Lecture on Musculoskeletal Issues by Professor D

Introduction

• Focus on musculoskeletal issues
• Special emphasis on osteoporosis and Paget's disease

Osteoporosis

• Pathophysiology: The rate of osteoclastic (bone breakdown) activity exceeds osteoblastic (bone building) activity
• Incorrect Assumptions:
  • Weight-bearing activity is actually beneficial
  • Osteoporosis is not due to inefficient intestinal absorption of calcium, magnesium, or phosphorus
  • Not linked to atrophy of bones and muscles due to disuse

Risk Factors for Secondary Osteoporosis

• Females are at higher risk, especially post-menopausal women
• Steroids (e.g., prednisone) can increase risk
• Decreased estrogen levels during menopause lead to calcium leaving the bones, increasing porosity

Assessment and Management

• Signs: Slow movement and tenderness at specific vertebrae (e.g., T8) can indicate compression fractures
• Treatment: Calcium carbonate should be taken with food for absorption; patients should stay hydrated to avoid kidney stones
• Medications: Avista can affect the liver, necessitating regular liver function tests

Exercise Recommendations

• Non-jarring, weight-bearing exercises such as walking are recommended to prevent bone density loss

Injury Prevention

• Use a lift sheet to avoid fractures in patients with severe osteoporosis

Paget’s Disease

Causes

• Possibly familial, with a strong genetic link

Symptoms

• Severe bone pain due to excessive breakdown and rapid, softening regrowth of bones

Medication

• Diadronel (etidronate) should be taken on an empty stomach with a full glass of water and requires the patient to remain upright post-ingestion

Osteomyelitis

Risk and Treatment

• Recent injuries can be a source of infection
• Requires long-term IV antibiotic treatment (4-6 weeks)

Diagnostic Procedures

• Bone biopsy is necessary to determine if a bone tumor is benign or malignant

Carpal Tunnel Syndrome

• Diagnosis: Positive Phelan's test (pain or paresthesia when compressing the median nerve)
• Management:
  • Resting the wrist to alleviate symptoms
  • Loosening wrist splints if circulation issues arise
  • NSAIDs with food to avoid stomach ulcers

Plantar Fasciitis

• Common in runners and linked with obesity

Conclusion

• Encouragement to engage with the content and share resources with peers for educational support.