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Orthopedic 4

    1. Management: conservative treatment
      1. education should cover
        1. exercise patterns
        2. relaxation techniques
        3. nutritional assessment
        4. counseling about maintaining a normal weight
      2. nutritional management - weight reduction
      3. activity and rest management
        1. preservation of joint motion through a balance of
          1. rest (protection)
          2. activity (rehabilitation)
        2. individualized activity rehabilitation program
        3. physical or occupational therapist may be helpful
        4. passive range of motion exercises (illustration )
        5. active stretching
      4. protection from further injury by splinting or bracing
      1. Medication
        1. aspirin - most often recommended
          1. advantages: relatively safe and inexpensive
          2. disadvantage: GI problems may lead to ulcers and bleeding
        2. nonsteroidal anti-inflammatory medications (NSAIDs)
          1. reduce pain and inflammation
          2. inhibit prostaglandinformation
          3. may cause GI bleeding or gastric ulcers or cramping with diarrhea
        3. adrenocorticosteroid injections
        4. remissive agents 
          1. gold
          2. penicillamine (cuprimine)
          3. hydrochloroquinine (plaquenil)
      1. Nonmedication assistance
        1. assistive devices
          1. canes
          2. walkers
        2. non-traditional techniques
          1. guided imagery - the use of one's imagination to acheve relaxation and control
          2. therapeutic massage
          3. biofeedback
          4. hypnosis
          5. relaxation techniques
      2. Surgical management
        1. arthrodesis
        2. arthroplasty
        3. osteotomy
        4. total joint replacement
      1. Home care considerations in arthritis
        1. safety measures
          1. no scatter rugs at home
          2. well-fitted, supportive shoes
          3. night light, handrails at stairs and bathtub or shower
          4. assistive devices
            • canes
            • walkers
            • elevated toilet seats
            • grab bars
            • handrails in stairways
          5. splints and orthotic devices
        2. management of surgical pain by patient controlled analgesia pumps
        3. referral to agency and support group
    3. Charcot joints (also called neuropathic joint disease)
      1. Definition - multicausal degeneration and deformation of joint, usually ankle. (illustration)
      2. Etiology
        1. diabetes mellitus leading to foot neuropathy
        2. syringomyeliaresults in Charcot's jointof the shoulder
        3. tertiary syphilis
        4. peripheral neuropathies
        5. spina bifida with myelomeningocele
        6. leprosy
        7. multiple sclerosis
        8. long term intra-articular steroid injections
      3. Findings
        1. inspection: foot is everted, widened, and shorter than normal
        2. examination
          1. joint instability
          2. soft tissue swelling
          3. pain secondary to inflammation
      1. Diagnostics
        1. laboratory analysis of synovial fluid
          1. fluid is non-inflammatory
          2. low protein content
          3. no hemorrhage noted
        2. radiographs
          1. chronic destructive arthritis of the foot
          2. severe destruction of the articular cartilage, subchondral sclerosis
          3. fragments of bone and cartilage in joint
      1. Management
        1. conservative treatment
          1. protection from overuse/abuse
          2. braces and splints
        2. surgical management: arthrodesis
          1. treatment of choice for unstable joints
          2. fusion of the involved joint
      2. Nursing interventions
        1. expected outcome: preserve the joint
        2. education can prevent further injury
        3. protection of the joint
          1. braces
          2. orthopedic shoes
        4. prolonged immobilization
          1. eight to 12 weeks to decrease swelling
          2. leads to minimal joint deformity and a functional painless foot
    4. Chondromalacia patellae (also called patellofemoral arthralgia)
      1. Definition: progressive, degenerative softening of the bone; follows a knee injury (illustration)
      2. Etiology
        1. lateral subluxationof the patella (kneecap)
        2. direct or repetitive trauma to the patella produces chondral fracture
        3. underdevelopment of the quadricepsmuscles
      3. Findings
        1. pain with flexed knee activities (poorly localized)
        2. mild swelling
        3. occasional episodes of buckling of the affected knee
        4. minimal joint effusion
        5. evidence of 'squinting kneecaps'
        6. atrophy of quadriceps
        7. inverted 'J' tracking of the patella in the final 30 degrees of extension
        8. excessive quadriceps angle
        9. positive apprehension sign
        10. crepitationupon range of motion
      4. Diagnostics
        1. radiographs
          1. anterior posterior (AP) and lateral views are not helpful
          2. sunrise views with the knee in 30 degrees, 60 degrees and 90 degrees of flexion
        2. bone Scans
        3. MRI Scans
        4. arthroscopy(see Orthopedic surgery)
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