0. Essentials of Human Diseases and Conditions 4th edition
Margaret Schell Frazier
Jeanette Wist Drzymkowski

1. Chapter 7 Dieases and Conditions of the Musculoskeletal System

2. Learning Objectives List the functions of the normal skeletal system.
Distinguish among the pathologic features of lordosis, kyphosis, and scoliosis.
Describe the signs and symptoms of the most common form of arthritis.
Explain the importance of early diagnosis and treatment of Lyme disease.

3. Learning Objectives (cont’d.)
Describe the treatment of bone tumors, both benign and malignant.
Discuss the specifics of a physical examination when fibromyalgia is suspected.
Explain why joint disability results from gout.
Describe the picture of osteomyelitis and explain how it is treated.

4. Learning Objectives (cont’d.)
Describe the disability that results from advanced osteoporosis.
Explain why osteomalacia is termed a metabolic bone disease.
Distinguish between hallus valgus and hallus rigidus.
Distinguish between a strain and a sprain.
Explain the importance of proper treatment of dislocations.

5. Learning Objectives (cont’d.)
Describe the cause of shin splints.
List some factors that contribute to the development of plantar fasciitis.
Explain how torn meniscus is treated.
Describe the signs and symptoms of rotator cuff tears.

6. Chapter 7 Lesson 7.1

7. The Muscular System • Discuss the functions of the muscular system.
• What is muscle fiber made of?
• How is movement of the body and its internal organs accomplished?

8. The Muscular System (cont’d.)
The 3 Types of Muscles
striated (skeletal)
nonstriated (smooth)
cardiac
• What are differences among the three types of muscles? Refer to Figure 7-2 on page p. 277.
• How do voluntary and involuntary muscle classifications differ?
• What is the difference between origin and insertion of a muscle?

9. The Muscular System (cont’d.)

10. The Skeletal System • How many bones comprise the skeletal system?
• Discuss the balance of bone formation and bone reabsorption.
• Where and how are blood cells formed?
• What two substances are necessary for ossification?

11. The Skeletal System (cont’d.)
Types of Bones
long bones – humerus (upper arm)
short bones – carpal (wrist)
flat bones – scapula (shoulder)
sesamoid bones – patella (kneecap)
• Discuss the different types of bones.
• In which parts of the body are long bones found?
• What type of bone is the patella, or knee cap?

12. Joints • What is another name for joints?
• How do moveable and immoveable joints differ?
• What three types of material are found between between the bones?

13. Skeletal tissue
Ligaments: tough, dense, fibrous bands of connective tissue that hold bones together
Tendons: strong, tough cords of dense connective tissue that usually attach muscle to bone
Cartilage: semi-smooth, dense, supporting connective tissue
• Discuss the functionality of skeletal tissues. (Refer to Fig. 7-6, p. 280)
• What is an injury to a tendon called?
• What are fascia and bursae?
• Where is cartilage found?

14. Fibromyalgia
Fibromyalgia: a chronic pain condition associated with stiffness and tenderness that affects muscles, tendons, and joints throughout the body. The cause is unknown.
Eighteen tender points used in diagnosis
Treatment options
Stress reduction
Physical activity
Medications
• Besides stiffness and tenderness, what are some of the other characteristics
of fibromyalgia?
• What is substance P?
• What other conditions must be excluded before a diagnosis of fibromyalgia can
be made?

15. Major Spinal Disorders
Lordosis: an exaggerated inward curvature of the spine
Kyphosis: an abnormal outward curvature of the spine
Scoliosis: a lateral (sideways) curvature of the spine
• What are some of the possible causes of lordosis?
• What is Scheuermann disease?
• What is a probable cause of hunchback in older persons and post-menopausal women?
• What age and gender group is most likely to develop scoliosis?

16. Lordosis - Treatment Options
Weight loss
Exercises to strengthen abdomen
Pelvic tilt exercises

17. Kyphosis - Treatment Options
Exercises to strengthen muscles and ligaments
Back brace to stabilize condition
Spinal fusion and temporary immobilization
Vertebroplasty

18. Scoliosis - Treatment Options
Exercise to strengthen weak muscles
Back brace
Fusion of the vertebrae

19. Osteoarthritis
Osteoarthritis: the breakdown and eventual loss of cartilage of one or more joints
Causes:
aging process
heredity
injury
chronic diseases such as diabetes and obesity
• What is the most common form of arthritis?
• In which parts of the body does osteoarthritis usually appear?
• Why is osteoarthritis such a growing problem today?
• Discuss advertising for today’s prescription and OTC arthritis drugs.

20. Osteoarthritis (cont’d.)
Signs and symptoms
Spur formations on fingers
Degeneration of spinal vertebrae and pelvic joints
Diagnosis
Radiographic testing to exclude other causes
Treatment
Reduce inflammation, minimize pain

21. Lyme Disease
Lyme disease: an infectious bacteriological disease spread by deer tick bites
Caused by the bacterium Borrelia burgdorferi
Characterized by red, itchy rash with a red circle center (“bull’s-eye” rash)
Often characterized by flu-like symptoms such as headache, fever, joint pain, and fatigue
• What areas of the body can be affected by Lyme disease?
• What precautions can be taken to help prevent Lyme disease?
• What are methods of removing ticks?
• What diseases can Lyme disease be mistaken for?

22. Lyme Disease (cont’d.) Treatment Prevention removal of tick
oral antibiotics
intravenous antibiotics
bed rest and physical therapy
Prevention
avoid tick bites by wearing long clothing
inspect clothes and body for ticks

23. Osteomyelitis
Osteomyelitis: a serious infection of bone that requires aggressive antibiotic treatment
Caused by bacterial organisms, viruses, and fungi
Characterized by inflammation, swelling, redness, pain, localized heat, and tenderness
• What conditions must be ruled out before a diagnosis of osteomyelitis can be made?
• Who is most likely to be susceptible to osteomyelitis?
• In infants and children, osteomyelitis can develop as a secondary infection from what condition?

24. Osteomyelitis (cont’d.)
Treatment
long-term antibiotic treatment
increased intake of proteins and vitamins A, B, and C
bed rest
control of chronic conditions
Immobilization of affected part

25. Gout
Gout: a chronic disorder of uric acid metabolism that manifests an acute, episodic form of arthritis
Causes
Overproduction or decreased excretion of uric acid
high levels of uric acid in the blood
high levels of uric acid in synovial fluid in joints and tissues
• What area of the body does gout typically affect?
• What dietary modifications can help in treatment of gout?
How is kidney function related to gout?

26. Gout (cont’d.) Treatment
bed rest to reduce pressure on affected joints
application of ice to inflamed joints
NSAIDs and corticosteroids
low-purine diet and frequent fluid intake
antihyperuricemic medications
Dairy products have been shown to reduce frequency of gouty arthritis.
Pain can be acute and severe with mild systemic symptoms.
Treatment with pain medication is urgent with gouty arthritis.

27. Musculoskeletal Tumors
Bone tumor: any abnormal growth (whether benign or malignant) in the bone
chondrogenic (from cartilage)
osteogenic (from bone)
fibrogenic (from fibrous tissue)
Muscle tumor: muscle neoplasms, benign or malignant sarcomas, that may arise at any site in the body
• What is the most common type of primary bone neoplasm?
What is the most common presenting complaint for bone tumors?
• What is a pathologic fracture?
• What areas of the body are most commonly affected by muscle tumors?

28. Musculoskeletal Tumors (cont’d.)
Symptoms
milignant tumors have characteristic signs
palpable mass; dull, localized pain
pathologic fracture, commonly in acetabulum or proximal femur
Diagnosis
radiographic studies,MRI, CT scan, biopsy
elevated serum alkaline phosphatase
elevated serum calcium
Treatment
surgical excision
chemotherapy/radiation therapy
• Are most muscle tumors malignant or benign?

29. Chapter 7 Lesson 7.2

30. Osteoporosis
Osteoporosis: a condition characterized by loss of normal bone mass and density due to imbalance between breakdown of old bone tissue and manufacture of new bone
• Why is osteoporosis classified as a metabolic bone disease?
• Name some of the possible causes of osteoporosis.
• Why is osteoporosis called a “silent” disease?
• What groups are most at risk and should have annual bone density tests?

31. Osteoporosis (cont’d.)
Symptoms
asymptomatic until bone breaks
spontaneous fractures and loss of height are the most common signs
Treatment
increased intake of calcium and vitamin D
estrogen replacement therapy
bisphosphonate medications
moderate exercise

32. Osteomalacia
Osteomalacia: a disease characterized by a defective mineralization of the bones, causing them to become soft, flexible, and deformed
When osteomalacia occurs in children, it affects the growing skeleton and is called rickets
• What are possible causes of osteomalacia?
• What is the difference between osteomalacia and rickets?
• What is the relationship of vitamin D to osteomalacia and rickets?

33. Osteomalacia (cont’d.)
Symptoms
general fatigue
muscle weakness
progressive stiffness
tender, painful bones
Treatment
vitamin D supplements
add vitamin D, calcium, and calcitonin to diet
exposure to sunlight

34. Hallus Valgus & Hallus Rigidus
Hallus Valgus (Bunion): a localized area of enlargement of the inner portion of the metatarsophalangeal (MTP) joint at the base of the big toe
Hallus Rigidus (Rigid Big Toe): a stiff big toe that develops as a result of degeneration of the cartilage of the first metatarsophalangeal (MTP) joint
• What are some of the possible causes of bunions?
• What are arthrodesis and arthroplasty?
• What role does footwear play in treatment of bunions and rigid big toe?

35. Hallus Valgus & Hallus Rigidus (cont’d.)
Symptoms
painful bunions
MTP joint becomes stiff, painful, and swollen
Treatment
wearing shoes with more room
application of ice
anti-inflammatory agents
for hallux rigidus, removal of bone spurs

36. Traumatic and Sports Injuries
Fractures (broken bones): caused by stress on the bones resulting from a traumatic insult to the musculoskeletal system, severe muscle spasm, or bone disease
• Discuss different types of fractures (Refer to Fig pp. 305, 306)
• Name some of the technologies used in diagnosing fractures.
• What are some immobilization techniques?

37. Traumatic and Sports Injuries (cont’d.)
General treatment of fractures depends on location, severity, type, and cause
simple fracture of long bone: reduction and immobilization
compound fracture: cleaning, debriding, reduction, immobilization
internal fixation (open reduction)

38. Traumatic and Sports Injuries (cont’d.)

39. Traumatic and Sports Injuries (cont’d.)

40. Traumatic and Sports Injuries (cont’d.)
Strains: injured tendons, muscles or other tissues resulting from overuse, overstretching, or excessive forcible stretching of the tissue beyond its functional capacity
Sprains: acute partial tears of a ligament
• Discuss the differences between strains and sprains.
Which is considered the more serious injury?
• Which symptoms do strains and sprains have in common?
• What is the difference between acute and chronic trauma?
• How long does it normally take for strains and sprains to heal?

41. Treatment of Strains and Sprains
Elevation and rest of affected limb
Immobilization with elastic bandage
Application of ice
Analgesics and anti-inflammatory agents

42. Traumatic and Sports Injuries (cont’d.)
Dislocation: the forcible displacement of a bone from its joint, causing loss of joint function
Treatment
Proper repositioning of joint within 30 minutes of injury
• Discuss the three most common causes of dislocation.
• What are possible consequences of untreated dislocation?
• Which joints are especially susceptible to recurring dislocation?
• What is Ehlers-Danlos syndrome?

43. Traumatic and Sports Injuries (cont’d.)
Severed tendon: caused by injury or laceration; involves the forearm, hand, calf, or foot. The severed ends snap away from each other.
Symptoms: immediate, severe pain, inflammation and immobility
Treatment: tenorrhaphy (suturing of the two ends of the tendon)

44. Traumatic and Sports Injuries (cont’d.)
Shin splints: a painful condition involving inflammation of the periosteum, the extensor muscles of the lower leg, and the surrounding tissues
Symptoms: inflammation, edema, pain on inner aspect of the tibia
Treatment: rest plus applications of ice or heat
• What are the two most common causes of shin splints?
• Discuss the relationship of pronation to shin splints.
• When do shin splints usually begin to appear?

45. Traumatic and Sports Injuries (cont’d.)
Plantar fasciitis: an inflammatory response at the bottom of the heel bone, generally caused by overuse
Symptoms: pain on bottom of foot
Treatment:
application of ice
anti-inflammatory medication
heel pads
cortisone
• What is the plantar fascia and what is its function? (Refer to Figure 7-30 p. 315)
• What conditions must be ruled out before plantar fasciitis can be diagnosed?
• Which people are most susceptible to plantar fasciitis?

46. Traumatic and Sports Injuries (cont’d.)
Torn meniscus: a crack or fissure to the meniscus cartilage in the knee joint
Symptoms
acute pain when putting full weight on affected leg and knee
snapping or clicking on flexion or extension
Treatment
immobilization and elevation
surgery
• What are the two types of meniscus cartilage in the knee joint?
(Refer to Figure 7-32 p. 317)
• What is the preferred technology for diagnosing torn meniscus?
• Discuss arthroscopic surgery.

47. Traumatic and Sports Injuries (cont’d.)
The rotator cuff: the four tendons of the rotator cuff, formed by the muscles of the shoulder, partially surround the head of the humerus and stabilize it in the glenoid cavity of the socket
Rotator cuff tears: tears to any of the rotator cuff tendons that limit the function of the shoulder
• What are the two major cause of rotator cuff tears?
• What is the usual treatment program for acute rotator cuff tendon tears?
• Which athletes are most susceptible to rotator cuff injury, and why?