1. Skeletal System Diseases and Disorders

2. Arthritis Rheumatoid Rheumatoid Osteoarthritis Osteoarthritis Juvenile Rheumatoid Arthritis Juvenile Rheumatoid Arthritis

3. Rheumatoid Arthritis Chronic disease Chronic disease Joints become inflamed and painful Joints become inflamed and painful Small joints of hands and feet affected first and moves to larger joints Small joints of hands and feet affected first and moves to larger joints More common in women More common in women ETIOLOGY – Thought to be autoimmune ETIOLOGY – Thought to be autoimmune

4. Rheumatoid Arthritis Diagnosed by blood test – rheumatoid factor present AND Diagnosed by blood test – rheumatoid factor present AND X-rays – boney changes X-rays – boney changes TX: Heat and medications to reduce inflammation and pain TX: Heat and medications to reduce inflammation and pain

5. Rheumatoid Arthritis

7. Osteoarthritis Chronic disease Chronic disease Joints have loss of articular cartilage and hypertrophy of bone at articular surfaces Joints have loss of articular cartilage and hypertrophy of bone at articular surfaces Mainly in hips and knees of older people Mainly in hips and knees of older people ETIOLOGY: Can be due to “old” injuries ETIOLOGY: Can be due to “old” injuries

8. Osteoarthritis Tx: Medication to reduce pain and inflammation Tx: Medication to reduce pain and inflammation Physical Therapy to loosen impaired joints Physical Therapy to loosen impaired joints Most common reason for joint replacement surgery Most common reason for joint replacement surgery

9. Normal Knee Knee with OA Osteoarthritis

10. Osteoarthritis Normal knee in figure 1 Narrow joint space and bone spur in figure 2

11. Juvenile Rheumatoid Arthritis Most common form of arthritis in children under age 16 Most common form of arthritis in children under age 16 Joint pain, swelling, and stiffness Joint pain, swelling, and stiffness Fever, rash, swollen lymph glands Fever, rash, swollen lymph glands Can cause growth problems and eye inflammation Can cause growth problems and eye inflammation ETIOLOGY: Autoimmune ETIOLOGY: Autoimmune

12. Juvenile Rheumatoid Arthritis Treatment Controlling pain Improving function Preventing joint damage

13. JRA Kelly Rouba, a communications and emergency management specialist for the state of New Jersey, has been coping with JRA from a very young age, and her experiences inspired her to write the book Juvenile Arthritis: The Ultimate Teen Guide.

14. Osteomyelitis Infection or inflammation of a bone Infection or inflammation of a bone Fever Fever Pain in area of infection Pain in area of infection Swelling, warmth and redness over area of infection Swelling, warmth and redness over area of infection

15. Osteomyelitis ETIOLOGY: Most cases are caused by Staphylococcus bacteria ETIOLOGY: Most cases are caused by Staphylococcus bacteria Can enter through the bloodstream Can enter through the bloodstream Nearby infection such as an infected puncture wound Nearby infection such as an infected puncture wound Direct contamination such as with a compound fracture and surgeries Direct contamination such as with a compound fracture and surgeries

16. Osteomyelitis Treatment Treatment Antibiotics through IV for 4 to 6 weeks Antibiotics through IV for 4 to 6 weeks Surgery to removed infected bone Surgery to removed infected bone

17. Osteomyelitis Osteomyelitis of proximal phalanx of 4 th digit.

18. Osteoporosis New bone growth does not keep up with old bone removal New bone growth does not keep up with old bone removal Bones become weak and brittle Bones become weak and brittle Bending over or coughing can cause fracture Bending over or coughing can cause fracture Hip, wrist and spine – most common places of fracture Hip, wrist and spine – most common places of fracture

19. Osteoporosis Symptoms Symptoms Asymptomatic in early stages Asymptomatic in early stages Back pain Back pain Loss of height Loss of height Stooped posture Stooped posture Bone fractures occur more easily than expected Bone fractures occur more easily than expected

20. Osteoporosis Treatment Treatment Bisphosphonates Bisphosphonates Estrogen in post menopausal women Estrogen in post menopausal women

21. Osteoporosis Normal Bone Osteoporotic Bone

22. Carpal Tunnel Compression of median nerve on anterior side of wrist. Compression of median nerve on anterior side of wrist. Burning, tingling, and itching numbness of palm, thumb, index and 3 rd fingers, and radial side of the 4 th finger Burning, tingling, and itching numbness of palm, thumb, index and 3 rd fingers, and radial side of the 4 th finger

23. Carpal Tunnel ETIOLOGY ETIOLOGY Predisposition: Carpal tunnel smaller in some people Predisposition: Carpal tunnel smaller in some people Injury to wrist Injury to wrist Repetitive movements of wrist Repetitive movements of wrist Vibrating hand tools Vibrating hand tools Idiopathic Idiopathic

24. Carpal Tunnel Treatment Treatment Anti-inflammatory medications Anti-inflammatory medications Cortisone injection into carpal tunnel Cortisone injection into carpal tunnel Splints to immobilize Splints to immobilize If above does not work, surgical release of carpal ligament If above does not work, surgical release of carpal ligament

25. Carpal Tunnel

26. Ankylosing Spondylitis Inflammatory disease that can cause vertebrae to fuse Inflammatory disease that can cause vertebrae to fuse Can result in hunched forward posture Can result in hunched forward posture

27. Ankylosing Spondylitis Etiology Etiology No known specific cause No known specific cause Appears to be genetic Appears to be genetic

28. Ankylosing Spondylitis Treatment Treatment Medication to reduce pain, inflammation and stiffness Medication to reduce pain, inflammation and stiffness Physical Therapy for strengthening and flexibility Physical Therapy for strengthening and flexibility

29. Ankylosing Spondylitis Progression of Ankylosing Spondylitis

30. Scoliosis Lateral curvature of the spine Lateral curvature of the spine Treatment Treatment Bracing to prevent progression Bracing to prevent progression Surgery: fusion of vertebrae Surgery: fusion of vertebrae Harrington rods if child is still growing. Harrington rods if child is still growing. –Rods can be lengthened every 6 months

31. Scoliosis-before/after

32. Kyphosis- humpback often due to osteoporosis

33. Lordosis-swayback