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`fibromyalgia and myofascial pain syndrome
FIBROMYALGIAFibromyalgiaa chronic condition characterized by widespread pain
that covers half the body (right or left half, upper or lower half)
has lasted for more than 3 monthsAdditional symptoms
11 of 18 tender points at specific sitesnonrestorative sleep (insufficiently refreshing sleep)morning stiffnessFatigue diminished exercise tolerance
Fibromyalgia tender points.
Characteristics of FMEarly to middle adulthood.Pain as muscular in origin predominantly reported to be in the scapula,
head, neck, chest, and low backsignificant fluctuation in symptoms from
diminished to so much worsened symptoms that patients cannot carry out their activities of daily living.
Contributing Factors to a Flareenvironmental stresses
Weather changes, especially significant changes in barometric pressure, cold, dampness, fog, and rain
physical stressesRepetitive activities, such as typing, playing
piano, vacuuming; prolonged periods of sitting and/or standing; and working rotating shifts.
emotional stresses.Any normal life stresses.
Management—Fibromyalgia
Research supports the use of exercise, particularly aerobic exercise.
In addition to exercise, interventions include:Prescription medicationOver-the-counter medicationInstruction in pacing activities, in an attempt
to avoid fluctuations in symptomsAvoidance of stress factorsDecreasing alcohol and caffeine consumptionDiet modification.
Myofascial Pain SyndromeA chronic, regional pain syndrome.The hallmark classification of MPS comprises
the myofascial trigger points (MTrPs) in a muscle which have a specific referred pattern of pain
The trigger pointA hyper irritable area in
a tight band of muscle. The pain from these points is described as dull, aching, and deep.
Active (producing a classic pain pattern)
Latent (asymptomatic unless palpated).
Possible Causes of Trigger PointsIdiopathic Chronic overload of the muscleAcute overload of muscleTrauma such as in a motor vehicle accident.Poorly conditioned musclesPostural stressesPoor body mechanics with lifting and other
activities
Management—Myofascial Pain SyndromeThree main components
Eliminating the trigger pointCorrecting the contributing factorsStrengthening the muscle
Contract–relax–passive stretch done repeatedly until the muscle lengthens
Contract–relax–active stretch also done in repetition
Trigger point releaseSpray and stretchDry needling or injection
Similarities and Differences between Fibromyalgia and Myofascial Pain Syndrome
OSTEOPOROSIS Osteoporosis is a disease of bone that leads
to decreased mineral content and weakening of the bone. This weakening may lead to fractures, especially of the spine, hip, and wrist.
diagnosisThe diagnosis of osteoporosis is determined
by the T-score of a bone mineral density (BMD) scan.
T score is the number of standard deviations (SD) above or below a reference value (young, healthy Caucasian women). Normal: –1.0 or higherOsteopenia: –1.1 to –2.4Osteoporosis: –2.5 or less
Risk FactorsPrimary osteoporosis. ( post-meupausal, low
calcium or vit-D,low body weight)Secondary osteoporosis. (due to some
medical condition-gastrointestinal disease, chronic renal failure, alcohol use, use of steroids)
Prevention of OsteoporosisDiet rich in calcium and vitamin DWeight-bearing exerciseHealthy lifestyle with moderate alcohol
consumption and no smokingTesting bone for its density and medication if
needed.
Recommendations for ExerciseWeight-bearing exercise, such as walking,
jogging, climbing stairsNon-weight-bearing exercise, such as with a
bicycle ergometerResistance (strength) training
Recommendations for ExerciseMODE : AerobicFrequency
5 or more days per weekIntensity
Thirty minutes of moderate intensity (fast walking) or 20 minutes of vigorous intensity (running). Doing three short bouts per day of 10 minutes of activity is acceptable
Recommendations for ExerciseMODE : resistance Frequency
Two to three days/week with one day of rest between each session
IntensityEight to 12 repetitions that lead to muscle
fatigue
Exercise Precautions and ContraindicationsSpinal flexion activities should be avoidedIt increases the risk of a vertebral
compression fracture.Avoid combining flexion and rotation of the
trunkincrease the intensity progressively
FRACTURES—POST-TRAUMATICIMMOBILIZATIONA fracture is a structural break in the
continuity of a bone, an epiphyseal plate, or a cartilaginous joint surface.
Types of fractures
Types of comminuted fractures
Types of fractures
Identification of A fracture Site: diaphyseal, metaphyseal, epiphyseal, intra-
articularExtent: complete, incompleteConfiguration: transverse, oblique or spiral,
comminuted (two or more fragments)Relationship of the fragments: undisplaced,
displacedRelationship to the environment: closed (skin in
tact), open (fracture or object penetrated the skin)Complications: local or systemic; related to the
injury or to the treatment
Force Type of Fracture
Bending (angulatory)
Twisting (torsional)Straight pulling (traction)Crushing (compression)
Repetitive microtraumaNormal force on abnormal bone
Transverse or oblique fractureGreenstick fracture in childrenSpiral fractureAvulsion fractureCompression fractureTorus (buckle) fracture in childrenFatigue fracture or stress fracturePathological fracture
Risk FactorsSudden impact (e.g., accidents, abuse, assult)Osteoporosis (women > men)History of falls (especially with increased
age, low body mass index, and low levels of physical activity
Symptoms and Signs of aPossible Fracture
Bone Healing Following a FractureStages of Cortical Bone healing
Stage of clinical unionStage of radiological unionRigid internal fixation.Time for healing.Childeren (4-6 weeks), adolescents (6-8 weeks),adults (10-18 weeks)Abnormal healing
Cancellous Bone (more prone to compression fractures)
Epiphyseal Plate (growth disturbance)
Types of Abnormal Healingof Fractures
Complications of Fractures