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Musculoskeletal Diseases and Disorders Chapter 15.

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Presentation on theme: "Musculoskeletal Diseases and Disorders Chapter 15."— 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:  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:  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:  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:  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:  Metabolic, renal, some genetics  S/S:  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  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  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:  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: 5-15 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:  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  3 rd 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  2 nd 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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