diseases of the musculoskeletal system
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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

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skeletal
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)
slide7
- 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
slide9
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
slide10
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
slide11
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
slide13
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
slide14
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
slide15
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
slide16
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
diseases of the joints
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
slide20
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
slide21
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
slide22
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
slide23
Get immune-mediated destruction of joints
    • Environmental stimulus immune response to Ag
    • If predisposed, Ab=s transform to Arheumatoid [email protected] (Rfs)
    • Rfs complex in blood, synovial fluid inflamm response at joint
    • Inflamm mediators breakdown joint tissue  joint tissue destroyed
slide24
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
slide26
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
diseases of skeletal muscle
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
slide28
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
slide29
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
slide30
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
musculoskeletal disorders
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
slide32
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
slide33
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
slide34
Clinical
    • Pain C sharp, localized
    • Soft-tissue swelling
    • Joint swelling
    • Flexion deformities
    • If in extremities, motion affected
  • Treatment
    • Suture tendon/ligament
    • Tendon/ligament grafting
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