Musculoskeletal Disorders

Musculoskeletal disorders (MSDs)

This are injuries or pain in the body's joints, ligaments, muscles, nerves, tendons, and structures that support limbs, neck and back.

MSDs are degenerative diseases and inflammatory conditions that cause pain and impair normal activities.

They can affect many different parts of the body including upper and lower back, neck, shoulders and extremities (arms, legs, feet, and hands).

MSDs can arise from a sudden exertion (e.g., lifting a heavy object), or they can arise from making the same motions repeatedly, repetitive strain, or from repeated exposure to force, vibration, or awkward posture.

• The most common for of MSD are arthritis, osteoporosis, rickets

Function of musculoskeletal system

• Supporting the body
• Allowing motion
• Protecting vital organs
• Serves as the main storage for calcium and phosphorus
• Critical component of hematopoietic system

Arthritis

Arthritis is a name for a group of conditions affecting the joints.

These conditions cause damage to the joints, usually resulting in pain and stiffness.

Arthritis can affect many different parts of the joint and nearly every joint in the body.

• common forms of arthritis are-
• Osteoarthritis,
• Gout
• Rheumatoid arthritis

Osteoarthritis

Osteoarthritis is a degenerative condition that mostly affects the hands, spine and joints such as hips, knees and ankles, and usually gets worse over time.

In a normal joint, the ends of the bones are covered by a layer of cartilage. Cartilage helps the joint move smoothly and cushions the ends of the bones.

Normally healthy cartilage allows bones to glide over one another and helps absorb the shock of physical movement.

In osteoarthritis the cartilage that covers the ends of the bones in the joints begins to break down and wear away.

This leaves the ends of the bones unprotected, and the joint loses its ability to move smoothly, causing the bones to rub together, creating pain, swelling and loss of motion .

A knee joint affected by various stages of osteoarthritis from healthy (left) to Stage 3 (right). Osteoarthritis is a degenerative joint disease that is mostly caused by strong or wrong strain. It is known as a "form-function" problem. The cartilage gradually frays and abrades until it is completely worn away. The worn off pieces of cartilage cause pain in the knee joint

Symptoms

The main symptoms of osteoarthritis are pain, stiffness and limited joint movement.

At first pain is felt during and after activity, but as the condition worsens pain may be felt during minor movements or even at rest.

Affected joints may become enlarged and tender, affecting fine motor skills and leading to difficulty in performing everyday activities.

OA mainly affects people over the age of 45, but it can develop in younger people.

• Risk factors
• Age -over 45 years, Being female, Joint misalignment, Joint injury or trauma (such as dislocation or fracture), Excess weight, and
• Repetitive joint-loading tasks (for example, kneeling, squatting and heavy lifting)

What causes it?

In many people there is no clear cause of OA. Research shows there are some things that may put you at more risk of developing OA in certain joints, such as:

• Knees: being overweight, having a previous knee injury, jobs involving kneeling, climbing and squatting
• Hips: being overweight, having a previous hip injury, jobs involving lifting heavy loads (including farming)
• Hands: having a history of OA in the family

What treatments are there for OA?

Treatments for OA vary depending on which joints are affected and the severity of your condition.

• In general terms, treatment usually includes:
• simple pain relief, using medicines such as paracetamol
• non-steroidal anti-inflammatory drugs (NSAIDs)
• an exercise program designed to suit your needs
• a weight loss program, if you are overweight joint replacement surgery, if your symptoms are no longer controlled with other therapies.

DIETARY CONSIDERATIONS IN OSTEOATHRITIS

• Increase intake of vitamin K-help in formation of osteoclast
• Increase intake of vitamin D
• High intake of calcium
• Consume antioxidants rich foods
• Add omega 3 fatty acids to food
• Maintain weight

Gout-What is it?

Gout is a type of arthritis that is characterized by crystals of sodium urate on and within the joints.

This build-up of uric acid is caused by excreting too little uric acid or producing too much.

When there are lots of sodium urate crystals concentrated around a joint, they can protrude from the cartilage and inflame the soft joint lining. In other cases, sodium urate crystals can cause pain by grouping together and causing progressive damage to the nearby bone and cartilage.

While gout can affect any joint, But it is most common in the big toe.

Risk factors

Gout is significantly more prevalent in men than it is in women.

This is because the estrogen that accompanies a woman's menstrual cycle increases the excretion of uric acid through the kidneys.

Gout tends to trouble men over 30 and women over 60.

Older people taking diuretics (also known as 'water pills' or tablets which help the body get rid of water).

Symptoms

Gout reveals itself as a severe and sudden pain in one or more joints, usually those in the big toes. While symptoms can occur at any time, most suffers of gout find that they experience symptoms at night.

Symptoms develop quickly usually between in less than a day. Sometimes called a 'gout attack', these symptoms can last up to 10 days.

Joint tenderness is another symptom of gout. Indeed, some sufferers find the pressure of a duvet or blanket on the affected joint unbearable.

The joints affected by gout are also swollen and often covered by shiny red skin due to the inflammation stretching the skin. After the inflammation has subsided this swollen skin often becomes flaky and itchy. Often the joint is intensely sore to touch.

Gout normally affects one joint at a time, often the joint of the big toe. Other joints such as the hands, wrists, knees, ankles and elbows can also be affected by gout.

• Chronic gout can lead to joint deformities and renal failure if left untreated

What causes it?

Gout is usually caused by the kidneys not flushing uric acid out of your body quickly enough.

Gout runs in families, although not all family members will be affected.

• There are some lifestyle factors which may increase your risk of developing gout, including:
• drinking alcohol
• dehydration (not drinking enough water)
• being overweight or overeating
• 'crash' dieting or fasting weight loss
• Low CHO diet
• eating certain foods with high purine Taking diuretics (water tablets) and/or having kidney disease also increases your risk of developing gout.

How is it diagnosed?

Gout is diagnosed by finding crystals of uric acid in fluid taken from your joint.

the doctor may test your urine to see if your body is getting rid of extra amounts of uric acid. Uric acid levels can also be measured by blood tests,

• Prevention Medicines: There are medicines that can lower uric acid levels in your blood. These medicines need to be taken every day, whether you are having an attack or not.

Alcohol: Cut down the amount of alcohol you drink and avoid drinking a lot of alcohol at one time (binge drinking). Interferes with liver &kidney

Weight loss: If you are overweight, lose weight gradually. Make sure you have a healthy diet, as 'crash' or 'starvation diets' can actually increase uric acid levels. See a dietician for advice.

Changes in your diet: It is believed that some foods may trigger attacks of gout. These foods tend to contain high levels of purines, a substance that can be made into uric acid in the body, such as offal, seafood and products made from yeast extract.

Treatment

There are two parts to managing gout: dealing with the immediate symptoms and preventing future attacks.

The treatment of gout varies on the severity of the case.

anti-inflammatory painkillers and applying a cool compress to the affected joint.

stronger steroidal anti-inflammatories.

When experiencing a gout attack, it is important to rest and avoid knocking the affected joint.

While these treatments may relieve the painful symptoms until the attack passes, gout is usually reoccurring.

Diet

• Reduce intake of meats and sea foods-are high in purines-organ meats(kidney, liver), peas, beans
• Foods low in purine-omega 3, soy pdcts, vitamin A & E
• Adequate intake of vitamin C-reduce inflammation and promotes healing
• Ginger, pineaples, fish oils -ant-inflammatory effect
• High fluid intake to flush out uric acid-3l/day
• Adequate intake of CHO to avoid ketoacidosis
• Encourage consumption of alkaline foods
• Avoid high fat intake -it reduces excretion of uric acid
• Diet should improve functions of liver and kidney

Rheumatoid arthritis (RA

Rheumatoid arthritis (RA) is an autoimmune disease that causes pain and swelling of the joints.

The normal role of your body's immune system is to fight off infections to keep you healthy.

In an autoimmune disease, your immune system starts attacking your own healthy tissues.

In RA, the immune system targets the lining of the joints, causing inflammation and joint damage.

RA usually affects smaller joints, such as the joints in the hands and feet. However larger joints such as the hips and knees can also be affected.

It is a painful, and potentially disabling, condition that can lead to substantial loss of functioning and mobility if not adequately treated.

Rheumatoid arthritis (RA

• What are the symptoms? Rheumatoid arthritis symptoms begin with the affected joints swelling, then becoming warm, painful and stiff, particularly upon waking up in the morning or after extended periods of inactivity.

This increased stiffness generally lasts for at least an hour, if not longer.

Gentle movements may relieve symptoms in the disease's early stages.

In later stages, the inflammatory activity causes tendon erosion and damage to the joint surface, which impairs range of motion and may lead to deformity.

• Other possible rheumatoid arthritis symptoms include:-
• joints that are tender to the touch,
• red and puffy hands,
• firm bumps of tissue under the skin (rheumatoid nodules) on one's arms,
• fatigue,
• fever, weight loss.

symptoms

NB/symptoms can vary in severity and can come and go with alternating flare-ups and periods of relative remission when the swelling, pain, difficulty sleeping and weakness fade or disappear.

Rheumatoid arthritis primarily affects joints, but problems involving other organs of the body are possible and occur in about 15-25% of individuals with the disease.

Anemia is quite common in those suffering from rheumatoid arthritis.

What causes it?

It is not known what causes RA. It is more common in people who smoke and/or have a family history of RA. genetic components have been suspected.

• How is it diagnosed?
• blood tests for inflammation blood tests for rheumatoid factor.

x-rays to see if your joints are being damaged by the disease.

What treatments are there for RA?

Rheumatologist will tailor your treatment to your symptoms and the severity of your condition.

• medicines, such as
• non-steroidal anti-inflammatory drugs (NSAIDs)
• corticosteroid medicines or injections
• disease-modifying anti-rheumatic drugs (DMARDs) biological DMARDs, such as tumour necrosis factor (TNF) medicines.

Exercise, to keep the joints flexible and muscles strong.

See physiotherapist for advice.

Diet

• Adjust calories according to the diseases
• Increase calories to respond to inflammation when the disease is active. Reduce calories in remission state
• Protein -1.5-2.0 g/kg/bwt to reverse negative nitrogen balance
• Avoid pro inflammatory food- red meats, dairy pdcts
• Omega 3 fatty acids-has ant inflammatory effect, reliefs pain-can give supplements
• Eat food with antioxidants-slows down the inflammation process, prevents tissue damage around the joints by free radicals

Nutritional implication

• Low serum pyridoxal (B6) due to drug therapy. Give B6 supplements
• Low levels of ascorbic acid in WBC

osteoporosis

• Progressive bone disease characterized by decrease in bone mass and density (reduced bone mineral density
• This leads to increased risk of fractures and spinal compression
• It is common among women especially after menopouse
• It causes pain, weight loss, bending and susceptibility to fractures

Risk factors

• Female -women have 30% less bone mass than women
• Natural or surgically induced menopause-low estrogen levels increases calcium requirement by decreasing absorption
• Calcium deficiency
• Smoking and alcohol intake-associated with decrease estrogen
• Direct effect of nicotine on the bone cells blocks the bodys ability to use estrogen, calcium and vitamin D
• Excess alcohol promotes calcium excretion
• Renal disease (renal osteodystrophy)
• Low testostrone in men-testosterone is converted to bone preserving estrogen

Risk factors

• Hormonal imbalance-parathyroid hormone, growth hormone (help on how well bone use Ca and rebuild bone in case of breakup
• Lack of vitamin D
• Sedentary lifestyle-physical activity helps in bone mineralization

management

• High calcium diet-1000mg/day before menopause and 1500mg after menopause
• Avoid excessive intake of protein -it increases calcium requirement by reducing retention
• Avoid caffeine, smoking and alcohol
• Increase fluid intake-to dilute urine and prevent formation of calcium kidney stones
• Decrease fibers intake-lowers bioavailabilty of calcium
• Increase vitamin D intake

Rickets

• This is softening of bones especially n children potentially leading to fractures and deformities
• It occurs to children with malnutrition
• Predominant cause is vitamin D deficiency but lack calcium in the diet

Signs and symptoms

• Skeletal deformities-swelling of the bones in the wrist, ankles and ribs, fontanel takes long to close
• Muscle weakness-child learn to walk late
• Child experiences fever
• Bone pain and tenderness
• Impaired growth (FFT)
• Pot belly and head larger than normal
• Bow legs

Risk factors

• Breastfed children whose mothers are not exposed to sunlight
• Breastfed children who are not exposed to sunlight

Management

• Increase dietary intake of calcium and phosphorus
• Increase dietary intake of vitamin D
• Exposure to sunlight
• Taking fish oil
• calcium supplement
• Incase of severe deformities orthopedic correction is recommended