1 / 60

Diseases of the Musculoskeletal System

Diseases of the Musculoskeletal System. Steve Sandiford MBBS DM I Candidate/QEH. http://healthlibrary.stanford.edu/resources/bodysystems/musc_muscle.html http://orthoinfo.aaos.org/menus/diseases.cfm. Definitions…. Bones Muscles, tendons, ligaments Connective tissue Joints, cartilage.

gloriacook
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 Steve Sandiford MBBS DM I Candidate/QEH http://healthlibrary.stanford.edu/resources/bodysystems/musc_muscle.html http://orthoinfo.aaos.org/menus/diseases.cfm

  2. Definitions… • Bones • Muscles, tendons, ligaments • Connective tissue • Joints, cartilage

  3. Form; Stability; Movement; Protection

  4. Topics… • Metabolic bone disease • Tumors • Arthritis • Repetitive stress injuries

  5. Patient presentation… • 76 yo white f • Bending over in garden 3 days ago • Sudden back pain • Mid thoracic area

  6. Physical examination Kyphosis Antalgic gait Tenderness at T9 Normal neuro exam

  7. Xray T9 Normal bone: Abnormal loads Abnormal bone; Normal loads

  8. Work up… TOMEO • Tumor screening • Osteopenia screening • Marrow screening • Endocrine screening • Osteomalacia screening Tumor Osteopenia Marrow Endocrine Osteomalacia Metabolic; Tumor; Haematologic

  9. Work up… Tumor Osteopenia Marrow Endocrine Osteomalacia FBC, ChemistriesSerum electrophoresisBence Jones proteins (MM)Thyroid function testsDiabetes evaluation Tc bone scan (metastases?)CT, MRI

  10. Osteoporosis Osteomalacia Decreased Normal Bone mass Decreased Decreased Mineralization(Calcium content) Osteoporosis: decreased bone formation…. osteoblasts; increased resorption…. osteoclasts

  11. Osteoporosis Normal Osteoporosis Shoulder; wrist; hip; vertebrae

  12. Osteoporosis Type 11 Senile: M:F 2:1Cortical & trabecular Type 1 Post menopausalEsp trabecular bone Secondary osteoporosisHigh turnover osteoporosis Diabetes mellitusHyperparathyroidism, Hyperthyroidism Cushing's, Corticosteroid use

  13. Risk factors: osteoporosis CaucasianEarly menopauseCigarette smokingXS caffeineXS alcoholExercise induced amenorrheaInactivity DietaryHigh fibreHigh proteinHigh phosphate

  14. Work up… Densitometry Site Distal radius, calcaneus Spine, radius, hip, total body Spine Phalanges Single energy x-rayabsorptiometry Dual energy x-rayabsorptiometry:DEXA QuantitativeCT... most accurate Radiographicabsorptiometry

  15. Work up… Densitometry Physics Xray tube emits 1 or 2 beams;Attenuation detected by photon counter. 1-3 rads CT density calculations cp known phantom. 100-200 rads Xrays of hand and aluminum wedge reference. 1-3 rads Single energy x-rayabsorptiometry Dual energy x-rayabsorptiometry (DEXA) QuantitativeCT Radiographicabsorptiometry

  16. Osteoporosis Rx… Increase bone mass Calcium 1500mg, Vit D 400 unitsDi-phosphonates Fluorides Calcitonin: nasal spray ( osteoclasts)Estrogen + progestin Exercise Fosamax(Alendronate) oral; 10mg/day; 10% increase bone mass Decrease bone loss

  17. Estrogen & progesterone Contraindications Hx breast caThromboembolismEndometrial disease Pre-Rx gyn examination ES receptors on osteoblasts and osteoclasts

  18. Osteomalacia (Adult rickets) Vit D deficiencyDietaryMalabsorption Impaired Vit D synthesisLiver diseaseRenal diseaseHypophosphatemia Decreased available Calcium

  19. Osteomalacia … Pseudofracture (Looser’s zones) Osteomalacia Rx… Nutritional osteomalacia responds well to administration of 10,000 IU weekly of vitamin D for 4 to 6 weeks

  20. Bone Tumors Margins Well defined Sclerotic(Benign) Poorly defined Cortical breakthrough(Malignant) Metastasis from: Breast Prostate KidneyThyroid GI tract Matrix AppearanceDensity +/- calcification Architecture Metastasis more common than primary bone tumors

  21. Multiple myeloma Punched-out lesions Most common primary malignancy of bone (2.5-100,000)Malignant plasma cells.. Abnormal ImmunoglobulinsBence Jones proteins (urine); Serum Protein electrophoresis ChemoRx

  22. Xray appearance.. bone tumors Cloudy, blotchy Matrix Speckled calcification Cloudy, blotchy Hazy ground glass Permeative Moth eaten Honeycomb, soap bubble Prostate ca. (Pagets)

  23. Xray appearance.. bone tumors Matrix Speckled calcification Cloudy, blotchy Hazy ground glass Permeative Moth eaten Honeycomb, soap bubble Permeative motheaten met. breast

  24. Xray appearance.. bone tumors Soap bubble Honeycomb Matrix Speckled calcification Cloudy, blotchy Hazy ground glass Permeative Moth eaten Honeycomb, soap bubble Chondromyxoid fibroma Non-ossifying fibromaAneurysmal bone cyst

  25. Xray Unicameral bone cyst(well defined) Margins Well defined Sclerotic Poorly defined Cortical breakthrough

  26. Xray appearance.. bone tumors Codman’s triangle (Seen also in osteomyelitis) Osteosarcoma

  27. Number of disordersSoft tissuesNerve entrapmentsTendinitis Repetitive Stress Injuries Cumulative Trauma Disorders

  28. Presentation Specific entities Carpal Tunnel Syndrome Tennis elbow De Quervains Sub-acromial syndromes Cervical radiculopathy Abnormal posture Repetitive micro-trauma

  29. Cumulative trauma Occupational hazard? Hairdresser Computer keyboard

  30. At risk! Power tools… Vibration

  31. Cumulative trauma Entrapment neuropathiesCarpal Tunnel Syndrome

  32. Carpal Tunnel Syndrome Night Sx: pain, dysesthesias Thenar Muscle wasting Tinnel’s test Phalen’s test Nerve conduction tests!!!Bilateral!!! Rx: NSAID’s.. Brace.. Steroid injection.. Surgery

  33. Sub-acromial syndromes Younger… trauma Older… degenerative CausesPatient factors: arthritis, anatomy, shape of bones External factors: sports, injury, work activity 54% over 60yrs have partial/complete tears

  34. Repetitive overhead motions

  35. Treatment Pain? Tear? If on exam.. cant abduct against resistance Sub acromial injection steroid+lidocaine Attempt abduction against resistance Surgery: Subacromial decompression

  36. Cumulative trauma Lateral EpicondylitisTennis Elbow Which muscles involved??

  37. Tennis elbow NSAID’sBracingSteroid injectionSurgery Extensor Carpi radialis brevis/longus

  38. Arthritis Degenerative (Osteoarthritis)Joint space narrowing; sclerosis; sub-chondral cyst; osteophytes; joint deformity; wt bearing jointsRx: analgesics; steroid (joint) injection Inflammatory (Rheumatoid arthritis)Auto-immune; polyarthritis75%pts Rh Factor (Abnormal Ig)Rx: analgesics; splinting; methyltrexate; prednisone.

  39. Joint Replacement Knee Hip http://www.bio.davidson.edu/Courses/Immunology/Students/Spring2003/Super/rheumatoidarthritis.htm

  40. Scoliosis

  41. Idiopathic Congenital Neuromuscular Abnormal vertebral formation Atrial Septal defectAbnormal kidney Trauma Tumors

  42. PA 15 yo 84R Observation… BracingSurgery: Arthrodesis & instrumentation

  43. Child with a limp Spine.. Hip.. Knee.. Foot/ankle Abnl neuro exam:Reflexes, BabinskiBladder/bowelBalanceFocal WeaknessBack pain at nightFevers... Weight lossLeg length discrepancy SpineNeoplasmInfectionTraumaScoliosis

  44. The hip Decreased ROM esp Internal Rotation Severe pain on ROM: Infection Transient synovitisSeptic hipSUFE AVN/ Sickle CellPerthes

  45. The hip Slipped Upper Femoral Epiphysis Age 11-13Obese boysEndocrine (hypoTh) AP & lateral xrays

  46. The hip SUFE Treatment

  47. The hip CRP, ESR, WBC, Temp Septic Hip…. Transient synovitis Xray/UltrasoundAspirate C&S, Gm stain Cell Ct (>50,000) IV antibiotics (Staph) INCISION & DRAINAGE Pain, poor ROM WBC >12,000ESR >40FeverNot Wt.Bearing

  48. The knee 12 year old boy LimpAnterior knee pain (tibial tubercle); worse when doing high jump; no night pain No trauma

  49. The knee Osgood Schlatters Fatigue fractures at growth plate of Tibial Tubercle apophysis (11-13yo) Pain on flexion Rx: rest, bracing

  50. The knee Blounts Infantile 3y Adolescent 10y Medial physis, epiphysis & metaphysis Varus deformity RX: Brace. Surgery (osteotomy)

More Related