`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