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Musculoskeletal Diseases and Disorders

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Presentation on theme: "Musculoskeletal Diseases and Disorders"— Presentation transcript:

1 Musculoskeletal Diseases and Disorders
Chapter 15

2 Musculoskeletal System
Bones Long, short, flat, irregular Compact, spongy Joints Bursae Muscles Tendons Ligaments

3 Musculoskeletal System
Two divisions: Axial skeleton Appendicular skeleton (inc. pelvic girdle) Muscle types: Skeletal muscle (voluntary, striated) Smooth muscle (involuntary, non-striated) Cardiac muscle (involuntary, striated)

4 Disorders of Bone Spinal deformities Herniated intervertebral discs
Osteoporosis Osteomyelitis Paget’s Disease (osteitis deformans) Fractures

5 Spinal Deformities Lordosis Abnormal “inward” or anterior curvature
Accentuation of normal curve of lumbar spine Frequently gradual onset Affects lumbar spine Also called “swayback”

6 Spinal Deformities Kyphosis Abnormal “outward” curvature of the spine
Accentuation of normal thoracic spine curvature Also called “humpback” or “roundback” Commonly due to pathological fractures of spine in osteoporosis

7 Spinal Deformities Scoliosis Lateral (sideways) curvature of the spine
May go to left or right May involve some rotation of spinal column May be caused by discrepancy in leg lengths Surgery possible if interferes with breathing or mobility

8 Spinal Deformities Etiologies
Posture, leg length differences, congenital, epiphyseal growth disturbance, trauma, tumors, infection, arthritis, TB, endocrine abn, aging S/S: usually backache, fatigue, abnormal appearance or fitting of clothes Treatment: PT, exercise, braces, surgery, pain relief

9 Herniated Intervertebral Discs
Disc Anatomy Annulus fibrosis Nucleus pulposis Herniation Nucleus pulposis pushes through annulus into spinal canal Rupture Pieces of the disc are free in the spinal canal

10 Herniated Disc S/S: Treatment: Back pain Paresthesias
Sciatica: inflammation of sciatic nerve, leg pain Treatment: PT, exercise, pain relief meds, surgery (rarely), life correctly

11 Osteoporosis Metabolic disorder of bones
Less bone mineral (calcium) than normal Over 10 million in US affected Post-menopausal females most commonly Bones are brittle, porous, easily broken More prone to pathological fracture

12 Osteoporosis Etiology: S/S: often asymptomatic until pathological fx.
Genetics, calcium intake & dietary, sedentary lifestyle, estrogen, vit D, or adrenal deficiency, steroid use, alcoholism, etc S/S: often asymptomatic until pathological fx. Treatment: calcium supplements, meds (antiresorptive, restorative of lost bone, etc)

13 Osteomyelitis Acute or chronic bone infection
Inflammation, edema, circulatory problems More common in children Etiology: Trauma most commonly with bacterial invasion from the skin Infection may also spread from adjacent tissues or blood supply

14 Osteomyelitis Risk factors: S/S: may be asymptomatic for years
Diabetes, orthopedic hardware, splenectomy & SSA, hemodialysis, IV drug users S/S: may be asymptomatic for years Treatment: Long-term antibiotics, sometimes surgical debridement

15 Paget’s Disease Osteitis Deformans Chronic metabolic bone disease
High rate of bone turnover (reabsorption & deposition) Thicker but softer bone is the result Patients typically over 40 YOA One or many bones Usually lower torse involve

16 Paget’s Disease Etiology: Unknown
S/S: graduation onset of swelling & pain Treatment: PT, pain management, surgery Medications (biphosphonates or calcitonin) Joint replacements

17 Fractures Closed/simple Open/compound Greenstick Displaced Comminuted
Segmental Spiral Pathological

18 Fractures Etiology: trauma or disease S/S: usually pain and swelling
Treatment: Rest, decreased use Splint, sling, cast Surgery (ORIF, etc)

19 Joint Diseases Osteoarthritis Rheumatoid Arthritis
Gout (gouty arthritis)

20 Osteoarthritis Most common form of arthritis
Chronic inflammation causing degeneration and new bone formation Weight-bearing joints most common Knees, hips Common in older patients (over 55 YOA) In over 70 YOA, females more frequently affected

21 Osteoarthritis Etiology: S/S: Treatment:
Mechanical, chemical, genetic, autoimmune, metabolic Aging seems to be important S/S: May be asymptomatic indefinitely Pain, swelling, sometimes erythema, limitation of motion Treatment: Anti-inflammatories, PT, exercise, surgical

22 Rheumatoid Arthritis Chronic, systemic, polyarticular inflammatioy disease Destruction (erosion) of bone & cartilage Causes ankylosis (fibrous fusion of joints, immobile) Exacerbations and remissions unpredictable Affects mostly females Increasing risk with advancing age

23 Rheumatoid Arthritis (RA)
Etiology: autoimmune, genetics S/S: symmetric pain, swelling of hands & fingers, also other LE joints, systemic (fever, fatigue, wt. Loss) Dx testing: Rheumatoid factor blood test Treatment: Antiinflammatories, PT, antimetabolites, antirheumatic drugs

24 Gout Gouty arthritis Chronic uric acid metabolism disorder
Uric acid crystals deposited in joints Tophi formation (urate compounds) around joints Acute, severe episodes of arthritis Mostly male patients Other associated problems: Kidney stones, renal failure, hyperuricemia

25 Gout Etiology: S/S: Treatment: Metabolic, renal, some genetics
Severe signs & symptoms of inflammation Big toe is classical site Treatment: Pain relief, antiinflammatories, colchicine, diet low in purines, alopurinol

26 Muscles & Connective Tissue Diseases
Sprains & strains Bursitis & tendonitis Carpal Tunnel Syndrome Myasthenia Gravis (MG) Polymyositis Systemic Lupus Erythematosus (SLE) Duchenne’s Muscular Dystrophy

27 Sprains & Strains Sprain Strain Etiology: trauma or overuse
Ligamentous tearing/stretching after a tortion injury Strain Tearing/stretching of tendon or muscle Etiology: trauma or overuse S/S: localized pain, swelling, limitation of motion Treatment: supportive, pain relief

28 Bursitis & Tendonitis Bursitis Tendonitis
Inflammation of fluid-filled bursae near joints Shoulder, hip, elbow, knee Tendonitis Inflammation of tendon or tendon-muscle attachement Shoulder, wrist, Achilles, hamstring Etiology: trauma, excessive use, other diseases S/S: pain, swelling, LOM, fluid accumulation

29 Bursitis & Tendonitis Treatment
Varies with anatomic location & degree of disability Anti-inflammatories & pain relievers, splinting, exercise, orthotics, steroid injections, PT

30 Carpal Tunnel Syndrome
Compression of median nerve within the carpal tunnel of the wrist Common syndrome with repetitive use work Involves pain, sensory & motor symptoms Etiology: edema within the carpal tunnel, causing inflammation of the nerve & other structures there

31 Carpal Tunnel Syndrome
S/S: Wrist pain, burning or tingling paresthesias, numbness Weakness of hand grasp Tinel’s sign Treatment: Wrist immobilization, anti-inflammatories Rarely surgery

32 Myasthenia Gravis Rare, autoimmune disorder of the neuromuscular junction Antibodies against the acetylcholine receptors (post-synaptic) Chronic, progressive disease causing sporadic weakness of the skeletal muscles Most common in females, ages YOA

33 Myasthenia Gravis (MG)
Reduced muscle strength & longer recovery time with repeated use Symptoms late in the day Bulbar (eye & facial) muscles involved first Facial expression, drooping lids, etc. Thymomas in 15% MG patients 75% have some thymic abnormality (hyperplasia)

34 MG Diagnostic testing: Treatment:
Tensilon test (edrophonium challenge will increase muscle strength) Treatment: Oral anticholinergic meds (pyridostigmine, neostigmine), immune suppressives, cholinesterase inhibitors like edrophonium Prognosis: normal life expectancy in modern times

35 Polymyositis Chronic, idiopathic inflammatory disease of connective tissues and muscles Exacerbations & remissions May have skin involvement (dermatomyositis) females more than males Bimodal peak of onset: YOA & 50-70YOA

36 Polymyositis S/S: sudden or slow weakness of muscle group over weeks to months Often have trouble arising from sitting or raising arms above head, also voice changes Fever, fatigue, weight loss Skin: lilac-colored rash of eyelids, nose and face Dx via EMG & muscle biopsy Treatment: immune suppressive

37 Systemic Lupus Erythematosus
Lupus or SLE Multisystem, autoimmune, inflammatory disease due to antibodies against cell nuclei Females outnumber male patients ( 9 to 1) Genetics may also be involved Arthralgias are first complaint in most patients

38 SLE Organ involvement: Four criteria at any time:
Skin, renal, CNS, GI, blood, musculoskeletal, CV, pulmonary, vascular endothelium (Raynaud’s) Four criteria at any time: Malar rash or discoid rash, photosensitivity, arthritis, renal disease, neuro, skin, hematologic, or immune disorders, +ANA blood test

39 SLE Treatment: Anti-inflammatories, pain relief, immune suppressives

40 Duchenne’s Muscular Dystrophy
Inherited, x-linked, recessive disorder Seen only in males Occasionally no family history Rapidly progressive wasting of skeletal muscles First in lower extremity & pelvis, then generalizes Usually appears by 6 YOA Cause of death: respiratory insufficiency usually by 25 YOA

41 Duchenne’s Muscular Dystrophy
At first muscles appear larger Due to fat and CT infiltration Then atrophy (wasting, decrease in size) Then scarring & contractures Cardiomyopathy present in almost all cases

42 Neoplasms Osteogenic sarcoma Chondrosarcoma Malignant giant-cell tumor

43 Osteogenic Sarcoma Most common bone cancer
3rd most common cancer in adolescence Slightly more males Risk factors: radiation therapy, genetics Treatment: surgical, but mets later in 80% Most in long bones Femur, tibia, humerus (in that order)

44 Chondrosarcoma 2nd most frequent primary bone cancer (25%)
Malignant tumor of cartilage Mostly over 40 YOA (mostly geriatric) Affects pelvis, femur, humerus, ribs

45 Giant Cell Tumor Multinucleated cells
5-10% of all giant cell tumors are malignant Recurs locally about 50% of the time Only 4-5% of all bone tumors Mostly long bones Mostly 20-40YOA Relatively good Px after tumor excision


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