2. FIBROMYALGIA Fibromyalgia a 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 months Additional symptoms 11 of 18 tender points at specific sites nonrestorative sleep (insufficiently refreshing sleep) morning stiffness Fatigue diminished exercise tolerance

3. Fibromyalgia tender points.

4. Characteristics of FM Early to middle adulthood. Pain as muscular in origin predominantly reported to be in the scapula, head, neck, chest, and low back significant fluctuation in symptoms from diminished to so much worsened symptoms that patients cannot carry out their activities of daily living.

5. Contributing Factors to a Flare environmental stresses Weather changes, especially significant changes in barometric pressure, cold, dampness, fog, and rain physical stresses Repetitive activities, such as typing, playing piano, vacuuming; prolonged periods of sitting and/or standing; and working rotating shifts. emotional stresses. Any normal life stresses.

6. Management—Fibromyalgia Research supports the use of exercise, particularly aerobic exercise. In addition to exercise, interventions include: Prescription medication Over-the-counter medication Instruction in pacing activities, in an attempt to avoid fluctuations in symptoms Avoidance of stress factors Decreasing alcohol and caffeine consumption Diet modification.

7. Myofascial Pain Syndrome A 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

8. The trigger point A 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).

9. Possible Causes of Trigger Points Idiopathic Chronic overload of the muscle Acute overload of muscle Trauma such as in a motor vehicle accident. Poorly conditioned muscles Postural stresses Poor body mechanics with lifting and other activities

10. Management—Myofascial Pain Syndrome Three main components Eliminating the trigger point Correcting the contributing factors Strengthening the muscle Contract–relax–passive stretch done repeatedly until the muscle lengthens Contract–relax–active stretch also done in repetition Trigger point release Spray and stretch Dry needling or injection

11. Similarities and Differences between Fibromyalgia and Myofascial Pain Syndrome

12. 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.

13. diagnosis The 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 higher Osteopenia: –1.1 to –2.4 Osteoporosis: –2.5 or less

14. Risk Factors Primary 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)

16. Prevention of Osteoporosis Diet rich in calcium and vitamin D Weight-bearing exercise Healthy lifestyle with moderate alcohol consumption and no smoking Testing bone for its density and medication if needed.

17. Recommendations for Exercise Weight-bearing exercise, such as walking, jogging, climbing stairs Non-weight-bearing exercise, such as with a bicycle ergometer Resistance (strength) training

18. Recommendations for Exercise MODE : Aerobic Frequency 5 or more days per week Intensity 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

19. Recommendations for Exercise MODE : resistance Frequency Two to three days/week with one day of rest between each session Intensity Eight to 12 repetitions that lead to muscle fatigue

20. Exercise Precautions and Contraindications Spinal flexion activities should be avoided It increases the risk of a vertebral compression fracture. Avoid combining flexion and rotation of the trunk increase the intensity progressively

21. FRACTURES—POST-TRAUMATIC IMMOBILIZATION A fracture is a structural break in the continuity of a bone, an epiphyseal plate, or a cartilaginous joint surface.

22. Types of fractures

23. Types of comminuted fractures Types of fractures

24. Identification of A fracture Site: diaphyseal, metaphyseal, epiphyseal, intra-articular Extent: complete, incomplete Configuration: transverse, oblique or spiral, comminuted (two or more fragments) Relationship of the fragments: undisplaced, displaced Relationship 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

25. ForceType of Fracture Bending (angulatory) Twisting (torsional) Straight pulling (traction) Crushing (compression) Repetitive microtrauma Normal force on abnormal bone Transverse or oblique fracture Greenstick fracture in children Spiral fracture Avulsion fracture Compression fracture Torus (buckle) fracture in children Fatigue fracture or stress fracture Pathological fracture

26. Risk Factors Sudden 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

27. Symptoms and Signs of a Possible Fracture

28. Bone Healing Following a Fracture Stages of Cortical Bone healing Stage of clinical union Stage of radiological union Rigid 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)

29. Types of Abnormal Healing of Fractures

30. Complications of Fractures