Download 1 - Prof M

LECTURE 6
Today's lecture will cover Skeletal and Muscular (Ch.2).
The Skeletal and Muscular System:
If you need to review the basics of the skeletal and muscular system, you can do
so before examining the pathologies of these system.
Fibromyalgia
definitions: group of sign or symptoms involving muscle, ligament, tendon, and other
soft tissue pain.
Other:
Diagnostic criteria by American College of Rheumatology in 1990:
-chronic pain for a minimum of 3 months
-11 of 18 trigger points currently active
-trigger points widely distributed, all quadrants
etiology
idiopathic.. it is thought to be a neurotransmitter problem(i.e. substance P)
possibly relating to sleep.
Signs&Symptoms
-9 tender points
-widespread in shifting locations
-stiffness after rest
-low stamina
-sensitivity to cold, esp. damp cold
-low pain tolerance
TX
mild depressants for improved sleep and depression
MT
According to book gentle massage is appropriate and will reduce
stress and improve sleep. However, sometimes a gentle touch can be
extremely painful for someone with fibromyalgia. Also, cold compress
should be avoided.
notes
-85% all cases women
-70% cases meet criteria for chronic fatigue syndrome
-many do not think this syndrome exists
-as a consequence, getting help can be difficult
Myofacial Pain Syndrome
definitions
A collection of signs and symptoms that indicate trauma to muscles that
leads to a cycle of chronic spasm, ischemia, and pain
etiology
repetitive stress?
Signs&Symptoms
trigger points(specific to certain areas--see p. 59, F. 2-4), referred pain,
TX
muscle relaxants, non-steroidal inflammatories(NSAIDS)
MT
Massage therapy is indicated.
notes
Massage therapy can be part of treatment.
Muscular Dystrophy(MD)
definition: A group of related inherited disorders, all of which involve the degeneration
and wasting of muscle tissue
Other: two most common varieties are X-linked herited - Becker and Duchenne
etiology:
Involves a genetic mutation that either prevents the production of dystrophin
altogether or allows its production only at subnormal levels.
Signs&Symptoms:
A toddler might begin having trouble walking or climbing stairs, may complain
of leg pain, waddling gait, progressive, occasionally but not always
accompanied by mental retardation, postural deviations
TX: no treatment for the child who already has MD, short term prednisone can preserve
function temporarily
MT: Disorder of muscle function - sensation is intact, therefore Massage Therapy is
indicated
Myositis Ossficans
definitions: The growth of a calcium deposit in soft tissue
Other
etiology:
Usually following a trauma that leads to bleeding, usually between fascial sheets
where the capillary supply is practically non-existant. The blood pools between
layers of muscles, where it quickly coagulates, becoming thick and jelly-like. If
the blood is not reabsorbed into the body, the liquid disperses, leaving behind
a calcium/iron formation that looks and feels like a bone.
Signs&Symptoms:
identified by a specific bony pattern within weeks of the injury, most often
occurring in in adolescents and young adults, frequently involved with
the quadriceps and the brachialis; in acute stage, the area feels
bruised, later it will start to feel harder, crusty, and locally very tender.
TX:
Patients should rest and isolate the injured area in the acute stage to limit further
bleeding. Subacute stage - passive stretching, range of motion, followed by
resistive exercises.
MT: Massage Therapy is locally contraindicated
Shin Splints
definition: refers to a collection of lower leg injuries including muscle tears, periostitis,
hairlines fractures.
Other: common injury for long distant runners or joggers
etiology: Usually brought about by overuse and/or misalignment at the ankle. The tibialis
anterior fascia actually blends directly into the periosteum along the whole bone
Signs&Symptoms: Pain can be mild or severe, depending upon damage
TX: reduce activity for mild, change sneakers, etc. Steroid injections or surgery may be
suggested for chronic problems
MT: Massage Therapy is indicated as long as the problem is not too advanced.
notes: some people who have flat feet, poor sneakers, are overweight and run/jog get them.
Spasms, Cramps
definition:
Spasms are involuntary contractions of skeletal muscle. Spasms are considered
to be low grade, long lasting, whereas cramps are short-lived, acute contractions.
Cramps are extremely painful with visible shortening of muscle fibers.
etiology:
Overworked muscle may have low oxygen.
Cramps(charleyhorses) can be related to adolescence(growth?), lack of electrolytes
(potassium, calcium, etc.), liquid.
Signs&Symptoms: pain to muscle area gradual or acute.
TX:
kneeding of the muscle, liquids with electrolytes(i.e. gatoraid), time("outgrowing the
cramps"), possibly NSAIDS.
MT: Ischemic or exercise-related cramps indicate massage with caution. If the therapist
tries to "fluff up" a cramping gastrocnemius, he or she can damage the fibers.
A better
strategy is to stretch the tendons and antagonists of the affected muscle.
notes: parents of adolescents in sports should be familiar with this.
Strains
definition: injuries to muscle-tendon unit, with an emphasis on muscles
Other:
etiology: usually mechanical trauma or overuse
Signs&Symptoms:
mild or intense local pain, stiffness, occasionally palpable heat and swelling
TX: get precise diagnosis, control inflammation, rehabilitate damaged tissue,
prevent further injury
MT: Massage therapy is indicated except for acute injury.
Fractures
definition: any kind of broken or cracked bone
Other: kinds include comminuted, greenstick, oblique, spiral, transverse,
simple-skin unbroken, compound-skin broken,
depressed/compressed?-skull indented, impacted-bone forced into
other bone.
etiology: mechanical stress, in some cases(i.e osteoporosis) other factors
could be involved
Signs&Symptoms:
Most fractures are painful and involve loss of function at the nearest joints,
but some might be difficult to diagnose without an X-ray or other
imaging techniques
TX: casted to immobilize bones, pins, plates, grafting
MT: Massage Therapy is locally contraindicated, but elsewhere on the body can be very
beneficial
Osteoporosis
definition: literally "porous bones", loss of bone mass and density
Other
etiology: Brought about by endocrine imbalances and poor metabolism of calcium
Signs&Symptoms:
pain; later stages have compression or spontaneous fractures of the vertebrae,
wrists, or hips
TX: hormone replacement therapy(HRT), exercise with weight-bearing stress, calcitonin,
vitamin D
MT: The appropriateness of massage therapy varies from person to person, no exerting
of undue mechanical force
notes:
-osteoporosis is more common with elderly, so be mindful when massaging elderly
-weight bearing exercise which causes pull on bone increasing its want of
calcium and bone density
Paget's Disease
definition:
Condition in which healthy bone is reabsorbed up to 50 times faster than
normal, replaced with disorganized fibrous connective tissue
Other
etiology:
Cause is unknown. Everyday, on a microscopic level, small amounts of
calcium in the bones are dissolved into the bloodstream, to be replaced
by new supplies; both the osteoclasts and the osteoblasts become
hyperactive, and the reshaping process does not function correctly.
Signs&Symptoms: Usually has no symptoms until it has become advanced
TX: similar to that of osteoporosis, exercise is important
MT: Massage therapists are cautioned due to the many issues involved
notes
Postural Deviations
definition: Overdeveloped thoracic or lumbar curves (kyphosis and lordosis) or
an S-curve in the spine (scoliosis)
Other
etiology: most idiopathic, some congenital, other disease.
Signs&Symptoms:
curvatures are easily visible
Scoliosis (bend to right, left, front, back, C or S shaped, spiral )
Kyphosis ("hunchback" overdeveloped thoracic curve)
Lordosis ("swayback" - overpronouced lumbar curve)
TX: physical therapy, braces, exercise, range of motion, chiropractic therapy
MT: As long as no underlying pathology is contributing to spinal problems, all kinds may
indicate massage
notes
Ankylosing Spondylitis
definition: A spinal inflammation(spondylitis) leading to stiff joints (ankylosis)
Other: males represent 90% of the cases
etiology: A certain gene has been identified which seems to increase the tendency to develop
disease. Typically it begins at the sacroilic joint on one or both sides.
The pattern of inflammation and damage proceeds up the spine, leaving in its
wake, a trail of injured vertebrae that may eventually fuse in slight or sometimes
extreme flexion.
Signs&Symptoms: starts as chronic low back pain, pain in buttocks, misdiagnosed as
slipped disc, pain and stiffness stretch up the spine, can cause
complications in the lungs
TX: exercise, anti-inflammatories, joint replacement therapy
MT: Massage therapists must proceed with caution
notes: due to poor breathing be careful.. may be best for chair massage?
Dislocations
definition: traumatic injuries to joints where the srticulating bones are forcefully separated.
Other
etiology: mechanical trauma, congenital weakness..
Signs&Symptoms: extremely painful, joints lose all function
TX: immediate attention, splinted, physical therapy, painkillers
MT: Indicates massage in subacute stage, as long as work is conducted within pain
tolerance; out of the question for acute injury.
notes: subluxation=bones out of alignment
-injury to ligaments can cause joints to be less stable
Gout
definition: inflammatory arthritis caused by deposits of sodium urate(uric acid) in and around
joints.
Other: one of the oldest diseases recorded. 90% cases men, prime age 75 yrs.
etiology: If the kidneys are unable to extract uric acid from the blood, either because too
much uric acid is present or because they are otherwise impaired, hyperuricemia (higher
than normal levels of uric acid) develops.
Signs&Symptoms: causes joints to become red, hot, swollen, shiny, and extremely painful;
sudden onset, feet first, especially joint of big toe
TX: pain relief with analgesics other than aspirin, anti-inflammatory drugs, drugs that
modify metabloism and uric acid, losing weight, limiting purine-rich foods(diet)
MT: Gout is at very least a local contraindication for the affected joints at all times.
Lyme Disease
definitions: lyme disease is caused by a bacteria transmitted by ticks. It could cause arthritis
for this reasons it is listed here. Once bacteria enters body it could cause inflammation of
large joints in addition to neurological and cardiovascular symptoms.
Other: named after town of Lyme in Connecticut. ID'd in 1982.
etiology: Borrelia burgdorferi(bacteria) is transmitted via(by way of) Deer Tick vector.
Signs&Symptoms: rash(often "bulls-eyes" shaped), fever, fatigue, nite sweats. Later,
cardiovascular symptoms(i.e. irregular heart beat) and neurological symptoms
including chronic headaches, Bell's Palsy, numbness, tingling, forgetfulness) and
fatigue. Eventually, it could progress to inflammation of one or more large joints.
TX: antibiotics, and treating S&S. prevention includes wearing long sleeves, tucking
socks into boots; if have pets ongoing check for ticks.
MT during sub-acute stage massage may be appropriate.. might want to get Dr.'s note..
notes: This is a regional disease meaning 90% of all cases found in Northeast, MidAtlantic, and Wisconsin and Minnesota.
This particular tick is very tiny, not like typical wood ticks.
Osteoarthritis
definitions: arthritis caused by "wear and tear"
Other: also called degenerative joint disease; most common type of arthritis.
etiology: due to "wear and tear:, cartilage(mostly articulating) is damaged and decreases
in amount. This leads to a progression of deterioration of joint including
bone adaptation, muscle inflammation, etc. ultimately resulting in
inflammation.
Signs&Symptoms: inflammation of the joint capsule, hot, painful, swollen joint.
TX: usually treating S&S, NSAIDS, pain management, modest exercise,
surgery if needed
MT: subacute stages only.
notes:
Rheumatoid Arthritis(RA)
definitions: an autoimmune disorder resulting in arthritis
Other: women 3x more likely than men to get disease.
etiology: something(virus, bacteria, etc.) causes the T-cells
to elicit an attack on the joint.
Signs&Symptoms: vary.. typically weeks or months with feeling of illness.
may be after virus or bacterial infection...
TX: immune suppressant drugs, anti-inflammatories(inc. steroids),
new treatment(may not be available), anti-CD154***, surgery
MT: only in subacute stages..
notes: typical of autoimmune disorders there are "flare ups" and remmission.
-there have been significant advances in understanding RA
Septic arthritis
definitions: bacterial infection of joint usually introduced via a fomite(i.e.needle)
Other: usually young, old, or immunosuppressed patients,
etiology: Bacteria like Neisseria gonorrhoeae or Staph. aureus are the most common.
Signs&Symptoms: The cardinal S&S of inflammation, very high fever
N. gonorrhoeae pattern starts around sacroiliac joint and progressively
moves up the spine.
TX: antibiotics, joint aspiration, surgery
MT: contraindicated until arthritis over.
notes: usually a serious situation.
Spondylosis
definitions: basically, arthritis of the spine...
Other: also called degenerative joint disease.
etiology: thinning discs, herniated discs, chronic misalignment, etc.
Signs&Symptoms: sometimes there are no S&S, when osteophytes press
a nerve, neurological S&S can result including(shooting pain,
tingling, pins & needles, numbness, muscle weakness.
TX: anti-inflammatories
MT: indicated with caution.
notes: 75% of radiographs of 75 yrs old positive for spondylitis.
Sprains
definitions: tears or injury to ligaments
Other: more serious than strains or tendinitis
etiology: usually mechanical trauma
Signs&Symptoms: cardinal S&S of inflammation, loss of function
TX: RICE therapy, Rest, Ice(usually first few days), Compression, Elevation.
often bandages or splints to help keep joint immobile.
MT: Massage is indicated for subacute sprains.
notes
Temporalmandibular Joint Disease
definitions: a collection of signs and symptoms affecting the temporalmandibular joint
Other
etiology:
trauma, loose ligaments, osteoarthritis, infection(esp. dental), stress?
Signs&Symptoms:
malocclusion, bruxism; jaw pain, popping, locking, etc.
TX: bruxism mouthpiece, splints, anti-inflammatories, anesthetics, surgery, etc
MT: Can be useful in early stages but should get doctor's note("working as part
of a clinical team")
notes
Bunions
definitions: "Big toe" is distorted toward the lateral aspect of the foot.
Other hallux valgus
etiology: shoes(pointed, high-heeled, too small), overarched foot
Signs&Symptoms:bursitis of toe, lump on medial side of "big toe"
TX: change of shoes to normal-fitting low-heeled, cortizone shot, surgery
MT: point of bunion is locally contraindicated
notes: mostly found in elderly women who've ward high heeled and/or
pointed shoes
Bursitis
definitions: inflammation of the bursa
Other
etiology: repetitive stress sometimes associated with occupation
Signs&Symptoms: pain-often associated with movement, limited range of motion, etc
TX: stop the repetitive movement, anti-inflammatories, analgesics, aspiration,
surgery
MT: acute non-infectious bursitis locally contradicts massage
notes: may accompany other inflammatory conditions
Dupuytren's Contracture
definitions: thickening and shrinking of the palmar fascia
Other: also called palmar fasciitis
etiology: idiopathic
Signs&Symptoms: limited movement of fingers
TX: corticosteroid injection, worst case-surgery
MT: Massage Therapy is indicated
notes: 50% of cases are bilateral
Ganglion Cysts
definitions: small connective tissue pouches filled with fluid
Other: it is essentially a synovial pouch
etiology: idiopathic
Signs&Symptoms: a superficial cyst which may continue to grow
TX: may resolve themselves w/o(without) interference, aspiration, surgical
excision
MT: massage is locally contraindicated
notes
Hernia
definitions: "hole" through which tissue protrudes
Other: - five types in book; hiatal, epigastric, paraumbilical, femoral, inquinal
etiology: congenital weakness, straining(coughing, sneezing, heavy lifting)
Signs&Symptoms: depending on location of hernia, pain to that area
TX: some go away on their own, surgery
MT: without surgery, locally contraindicated
notes
Pes Planus
definitions: lack of a normal arch
Other: flat feet; impairs shock absorption; may lead to other problems(knee, etc.)
etiology: congenital
Signs&Symptoms:
TX: treatment isn't necessary in most cases, PT may be recommended or orthotics
MT: Massage therapy is indicated.
notes: long walks and jogs might cause pain therefore flat feet
was not desired in the armed services
Plantar Fasciitis
definitions: inflammation of the plantar fascia
Other:
etiology: stress on foot usually by running/jogging or being overweight, foot
problems(flat, pronated, high-arched, etc.)
Signs&Symptoms: distinct; severe pain on bottom of foot(anterior to the calcaneus) near
heal for the first several steps in morning or after long rest/nap which subsides
TX: stop running/jogging or avoid long duration on feet, arch/foot supports, night splint,
heat, anti-inflammatories, takes weeks to heal.
MT: massage is indicated
notes
Scleroderma
definitions: autoantibodies attack and damage small arteries which results in
excessive amounts of collagen in the skin.
Other: sclero(hard)derma(skin), affects women to men 4:1, most between 25 to 54 yrs old
etiology: autoimmune disorder, idiopathic
Signs&Symptoms:CREST(Calcinosis, Raynaud's, Esophageal dysmobility, Sclerodactyly,
Telangiectasia(reddish discoloration caused by stretched and damaged
capillaries)
TX: calcium channel blockers(Raynaud's), diuretics(kidney), antacids, NSAIDS, PT, OT
MT: may indicate massage if no circulation or kidney problems
notes: two types localized(skin of hands and face), systemic(more serious-lungs, kidneys,
or heart)
Tendonitis
definitions: inflammation of the tendon
Other
etiology: trauma,
Signs&Symptoms: stiffness, pain, problem with movement
TX: sometimes PT, movement till pain,
MT: massage is indicated
notes: new approaches to muscle, tendon, ligament injuries
encourage movement whereby older therapies would
suggest no movement
Torticollis
definitions: condition causing the head to be pulled to one side
Other: also called wryneck
etiology: congenital, infant, spasmodic(abnormal muscle contraction),
wryneck(C7 intertransverse ligament), other
Signs&Symptoms:
TX: depends on underlying cause; exercise of weak muscle, drugs
for spasms, manipulation if subluxation
MT: depends on underlying cause.. massage should be done in cooperation with
health care team.
notes: this may be a sign of another underlying pathology
Whiplash
definitions: head "whipping" or jarring back and forth
Other: cervical acceleration-deceleration(CAD)
etiology: trauma(car accident, sports, etc.)
Signs&Symptoms: these vary, sometimes S&S don't appear
until days or much longer(year+); neck pain and stiffness, dizziness and
nausea(and other brain injury-see notes), muscle spasm, tendon pull,
ligament pull, vertebrae misalignment or subluxation, etc.
TX: "neck collar" to keep neck straight
MT: according to text, in subacute stage gentle reflexive work is okay. I
would encourage a note from the doctor for "okay" to massage.
notes: "Coup contra-coup" is the jarring back and forth of the brain within
the skull whereby sometimes the front of the brain(frontal lobe) and
the back of the brain(occipital lobe) contact the skull and cause
neurological damage(mostly temporary but can be permanent) therefore
becoming a "brain injury". Sometimes in car accidents the patient
will have "smashed" the head against the windshield. Coup contra-coup
can occur. Therefore, neurological problems associated with the said
lobes may manifest including; vision problems, personality changes,
problems with studying and planning, etc.
Carpal Tunnel Syndrome
definitions: signs and symptoms in the wrist, hand, and fingers(usually thumb and
first two) usually resulting in numbing, tingling, pain, pins & needles, etc.
Other: Ulnar neuritis is similar but S&S occur on the pinky and 4th finger.
etiology: Repetitive stress associated with occupation(i.e. typist), hobby(i.e. knitting,
computers), music(i.e. pianist), etc., entraps the median nerve between the
carpals and the transverse carpal ligament.
Signs&Symptoms: neurological symptoms; pain, numbing, tingling, pins & needles.
TX: depends on cause; reduce or stop activity, anti-inflammatories, cortizone shots,
wrist brace, surgery
MT: According to textbook, Massage therapy depends on cause. I would suggest
if MT is exacerbating the symptoms that it is doing more harm than good
and therefore stop massage to that area.
notes: Phalen's maneuver is one of the ways of diagnosing carpal tunnel syndrome.
Ulnar neuritis can be caused by triceps extension(weightlifting, etc.)
Herniated Disc
definitions: a bulge of the vertebral disc
Other:
etiology: trauma, congenital,
Signs&Symptoms: often the bulge presses on nerves leading to neurological
symptoms; pain, muscle weakness, tingling, pins & needles, numbness
TX: osteopathic / chiropractic therapy, traction, PT, muscle relaxants, painkillers,
anti-inflammatories, surgery
MT: according to text, massage therapy is okay except if client is in pain.
notes
Myasthenia Gravis
definitions: the degeneration or destruction of specific receptor sites at neuromuscular
junctions
Other:
etiology: autoimmune disorder
Signs&Symptoms: wekness and fatiguability in affected muscles; flattened smile,
droppy eyelids(ptosis), difficulty with eating, swallowing, and speaking, etc.
TX: pharmacological(medication), steroids(suppress immune system), surgery..
MT: massage therapy is indicated with some caution.
notes: new drugs are coming out involved with autoimmune disorders