Question

MUSCULO-SKELETAL SYSTEM

1. List down interventions/strategies for Fall Prevention.

2. What are the effects of aging on musculoskeletal function?

3. Management for the following problems in musculoskeletal system.

a. Osteoporosis

b. Rheumatoid Arthritis

c. Gout

d. Osteoarthritis

Answer 1

1. STRATEGIES FOR FALL PREVENTION

The risk of falls increases with aging due to the loss of strength of older people. It can bring the changes in the patients balace, making the person unsteady and altered poprioception.

Some of the strategies which would prevent such falls are;

1. Setting of bed alarms
2. Siderails should be there
3. Providing safety assistance
4. Flooring should be old age friendly
5. providing chappals with proper grip
6. Safety sounds can be made available
7. Advice the patient to stay active inorder to improve the balance.
8. Regular vision check up.
9. Ensure safety proofing
10. Proper reassurance on environmental changes.

2. EFFECTS OF AGING ON MUSCULOSKELETAL SYSTEM

There are several age related changes in the musculoskeletal system. They are ;

In the muscle ; Replacement of muscle cells by fibrous connective tissue which results in decreased muscle strength and muscle mass. Chances are high for abdominal protrusions.

• Lost of elasticity and deterioration of cartilage resulting decreased agility
• Reduced ability to store and release glycogen resulting in slowed conduction time nerve impulses.
• Decreased basal metabolic rate.

In the joints ;

• Increased risk of cartilage erosion resulting in joint stiffness and decreased mobility.
• Loss of water from intervertibral disc

In the bone;

• Slowed remodelling of bone resulting in increased risk of osteoporosis .
• Decreased bone density and strength resulting in abnormal posture sch as kyphosis

3. MANAGEMENT OF OSTEOPOROSIS

It is a chronic, progressive metabolic bone disease marked by low bone mass and deterioration of bone tissue, leading to increased bone fragility.

• DRUG THERAPY ; Bisphosphonate's (alendronate, ibandronate etc), Salmon calitonin, Selective estrogen receptor modulator, Recombinat parathyroid hormone, monoclonal antibody
• Nutritive management ; Calcium suppliments, Vitamin D supliments , balanced diet
• Therapeutic exercise programme
• Adequate sun exposure (for vit D)
• Vertebroplasty
• Kyphoplasty

MANAGEMENT OF RHEUMATOID ARTHRITIS

Rheumatoid arthritis is a chronic, systemic autoimmune disease characterised by inflammation of connective tissue in synovial joints. It often has extra articular manifestations.

Management involves,

• DRUG THERAPY ; Disease modifying antirheumatic drugs should be administered. ( Methotrexate, Sulfasalazin, hydroxychloroquine, leflunomide etc.) , Biologic desease modifiers ( Etanercept, golimumab) , corticosteroids for symptomatic treatment, NSAIDS.
• Nutritional and weight management; A sensible weight loss programme along with a well balanced nutrition could reduce the stress of the affected joints.
• Therapeutic exercises ; Stretching, flowing motions, hand exercises, cycling, water exercises etc to increase the strength and flexibility of the affected joints.
• Heat and cold applications ; It helps relieve stiffness, pain and muscle spasm.
• Rest ; Scheduled rest periods with activity throughout the day helps relieve fatigue and pain. The patient should rest before getting exhausted.
• Joint protection ; Use of proper assistive devices for simplification of work ad proper delegation of task could reduce the constant stress on joints to a large extent.
• Psychologic support ; Help the patient understand about the course and prognosis of the disease condition.

MANAGEMENT OF GOUT

A type of acute arthritis characterised by elevation of uric acid and the deposition of uric acid crystals in one or more joints.

• DRUG THERAPY ; NSAIDS, colchicine, allopurinol, Corticosteroids, Adrenocorticotropic hormone etc.
• Joint immobilization
• Heat and cold applications
• Joint aspiration and intraarticular corticosteroids
• Nutritional therapy ; Avoidance of food and fluids with high purine content (wine, liver, beer etc.), limit alcohol , Weight reduction programme for obese people.

MANAGEMENT OF OSTEOARTHRITIS

Osteoarthritis is a slowly progressive noninflammatory disorder of synovial joints.

• DRUG THERAPY ; NSAIDS, acetaminophen, Intraarticular corticosteroids . inj of hyaluronic acid (for knee OA)
• Nutrional and weight management
• Rest and joint protection
• Heat and cold applications
• Movement therapies, massage , acupuncture
• Transcutanous electrical nerve stimulation
• Reconstrictive joint surgery