1 / 34

Diseases of the Musculoskeletal System

Diseases of the Musculoskeletal System. Chapter 37. Skeletal. Skeletal trauma/fractures Incidence Young males and older adults Tibia, clavicle, lower humerus (young persons) Hands, feet -- workplace accidents Upper femur, upper humerus, vertebrae, pelvis (elderly) Osteoporosis

haamid
Download Presentation

Diseases of the Musculoskeletal System

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Diseases of the Musculoskeletal System Chapter 37

  2. Skeletal • Skeletal trauma/fractures • Incidence • Young males and older adults • Tibia, clavicle, lower humerus (young persons) • Hands, feet -- workplace accidents • Upper femur, upper humerus, vertebrae, pelvis (elderly) • Osteoporosis • Diff types (complete/incomplete, open/closed) • Incomplete -- bones of children • Flexible • Growing • Stress w/ repeated stress (ex athletics) • Fatigue • Insufficiency (weight bearing bones)

  3. - Pathophysiology • Healing similar to soft-tissue injuries stages • No scar tissue • Periosteum, blood vessels disrupted • Bleeding  clot form=n (hematoma) • Stages • Hematoma • Procallus form=n • Intense inflammatory response • Fibroblasts, collagen, growth factors, osteoblasts impt • Callus • Hardened membr (woven bone) • Remodeling • Osteoclasts;  original shape • Resorption unneeded callus

  4. Clinical • Signs/symptoms • Impaired function • Unnatural alignment; possible rotation, angulation • Swelling • Tenderness • Severe pain (trauma, muscle spasm) • Stress fractures -- pain with accelerated remodeling • Relieved by rest • Treatment • Realign to normal position (manipulation, traction) • Surgery • Prosthesis, screw, plate, etc., possible • Splints, casts

  5. Metabolic bone disease (Osteoporosis) • remodeling imbalance favors bone resorption • Incidence • Common disorder of bone metabolism • Heredity evidence in women • Fracture due to bone weakness • Common -- vertebrae, distal radius, proximal femur • Fractures after trauma • Compression fractures (esp vertebral) • Non-symptomatic until indicated by fracture

  6. Pathophysiology • Age  • Bone resorption exceeding bone growth •  Net bone mass loss • More rapid in women • Exaggerated at menopause • Type I (Postmenopausal) • Type II C both sexes over age 70 • Neck, hip, humerus, tibia • May involve postaglandins, interleukins, various growth factors that affect osteoclasts • Estrogen decr w/ menopause  incr=d risk • Estrogen inhibits bone resorption • Also in young, female athletes • Training  decr=d estrogen • Found decr=d bone mass, incr’d fractures

  7. Clinical • Pain • Bone deformity • Fractures • Vertebral collapse  hunchback, decr=d height • Treatment C slow rate of Ca, bone loss • Incr dietary Ca • Vit D  incr intestinal abs=n Ca • Regular, moderate exercise • Hormone treatment (estrogen, progesterone) • Reduce risk of falls

  8. Bone tumors • Common secondary tumor site • Primary often prostate, breast, thyroid, lung, kidney • Access through blood • Often axial skeleton (not skull), proximal femur, humerus • May induce bone breakdown or bone growth

  9. Primary tumors less common • Actively growing bone • Pain early indication • May  bone weakening • Pressure  adjacent bone deformed by abnormal remodeling • Metastasis often to lung • Most more in males than females • About 1/3 primary tumors benign • Ex: osteoma of skull and osteoid osteoma of long bone • Ex: chondroblastoma • Arises in cartilage of epiphyses of arm, leg bones • Rare

  10. Malignant bone tumors • Osteogenic sarcoma (=osteosarcoma) most common • Usually age 10-20 years • Knee often • Common metastasis  lung • Previous metastasis by time of diagnosis  poor prognosis • Now better chemotherapy (80% 5 yr recovery rate) • Surgery often • Chondrosarcoma • Usually age 30-50 yrs • Slow-growing • May break through bone surface • Interior of pelvis, ribs, prox femur, humerus • Surgical excision

  11. Diseases of the Joints • Osteoarthritis = Degenerative Joint Disease • Incidence • Most common joint disease in US • Incr=s w/ age • Age 60 -- most affected • > 75 yrs -- 85% affected • Pathophysiology • Articular cartilage becomes thin, irregular, frayed • Probably enz breakdown of cartilage •  Cracks, fissures in articular cartilage • Fill w/ synovial fluid

  12. Pathophys (cont’d) • Penetrates to underlying bone w/ progression • May  fluid-filled cysts • Bone forms around cysts • May  microfractures • Fibrocartilage plugs form for repair • Activyt  plugs stripped away, then reformed, then restripped •  Smooth bone surface • Fibrocartilage fragments may react at synovial membr surface •  inflamm response C> repair •  decr=d movement • Cells in synovial membr may dev into osteoblasts •  form=n bone spurs at joint •  pain, decr=d movement

  13. Degeneration • Mostly at larger weight-bearing joints (also fingers) • Related to • Wear-and-tear OR • Biochem defect in joint cartilage OR • Excessive loading (malformed joint, postural defect, obesity) OR • Genetic • Clinical • Joint aches, stiffness • Incr w/ activity; diminish w/ rest • Progression w/ age • Loss of mobility if hip, knee affected • Therapy limited • Analgesics for pain • Reduce obvious stresses • Surgical removal of bone spurs or artificial joint replacement

  14. Rheumatoid arthritis C systemic disease involving joints • Incidence • About 1% adult pop=n affected • 3 female: 1 male • Age of onset usually 20-30 (but also infancy  90's) • May be due to • Infection • Autoimmune disorder • Genetic predisposition

  15. Get immune-mediated destruction of joints • Environmental stimulus immune response to Ag • If predisposed, Ab=s transform to Arheumatoid factors@ (Rfs) • Rfs complex in blood, synovial fluid inflamm response at joint • Inflamm mediators breakdown joint tissue  joint tissue destroyed

  16. Get pattern of chronic inflamm=n • Incr=d number of cells in synovium •  Thickening of synovium (maybe after cartilage destroyed by inflamm=n process) • Thickened synovium covers adjacent joint surfaces • Over time may enlarge, fill joint space • In late stage = ankylosis = fused joint • Causes swelling; stiffness; pain • Swelling also due to incr=d exudate in synovial membr • Joint deformities •  Loss of joint motion •  Muscular atrophy

  17. Sytemic effects variable • Generalized weakness, malaise • Rheumatoid nodules form • Focal subcu swelling • Elbow, heel, dorsal surface of head; also internal • Made of macrophages, lymphocytes, collagen, cell debris • Typically painless • Rheumatoid vasculitis common • Systemic inflamm=n of blood vessels • May involve pericardium, pleural effusion • Therapy C no cure; can’t reverse destruction of structures • Relieve pain, reduce swelling (antiinflammatories) • Reduce stress • Strengthen assoc=d muscles • Replace severely effected joints

  18. Diseases of Skeletal Muscle • Disuse atrophy • Pathologic reduction in size of muscle fibers • Follows prolonged bed rest, trauma, nerve damage • Muscle strength decr=s from baseline • About 3% per day • To prevent • Frequent isometric muscle contractions • Passive lengthening exercise • If no reuse in 1 year, regen=n muscle fibers impaired

  19. Fibromyalgia • Chronic musculoskel syndrome • Get diffuse chronic pain, tenderness w/ no inflamm=n, fatigue • Tenderness @ 9 common points in body (neck, shoulders, hips, knees) • Profound fatigue • May  depression • Also migraine, irritable bowel disease common • Incidence • Mostly women • Peak age = 30-50 yrs • Increases w/ age

  20. Probably several causes • virus, • Phys/emotional trauma, emotional trauma, • medication • Found metab alterations in muscle • May  pain, fatigue • Also found diff blood flow to thalamus • May C> chronic stress response • Treatment • Antiinflammatories (not very effective) • CNS active agents somewhat helpful

  21. Muscle Strains • Gen’l term for muscle damage • Seen after traumatic, sports injuries • Sudden, forced motion • Muscle becomes stretched beyond normal length • May include wounds • Often involves tendon also • May include hemorrhage, inflamm=n • Muscle cells usually regenerate in up to 6 weeks • Treatment • Ice relieves swelling • Analgesics • Alternating heat/cold if more severe form • Surgery, immobilization if tearing, bleeding

  22. Musculoskeletal Disorders • May accompany fractures, dislocations • Ligament = fibrous connective tissue band joining bones @ joint • Needed to support bones, joints • Strain = tear in tendon • May be due to major trauma • Also spontaneous w/ corticosteroid admin, rheumatoid arthritis, lupus

  23. Common sites • Tendons of hands, feet • Knee • Upper arm - w/ lifting excess wt • Thigh • Ankle • Heel - w/ forced flexion • Sprain = tear in ligament • Common sites • Wrist • Ankle • Elbow • Knee

  24. Avulsion = total sep=n tendon/ligament from bone • Due to abnormal stress • Young athletes (sprinters, hurdlers, runners) • Pathophysiology • Tearing  inflamm response • Exudate forms @ torn ends • Macrophages, fibroblasts • Repair • Collagen form=n random, then organized • Vascular fibrous tissue fuses new, old tissues • Healing tendon separates from surrounding soft tissue • Can=t support strong pull for 4-5 weeks

  25. Clinical • Pain C sharp, localized • Soft-tissue swelling • Joint swelling • Flexion deformities • If in extremities, motion affected • Treatment • Suture tendon/ligament • Tendon/ligament grafting

More Related