Skeletal System Diseases & Disorders

1. Skeletal System Diseases & Disorders

2. Osteoporosis

3. Osteoporosis bone mass reduced; hormone-related; need calcium and Vitamin D when young; leads to spontaneous fractures; curvature of spine

4. Osteomalacia “soft bones”; bones are inadequately mineralized; bone pain; aka Rickets in children; need for sunlight - Vit. D; calcium needs to be absorbed

5. Paget’s Disease

6. Paget’s Disease • age >40 • excessive bone formation and breakdown • usually spine, pelvis, femur, skull • virus?

7. Osteomyelitis • bacterial infection • area is tender and swells • need for antibiotics

8. “twisted disease”; abnormal lateral curvature in thoracic vertebrae; treat with surgery or body braces Scoliosis

9. Scoliosis

10. Kyphosis “hunchback”; exaggerated curvature of thoracic vertebrae; common in osteoporosis, rickets, osteomalacia

11. “swayback”; accentuated curvature of lumbar vertebrae • common in spinal tuberculosis, osteomalacia, men with potbellies or pregnant women Lordosis

12. Cleft Palate • congenital • right and left halves of palate fail to fuse • interferes with sucking & inhalation • surgery at 6 months & speech therapy

13. Bursitis

14. Bursitis • inflammation of a bursa • from blow or friction • “student’s elbow” • anti-inflammatory drugs or removal of fluid

15. Osteoarthritis • AKA degenerative joint disease (DJD) • MOST COMMON CHRONIC ARTHRITIS • articular cartilage deteriorates • leads to stiffness • no known cause • more common in women • joint replacement

16. Osteoarthritis

17. Rheumatoid Athritis

18. Rheumatoid Athritis • chronic autoimmune disease • ages 40-50 onset • Effects joints of fingers, wrists, ankles, and feet • cartilage is eroded • Antibiotics, anti-inflammatory drugs, & immunosuppressants to treat it

19. Dislocation

20. Dislocation • AKA subluxation • treatment is re-alignment or surgery • common for athletes

21. Sprain • damage to ligaments • synovial membrane • twisting of joint • treatment is to limit joint motion

22. Sprain

23. Osteosarcoma • bone cancer • 10-25 years old • painfully erodes bone • spread to lungs

24. Time to see what you are made of

25. Case 1 • PATIENT HISTORY: This 19 year old man complained of unremitting, progressive low back pain for several months. Otherwise, he was in good general health without other medical problems. Physical examination revealed no sensory or motor deficits. • Radiology images including plain radiographs, computer assisted tomography (CT) and magnetic resonance imaging (MRI) were obtained. These images demonstrated a large, destructive mass involving lumbar vertebra 3 with extension into the paraspinal soft tissues.

26. FINAL DIAGNOSIS: EWING'S SARCOMA/PNET • Contributor's Note: Ewing's sarcoma (ES) is a malignant neoplasm of bone and soft tissues with characteristic radiographic, morphologic, immunohistochemical and cytogenetic features. ES represents perhaps a more primitive, less differentiated neoplasm in the spectrum of peripheral primitive neuroectodermal tumors. Primitive neuroectodermal tumor (PNET), characterized by neuroectodermal differentiation (rosette formation, presence of neuropil), may be considered a more differentiated neoplasm in the same family. Both share the same cytogenetic abnormality (11;22)(q24q12) or (21;22)(q22;q12) in about 90% of cases.

27. female with left nipple discharge and an inverted nipple. The patient stated that left nipple retraction was chronic for many years, and described crusting of the left nipple. Digital diagnostic mammogram showed calcifications in the anterior left breast, some vascular, some coarse benign-appearing and others punctate benign-appearing. There were also benign-appearing calcifications in the anterior right breast. Ultrasound of the left retroareolar area revealed a focally dilated duct at 5 o'clock with abrupt termination of dilation approximately 2 cm from the nipple. No intraductal mass was identified. Paget’s Disease Paget's disease (PD) of the breast is rare, with a reported incidence of 0.5-2% of all patients with breast cancer. However, this disorder should be considered in the differential diagnosis of all the patients presenting with lesions of the nipple. The characteristic erythema and eczematous changes of the nipple with this disease were first described by Velpeau in 1856, but the association of nipple-areolar changes with underlying carcinoma of the breast was not reported until 1874 by Paget (1). Ulceration, crusting and serous or bloody discharge characterize more advanced cases. Surgical biopsy is the diagnostic standard. Patient History

28. Case Study 3 • A 66 year old woman with a 20 year history of rheumatoid arthritis comes to your office for a new patient consultation complaining of swelling and pain in her left knee. • She was diagnosed with rheumatoid arthritis when she was 45 years old, when she presented with swelling and pain in multiple joints including her elbows, wrists, hands, knees, ankles and feet. • She recalls being treated with a variety of non-steroidal medications (NSAIDs) and low dose prednisone. She initially was started on hydroxychloroquine and then intramuscular gold therapy. She did well on gold, eventually stopping therapy after 8 years. • Her rheumatologist told her she was "in remission" and stopped seeing her. She has been treated with NSAIDs alone for the past 7 years.

29. Her current knee problems began about 8 months ago. Over the past several months she has had 4 to 5 episodes of severe swelling and pain in her left knee. She has morning stiffness lasting 15 minutes daily, mainly in her hands. She is currently only taking Ibuprofen 800 mg 4 times daily. On exam she has chronic deformities at the wrists, MCP and PIP joints, with chronic synovial thickening. Her left knee has good range of motion with crepitus but no demonstrable swelling, warmth or tenderness. Her right knee exam is similar to her left. Her shoulders have good active range of motion. Her feet show cock-up deformities at the MTP joints. • She has x-rays of her hands, which show deformities of rheumatoid arthritis. What to do next?

30. Your diagnostic impression is:a. gout b. osteoarthritis c. rheumatoid arthritis d. pseudogout