calcitonin
 Other agents used with varying
Diet Therapy
Vitamin K
Trace minerals
Calcium and vitamin D
Avoid alcohol and caffeine
 Pain management
 Orthotic devices
Softening of the bone tissue characterized by inadequate
mineralization of osteoid
Vitamin D deficiency, lack of sunlight exposure
Similar, but not the same as osteoporosis
Major treatment: vitamin D from exposure to sun and
certain foods
Paget’s Disease of the Bone
Metabolic disorder of bone remodeling, or
turnover; increased resorption of loss
results in bone deposits that are weak,
enlarged, and disorganized
Paget’s Disease of the Bone
Nonsurgical management: calcitonin, selected
bisphosphonates, mithramycin
Surgical management: tibial osteotomy or partial or total
joint replacement
A condition caused by the invasion by
one or more pathogenic
microorganisms that stimulates the
inflammatory response in bone tissue
 Exogenous, endogenous,
hematogenous, contiguous
Nonsurgical Management
Drug therapy
 Infection control
 Hyperbaric oxygen therapy
Surgical Management
 Bone grafts
 Bone segment transfers
 Muscle flaps
 Amputation
Bone Tumors
Benign bone tumors (noncancerous):
– Chrondrogenic tumors: osteochondroma, chondroma
– Osteogenic tumors: osteoid osteoma, osteoblastoma,
giant cell tumor
– Fibrogenic tumors
Nondrug pain relief measures
 Drug therapy: analgesics, NSAIDs
 Surgical therapy: curettage (simple
excision of the tumor tissue), joint
replacement, or arthrodesis
Malignant Bone Tumors
Primary tumors, those tumors that
originate in the bone
– Osteosarcoma
– Ewing’s sarcoma
– Chondrosarcoma
– Fibrosarcoma
– Metastatic bone disease
Acute Pain; Chronic Pain
Interventions include:
– Treatment aimed at reducing the size or
removing the tumor
– Drug therapy; chemotherapy
– Radiation therapy
– Surgical management
– Promotion of physical mobility with
ROM exercises
Potential for Fractures
– Nonsurgical management: radiation
therapy and strengthening exercises.
– Surgical management: replace as much
of the defective bone as possible, avoid
a second procedure, and return client to
a functioning state with a minimum of
hospitalization and immobilization.
Carpal Tunnel Syndrome
Common condition; the median nerve
in the wrist becomes compressed,
causing pain and numbness
 Common repetitive strain injury via
occupational or sports motions
 Nonsurgical management: drug
therapy and immobilization
 Possible surgical management
Phalen’s maneuver for detection of carpal
tunnel syndrome
Hand Disorders
Dupuytren's contracture—slowly
progressive contracture of the
palmar fascia resulting in flexion of
the fourth or fifth digit of the hand
 Ganglion—a round, cystlike lesion,
often overlying a wrist joint or
Disorders of the Foot
Hallux valgus
 Hammertoe
 Morton’s neuroma
 Tarsal tunnel syndrome
 Plantar fasciitis
 Other problems of the foot
Changes in muscles and ligaments on the concave side of
the spinal column
Congenital, neuromuscular, or idiopathic in type
Assessment: complete history, pain assessment,
observation of posture
Interventions: exercise, weight reduction, bracing, casting,
Osteogenesis Imperfecta
Rare genetic disorder in which the
bones are fragile and fracture easily,
resulting in bone deformity
 Clinical manifestations: poor skeletal
 Treatment: palliative; client’s life
span is often shortened
 Steroids, calcium, vitamin C, and
possibly sodium fluoride
Progressive Muscular
At least nine types of muscular
dystrophies identified; categorized as
slowly or rapidly progressive
 Diagnosis often difficult
 Management
– Supportive, making client as
comfortable as possible
– Prednisone, immunosuppressive agents,
anabolic steroids
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