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