Musculoskeletal Dysfunction

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MUSCULOSKELETAL DYSFUNCTION

COMMON ORTHOPEDIC PROBLEMS OF THE CHILD
JUVENILE RHEUMATOID ARTHRITIS
New name: Juvenile Idiopathic Arthritis (JIA)
Autoimmune inflammatory disease causing inflammation of joints and other tissue. Cause: unknown
Peak ages of onset:
1 and 3 yrs of age
8 and 10 yrs of age

Factors that may trigger immune response:
-infection
-trauma
-emotional stress

JUVENILE RHEUMATOID ARTHRITIS
Manifestations:
* Intermittent joint pain that last for 6 weeks or more.
* Stiffness-worst in the AM or after long period of rest. * Warm to touch but without redness
* Limited ROM
* Limping
* Recurrent fevers
* Rash
* Myalgia
* Uveitis (inflammation of iris & ciliary body)
Types of JIA:
* Pauciarticular onset
* Polyarticular
* Systemic (Still’s disease)
JUVENILE RHEUMATOID ARTHRITIS
DIAGNOSTICS
* Rheumatoid factor
* ANA
* Increased ESR
* C-reactive Protein
* HLA (+)
* X-ray

JUVENILE RHEUMATOID ARTHRITIS
Therapeutic management:
No cure; major goals of therapy includes:
Control pain
Preserve joint ROM and function
Minimize effects of inflammation such as joint deformity
Promote normal growth and development

JRA : Implementation
A. Supervise medication administration.
GOAL: to relieve pain
1. NSAIDs – first drug of choice (ibuprofen, naproxen, tolmetin, diclofenac and nabumetone) 2. Slow-acting antirheumatic drugs (SAARDs)
methotrexate – 1st SAARD regimen used
Sulfasalazine
D-penicillamine
Monitor CBC and liver function
Avoid alcohol especially in teens

3. Corticosteroids – potent anti-inflammatory agents.
Ex: prednisone
Will not cure arthritis;
Administered when other medications have failed to control a disease flare and the child has substantial physical disability.

4. Biologic agents:
Etanercept
* Used if unresponsive to NSAIDs and methotrexate
* Given 2x/week subcutaneously
* Blocks the binding of tumor necrosis factor with cell surface receptors, thereby reducing inflammatory activity.

JRA : Implementation
B. Maintain joint function
1.Physical and Occupational Therapy
-Rehab (strengthening)
-Pool exercises
-Night Time Splinting
2. Surgery
-Arthroscopic Exam/ or with open biopsy
-Tenotomy
-Arthroplasty and Joint Replacement

Nursing Care Management: JIA
* Pain Management (medication, relaxation techniques)
* Promote General Health (well-balance diet, avoid excessive weight gain, adequate sleep and rest, avoid exhaustion, effective communication) * Encourage school attendance
* Facilitate compliance (Purpose and correct use of splinting and other therapies, Drug effects-S/E-toxicity, Follow up appointments) * Encourage comfort measures and ADLs

LEGG-CALVE PERTHES DISEASE (LCPD)

Also called coxa plana or osteochondritis deformans juvenilis a self-limited disorder in which there is aseptic necrosis of the femoral head produces hip deformation and dysfunction. Incidence: children ages 2-12 yrs.

Most cases occur in boys between 4 and 8 yrs.

Etiology : unknown, but (+) disturbance of circulation to the femoral capital epiphysis that produces an ischemic aseptic necrosis of femoral head.

Clinical Manifestations:
* Constant or intermittent hip soreness, ache, stiffness. * Limping, more pronounced with increased activity.
* Limited ROM

Diagnostics:
* Radiographic Exam
* MRI-definitive (Osteonecrosis)

Therapeutic Management
Goal: To maintain the spherical shape of the femoral head and maintain full ROM. * Recommend non weight bearing activities
* Maintain hip on abducted position (abduction brace, scottish rite brace for 18 months, leg cast, leather harness sling. * Early surgery (Osteotomy, removal of necrotic bone with viable bone)

Nursing Care Management
1. Health teaching
purpose, function, application, and care of corrective device Importance...
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