PATHOLOGIES OF THE SKELETAL SYSTEM

1. PATHOLOGIES OF THE SKELETAL SYSTEM

2. Osteosarcoma • Definition: • Rare form of cancer that originates in bone tissue • Not the same as metastasis to bone • Most common in adolescents and young adults

3. Osteosarcoma, cont. • Etiology: what happens? • Bone grows most quickly in young people; this is where cancer is most likely to occur. • Usually grows as one major tumor at a time, near growth plates of long bones. • No risk factors identified other than • Age • Childhood exposure to radiation • Genetic predisposition

5. Osteosarcoma, cont. • Signs and Symptoms: • Silent until well established • Pain with activity, then also at rest • (looks like “growing pains”) • Palpable mass on affected bone • Metastasis to lung with respiratory symptoms

6. Osteosarcoma, cont. • Treatment: • Surgery • Medications: • Chemotherapy (high relapse rate) • Drugs to manage chemotherapy side effects

7. Osteosarcoma, cont. • Massage • Risks: Early symptoms may lead patients to seek massage. In established cases, fractures are possible. Always accommodate for cancer treatment challenges. • Benefits: Massage can improve mood, lessen anxiety and depression, promote sleep, and mitigate some side effects of treatment. A client who has fully recovered can also enjoy massage.

9. Osgood-Schlatter Disease • Definition: • Irritation and inflammation at quadriceps attachment on tibia • AKA: tibial tuberosity apophysitis

10. Osgood-Schlatter Disease, cont. • Etiology: what happens? • Rapid bone growth, especially at tibia and femur during adolescence • Soft tissues may not keep up • Quads are taxed with athletics • Stress at attachment leads to pain and inflammation • Tibial tuberosity enlarges; microscopic fractures, possible avulsion • Usually unilateral

11. Osgood-Schlatter Disease, cont. • Signs and Symptoms: • Almost always among athletic teens • Acute: tibial tuberosity is hot, swollen, painful • Subacute: permanent remodeling of tibial tuberosity

12. Osgood-Schlatter Disease, cont. • Treatment: • Goals: reduce pain, limit damage to quad attachment • Careful heating, warming up before activity • Cooling down and stretching • Rest if necessary • Brace or cast followed by rehabilitative exercises • Surgery if necessary • Medications: • NSAIDs for pain and inflammation

13. Osgood-Schlatter Disease, cont. • Massage • Risks: Local massage may exacerbate symptoms during acute flares. • Benefits: Lymphatic work may help reduce edema and pain. Later, any work around the knee and generally that is well-tolerated is fine to ease pain, increase flexibility, and reduce tension in the quads.

15. Osteoporosis • Definition: • Porous bones: calcium is removed faster than replaced • Affects about 10 million in US • Many more are osteopenic • Women vastly outnumber men

16. Osteoporosis, cont. • Etiology: what happens? • Bone density increases until about age 30 • Then bone density remains stable or decreases

17. Osteoporosis, cont. • Noncontrollable risk factors: • Being female • Body size • Ethnicity • Family history

18. Osteoporosis, cont. • Controllable risk factors: • Hormone levels • History of anorexia • Calcium, vitamin D • Medications • Sedentariness • Diet • Cigarette, alcohol use

19. Osteoporosis, cont. • Factors that affect bone health: • Calcium absorption from diet • Requires highly acidic environment, vitamin D, vitamin K • Calcium loss • Accelerated with caffeine, soda, some medications, smoking, alcohol use, some conditions • Bone density maintenance • Hormonal signals, especially to trabecular bone

21. Osteoporosis, cont. • Signs and Symptoms: • Silent while early • Pathologically weak bones, spontaneous fractures • Hip, vertebral bodies, wrists • Slow healing

22. Osteoporosis, cont. • Treatment: • Pharmaceutical interventions plus • Exercise • Dietary adjustments • Medications: • Vitamin and mineral supplements • Hormone replacement therapy • SERMs • Bisphosphonates • Parathyroid hormone • RANK ligand inhibitors

23. Osteoporosis, cont. • Massage • Risks: Beware of fracture risk, positioning; elderly clients may have other disorders along with osteoporosis. • Benefits: Massage won’t reverse this, but it can ease pain and may improve range of motion. • Options: Clients may need imaginative bolstering to be comfortable on the table.

25. Postural Deviations • Definition: • Overdeveloped spinal curves: • Hyperkyphosis (“humpback”) • Hyperlordosis (“swayback”) • Scoliosis (“S”, “C” or “Reverse- C” curve)

27. Postural Deviations, cont. • Etiology: what happens? • Functional problem: soft tissue tension • Structural problem: bony distortion • Most cases are idiopathic • Some related to congenital problems: • Cerebral palsy, polio, muscular dystrophy, osteogenesis imperfecta, spina bifida…

28. Postural Deviations, cont. Types of postural deviations • Hyperkyphosis: over-developed thoracic curve, can be complication of osteoporosis, ankylosing spondylitis • Scheuermann disease: mostly affects young men, can create extreme “hunchback” appearance • Hyperlordosis: over-developed lumbar curve, can cause severe low back pain • Scoliosis, rotoscoliosis: common among teens, especially girls. Bending with twisting is rotoscoliosis.

29. Postural Deviations, cont. • Signs and Symptoms: • Can be subtle or extreme • Muscle tension, nerve impingement, chronic ache, loss of range of motion • Can lead to breathing and cardiac problems

30. Postural Deviations, cont. • Treatment: • If treated at all, mild cases are treated with osteopathic, chiropractic, or massage therapy. • Bracing if necessary • Surgery for very extreme cases

31. Postural Deviations, cont. • Massage • Risks: postural deviations that are a complication of underlying neurological disorders may not respond well to massage. Hyperkyphosis may be related to other issues that require adjustments in bodywork. • Benefits: massage may help to address the soft tissue influences on functional postural deviations (as opposed to structural deviations). • Options: addressing both hyper and hypotonicity appears to achieve the best results.

32. Bone Landmarks

33. Bone Landmarks • Distinctive lines, grooves, bumps, and projections make each bone unique (see Table 5-2) • Landmarks serve as attachment points for muscles or passageways for blood vessels and nerves • Some landmarks can be felt when palpating superficial tissue • Important to manual therapists because they help locate internal structures

34. Landmarks of Thorax • Sternum • Manubrium • Xiphoid process • 23 pairs of costals (see Figure 5-14) • True ribs • False ribs • Floating ribs

35. Landmarks of Pectoral Girdle • Clavicle • Clavicular notch • Sternoclavicular (SC) joint • Acromioclavicular (AC) joint • Scapula (see Figure 5-15) • Superior and inferior angles • Axillary and vertebral borders • Fossae and processes

36. Landmarks of Upper Extremity • Glenohumeral (shoulder) joint • Humerus, radius, and ulna • Wrist and hand • See Figures 5-16 to 5-18

37. Landmarks of Pelvic Girdle • Sacrum and os coxae (ilium, ischium, pubis) • Acetabulum • Obturator foramen • Pelvic inlet • Anterior and posterior superior iliac spines • Iliac fossa • Ischial tuberosity • See Figure 5-19

38. Landmarks of Lower Extremity • Hip joint • Femur, tibia, fibula, patella • Ankle and foot • See Figures 5-20 to 5-22

39. Surface Anatomy for Manual Therapists • Upper body anterior view

40. Surface Anatomy for Manual Therapists • Upper body posterior view

41. Surface Anatomy for Manual Therapists • Lower body anterior view

42. Surface Anatomy for Manual Therapists • Lower body posterior view