Diseases and Conditions

1

• Chapter 7
• Diseases and Conditions
• of the Musculoskeletal System

2
The Musculoskeletal System

• This system provides support, flexibility and
  protection of internal structures.
• Trauma is a major cause of disorders, there are
  also, rheumatic, inflammatory and degenerative
  conditions that can affect the ability of the
  system to perform its functions.

3
The Muscles

• Muscles contract from stimulation of a nerve at
  the request of the brain.
• Point of attachment to the stationary bone is the
  origin and the insertion it on the bone that
  moves.
• There are 3 muscle types
• Skeletal-striated and voluntary
• Smooth-non-striated and involuntary
• Cardiac-striated and involuntary

4
Skeletal System

• 206 bones, provide support and protection the
  bone marrow of some bones is the site of blood
  cell production hematopoiesis.
• Bone are organs with connective tissue, blood
  vessels and nerves.
• Bone types
• Long bones-extremities
• Short bones-carpals, tarsals
• Flat bones-skull, scapula,ribs
• Sesamoid-patella

5
Articulations

• Joints are the structures where bones are joined,
  ligaments hold bones together. Tendons attach
  muscle to bone.
• Synarthroid-immovable joint-skull bones
• Amphiarthroid-slightly movable-vertebrae
• Diarthroid-freely movable-synovial joints.

6
Other Tissues and Structures

• Fascia-covers and separates muscle layers
• Cartilage-dense support tissue, protects and
  cushions joints.
• Bursae-closed sac of synovial fluid for friction
  control
• Collagen-connective tissue to hold cells
  together. ½-1/3 of body protein.

7
Fibromyalgia

• Chronic pain condition with stiffness and
  tenderness affecting muscles,tendons,and joints.
• SS-fatigue,restless sleep,anxiety,bowel
  dysfunction,diffuse aching or burning, poor
  concentration, irritability, and depression,
  headache, jaw pain,sensitivity to odors, lights
  and sounds,urinary urgency and frequency.

8
Fibromyalgia

• Etiology-unknown,elevated levels of nerve growth
  factor, substance P in CSF. They respond with
  pain for stimuli not usually perceived as pain.
  Low levels of serotonin. Associated with
  psychologic distress, trauma, and infection.
  Aggravated by poor posture, exercise and smoking.

9
Fibromyalgia

• Dx-usually by excluding other possible causes for
  pain. Tenderness and aching in at least 11 of 18
  specific tender points.
• Tx-stress reduction, activity, and meds for pain,
  massage therapy, acupressure.
• Prognosis- condition can be controlled
• Prevention-can only prevent symptoms getting
  worse.

10
Spinal Disorders

• Lordosis-exaggerated inward curvature of the
  spine. Also called-swayback or saddleback.
• Etiology-excesive abdominal weight, rapid growth,
  osteoporosis.
• Tx-weight loss, abdominal muscle exercise
• Prognosis- untreated can lead to degenerative
  disk disease.

11
Spinal Disorders

• Kyphosis-Abnormal outward curve of spine.
• Etiology- child-developmental, teen-degenerative
  deformity, tumors, TB, ahkylosing spondylitis,
  osteoporosis.
• Tx-back brace, exercises, spinal fusion
• Prognosis-depends on cause
• Prevention-posture habits, calcium

12
Scoliosis

• A lateral curve to the spine
• Etiology-idiopathic usually,some genetics, muscle
  degeneration, paralysis, cerebral palsy, muscular
  dystrophy.
• Tx-exercise to strengthen back muscles, braces,
  surgery
• Prognosis-depends on severity of curve.
• Prevention-good posture, exercise, braces

13
Osteoarthritis(degenerative arthritis)

• Breakdown and eventual loss of the cartilage of
  one or more joints.
• SS- insidious onset, joint soreness,aching
  stiffness especially in A.M.,edema, dull pain and
  deformity. Crepitation- heard with joint
  movement. Decreased range of motion. Joint
  instability, pain with use.

14
Osteoarthritis

• Etiology-results from wear and tear on the
  joints. Most common in the elderly and almost
  universal in those over 75. Tendency may be
  inherited, may follow injury, associated with
  hormonal disorders and underlying disease.
• Dx-exclude other possible causes, x-rays, CT,
  MRI, mainly weight bearing joints, knee and hip,
  wrists, elbow, ankles, digits

15
Osteoarthritis

• Tx-cannot be cured, reduce inflammation and pain,
  physical and drug therapy, surgery. Cane,walker,
  crutches to reduce strain on some joints.
  NSAIDs, muscle relaxant,steroid injection,joint
  replacement
• Prognosis-depends on severity
• Prevention-avoid injury, early treatment

16
Lyme Disease

• Arthritis
• SS-characteristic red itchy rash with a red
  circle center bulls eye, hides as arthritis
  and causes flu-like symptoms of headache, fever,
  fatigue, joint pain and general malaise.Without
  medical attention muscle weakness, paralysis,
  learning difficulties, coordination problems,
  encephalitis, gastritis, carditis.

17
Lyme Disease

• Etiology-bacterium Borrelia burgdoferi injected
  by tick carried on mice and deer., infects
  internal organs causing various symptoms delaying
  diagonsis.
• Dx-physical exam, finding a tick, classic lesion,
  detect antibodies, ID the bacterium from skin
  biopsy.

18
Lyme Disease

• Early diagnosis-oral antibiotics, later stage
  requires IV antibiotics, bed rest, analgesics and
  antipyretics, antiinflammatories.
• Prognosis-curable with antibiotics, may be
  residual damage to heart joints and nerves
• Prevention- avoid tick bites

19
Bursitis

• Inflammation of the bursa. (a fluid filled sac
  that acts as a gliding surface to reduce
  friction. They are between muscles and tendons
  and cover bony projections to help with movement.
• SS-tenderness and pain when moving the affected
  joint. Some can point to the area of tenderness.

20
Bursistis

• Etiology-Continual or excessive friction between
  the bursa and surrounding tissues. Systemic
  problems such as gout and rheumatoid arthritis,
  can lead to its development. Overuse trauma.
• Dx-History and physical exam usually enough, MRI,
  underlying disease, exam of fluid aspirated from
  the bursa.

21
Bursitis

• Tx-avoid activities, moist heat, NSAIDs, local
  corticosteroids, drain bursa, antibiotics, active
  ROM exercises to prevent adhesions, surgical
  removal.
• Prognosis- excellent
• Prevention-avoid repetitious motions, kneeling
  and leaning on elbows.

22
Osteomyelitis

• Serious bone infection.
• SS-inflammation, swelling, heat, redness and
  pain and tenderness over and around the affected
  bone. Chills fever, sweating, malaise, purulent
  abscess may press and cause a fracture. Most
  commonly seen in the upper humerus and tibia,
  lower femur and vertebrae.

23
Osteomyelitis

• Etiology-90 are caused by Staph. aureus, blood
  borne pathogens deposit on the bone after a
  trauma or surgery. Diabetics, peripheral vascular
  disease and prosthetics, may predispose the
  development. Secondary to Strep infection in
  children, sickle cell, immunodeficiency and
  malignancy also increase the risk

24
Osteomyelitis

• Dx- aspiration and culture from the site, blood
  culture, CBC, MRI, CT and bone scans.
• Tx-extensive long term antibiotic therapy,
  increased protein intake, vitamin A,B,C to
  promote cells, bed rest, immobilization,
  analgesics, bone grafts, hyperbaric O2.

25
Osteomyelitis

• Prognosis-curable, long term depends on amount of
  damage, if growth plates were damaged there may
  be deformity in children
• Prevention-cannot be prevented, random disease,
  high risk patients must take care of any
  infections promptly.

26
Gout

• An acute episode of arthritis caused by nodules
  of hard deposits of uric acid.
• SS-most often affects the first metatarsal joint
  of the big toe. Excruciating pain is the main
  symptom. (feet, ankles and knees can also be
  involved. Pain peaks after a few hours then
  subsides. Slight fever, chills, headache or
  nausea, renal calculi and renal dysfunction may
  be also present

27
Gout

• Etiology- inherited metabolism disorder, causes a
  buildup of uric acid in the blood. Renal
  dysfunction cause some forms of gout, weight
  gain, leukemia, lymphoma, some meds may
  contribute
• Dx-exam of aspirated synovial fluid will shoe the
  presence of the crystals. X-rays to evaluate the
  damage to the joint.

28
Gout

• Tx-bed rest to relieve pressure on the joint, ice
  packs, NSAIDs and corticosteroids to help
  relieve the inflammtion. Low purine diet,
  increased fluid intake.
• Prognosis-management damage can be avoided.
• Prevention-limit alcohol intake, avoid
  dehydration, proper diet.

29
Paget Disease(osteitis deformans)

• Enlarged deformed bones from irregular breakdown
  and repair of bone tissue.
• SS-2 stages vascular stage-bone tissue is
  replaced with blood vessels and fibrous tissue,
  sclerotic stage-vascular tissue hardens but is
  not as strong as bone. Most common sites are
  pelvis and tibia, usually patients are over 40,
  local bone pain, aching, edema, deformity,
  fractures

30
Paget Disease

• Etiology- not known
• Dx-PE, history, blood work, x-rays, bone scans,
  bone marrow biopsy.
• Tx-analgesics, antiinflammatory drugs,
  calcitonin, high protein high calcium diet,
  vitamin D supplements.
• Prognosis-most have no symptoms
• Prevention-calcium and vitamin D

31
Marfan Syndrome

• Group of inherited conditions with abnormal
  connective tissue, weak blood vessels and long
  extremities.
• SS- tall, slender, long narrow digits, asymmetry
  of the skull, visual difficulties, scoliosis,
  hyperextendable joints, mitral valve prolapse,
  aortic aneurysms.

32
Marfan Syndrome

• Etiology- genetic disorder, autosomal dominant.
  Affects fibrillin-a component of connective
  tissue. variable expression
• Dx-family history, PE, eye deformity, blood
  vessel and heart tests. Echocardiography to
  detect aortic dissection.
• Tx-use hormones to control height, control blood
  pressure.

33
Marfan Syndrome

• Prognosis- major risk is rupture of arteries may
  be disabled by severe spine abnormalities and
  joint dislocations
• Prevention-complications can be avoided by
  control of blood pressure and trauma. Monitor the
  aorta.

34
Bone Tumors

• Chondrogenic, osteogenic, fibrogenic
• SS-pathologic fracture, palpable mass, pain that
  is dull or severe and localized. Limping reduced
  activity.
• Etiology-benign usually slow growing. Malignant
  can be primary or secondary. 1otumors represent
  85 of tumors in children, but are rare after age
  30. Males more often, bones often affected are
  pelvis,vertebrae, ribs, hip femur, and humerus.

35
Bone Tumors

• Dx- biopsy, CT scans to evaluate spread of the
  cancer.
• Tx- surgical excision, limb amputation, also
  chemo and radiation for malignant tumors.
• Prognosis-overall 5yr survival is 70,
• Prevention- hard since risk factors have not been
  identified.

36
Muscle Tumors

• Benign tumors or malignant sarcomas
• SS-painless lump for a few weeks or months time,
  may be pain and tenderness if pressure on a
  nerve.
• Etiology-rare,mostly benign and not life
  threatening,Leiomyomas-smooth muscle tumor,
  Rhabdomyomas-striated muscle. Occcur most often
  in patients over 50. Exposure to
  radiation,chloride gas,arsenic

37
Muscle Tumor

• Dx-MRI, x-rays, CT, biopsy
• Tx- surgical resection, benign that is enough for
  sarcomas radiation will be needed, chemo for
  children, amputation.
• Prognosis-worsens with the tumor grade, overall 5
  yr survival 30-95 based on type and grade
• Prevention- none known

38
Osteoporosis

• Loss of normal bone density, leads to porous bone
  that is compressible like a sponge not dense like
  a sponge.
• SS-none unless in vertebrae or weight bearing
  bones. Silent unless there is a bone break.
  Spontaneous breaks and loss of height
• Etiology-more often in women, small boned,
  northern European or Asian genetics, family
  history.

39
Osteoporosis

• Etiology-imbalance between the breakdown of old
  bone tissue and creation of new bone tissue,
  usually come from hormonal or dietary issues, but
  trauma may also cause it to develop. Radiation,
  malabsorption, smoking, immobility, and chronic
  disease such as rheumatoid arthritis, heparin,
  lack of estrogen, phenytoin, prednisone,
  prednisolone.

40
Osteoporosis

• Dx-blood tests, bone scan, best test is a
  DEXA-dual energy x-ray absorptometry.
• Tx-increased dietary calcium, calcium carbonate,
  calcium carbonate with sodium fluoride, phosphate
  supplements and vitamin D. Estrogen replacement
  therapy, exercise, physical therapy, analgesics
• Prognosis-depends on age, severity of loss
• Prevention-bone density testing

41
Osteomalacia and Rickets

• Defective mineralization of bones.
• SS-general fatigue, progressive stiffness,
  tender painful bones, back aches, muscle twitches
  and cramps, difficulty standing, fractures,
  bowing of the legs, chest deformity, shortening
  of the spine.
• Etiology-deficiency or ineffective use of Vitamin
  D vital for bone formation, inadequate exposure
  to sunlight

42
Osteomalacia and Rickets

• Dx-evaluation for renal and bowel disease,
  metabolic disorders, blood tests,ESR, bone scans
  and x-rays, biopsy
• Tx-vitamin D supplements, calcium and calcitonin,
  sunlight (especially for elderly)
• Prognosis-depends on how early it was detected,
  severity, underlying causes and complications
  such as fractures.
• Prevention-early diagnosis and treatment

43
Fractures

• Colles fracture-the distal head of the radius
• Basilar skull fracture-floor of the cranial
  vault.
• LeFort fracture-bilateral horizontal fracture of
  the maxilla
• Pott fracture-lower part of fibula

44
Fractures

• SS-pain, edema tenderness, discoloration of the
  skin, inability to move the affected part,
  deformity
• Etiology-any force that disrupts the continuity
  of the bone, diseases,.
• Dx-x-ray
• Tx-reduced and immobilized
• Prognosis-complications include compartment
  syndrome, nonunion, malunion, infection,
  necrosis, fat emboli, and pulmonary emboli.
• Prevention-protective gear

45
Strains and Sprains

• Strain-an injury to tendon, muscle, or other
  tissue from stretching of the tissue beyond its
  capacity.
• Sprain-acute partial tear of a ligament,
  classifed as 1st ,2nd or 3rd degree or grade more
  serious of the two.
• SS-localized pain, weakness, numbness and edema,
  using the affected limb is difficult if not
  impossible.

46
Strains and Sprains

• Etiology- acute or chronic trauma
• Dx-x-ray to rule out fracture, PE and history.
• Tx-elevation and rest of the limb, ice to reduce
  edema, immobilization, elastic bandage, cast or
  splint,, analgesics, antinflammatories, surgery.
• Prognosis-2-4 weeks for healing.
• Prevention-warm ups, bracing.

47
Miscellaneous Pathology

• Dislocations-forced displacement of a bone from
  its joint. Deformed, extreme pain, edema,
  ecchymotic and immovable. After 15-30 minutes may
  require general anesthesia to perform the
  reduction.
• Frozen shoulder-limited ROM from inflammation,
  scarring, thickening and shrinkage of the capsule
  of the joint

48
Miscellaneous Pathology

• Severed tendon-completely torn into two pieces,
  prevents muscle from performing the function.
• Shin Splints-involves inflammation of the
  periosteum, extensor muscles of the lower leg and
  tissues. Pain is along the inner aspect of the
  tibia. Worsens with exercise and diminishes at
  rest, high impact aerobics, usually bilateral.

49
Miscellaneous Pathology

• Plantar Fasciitis-heel spur, an inflammatory
  response at the bottom of the heel bone. Dull
  intermittent pain on bottom of foot progressing
  to sharp persistent pain. Worse in a.m. or after
  sitting for a time. See factors that contiribute
  to the development of the problem on pg. 306

50
Miscellaneous Pathology

• Ganglion-benign sac-like swelling or cyst, that
  is filled with a colorless, jelly-like fluid.
  Formed from the tissues lining the joint. Usually
  painless and not a bother.
• Torn meniscus-cartilage in the knee joint that is
  cracked, torn, or has a fissure from wear and
  tear or injury. Knee locks or gives way, crepitus
  may be heard, pain upon flexion of the joint.

51
Miscellaneous Pathology

• Rotator Cuff Tears tears in any of the 4
  tendons of the muscles of the shoulder. Immediate
  snapping sound and acute pain. Patient is unable
  to abduct the arm. ROM is limited.