Prepared by:

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COMMON MUSCULOSKLETAL DISORDERS

• Prepared by

Dr. Mohsen Abdul Ghaffar Consultant Orthopaedic
Surgery Al Jedaani Group Of Hospitals
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PATHOLOGICAL CONDITIONS INORTHOPAEDICS

• Congenital Developmental.
• Traumatic .
• Inflammatory .
• Neoplastic .
• Metabolic .
• Degenerative .

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CONGENITAL DEVELOPMENTAL DISORDERS

• Achondroplasia ( Dwarfism)
• Arthrogryposis Multiplex Congenita
• Neurofibromatosis
• Congenital Muscular Torticollis ( Wryneck )
• Congenital ( Idiopathic Scoliosis )
• Developmental (Congenital) Dislocation Hip
  DDH,CDH
• Legg-Calve-Perthes Disease
• Congenital Bowing of Tibia
• Tibia vara ( Blount Disease)
• Limb-Length Discrepancy
• Congenital Clubfoot (Cng.Talipes-Equino-Varus)
• Congenital Scoliosis

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ARTHROGRYPOSIS MULTIPLEX CONGENITA

• This is a non-progressive syndrome , that is
  evident at birth.
• It means multiple congenital curved joints .Its
  etiology rema-
• ins unclear,and is believed to be due to
  intrauterine infection,
• probably viral,leading to failure of development
  or destruction
• of anterior horn cells with resultant loss of
  muscle tone and
• motor power or absence of muscle .

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SCOLIOSIS

• This Is a rotational deformity of the spine and
  ribs.In most cases , the cause is unknown, but a
  genetic factor appears to have a role . It may
  result from a variety of conditions , congenital
  , neuromuscular , and traumatic . It is a
  complicated deformity characterized by both
  lateral curvature and vertebral rotation.
• It can be classified according to - The
  etiology , flexibility ( rigid, structural
  mobile , nonstructural ) , Age of onset (
  infantile, juvenile adolescent ) or curve
  pattern .

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CONGENITAL(DEVELOPMENTAL)
DISLOCATION OF HIP

• The term congenital is replaced by developmental
  because not all cases appear at birth , in
  addition, postnatal factors contribute to produce
  hip instability and subsequent dislocation .
• The etiology is multifactorial including
  mechanical,hormonal and postnatal environmental
  factors .
• Diagnosis depends upon clinical radiographic
  findings , which vary according to the
  age of the patient . Ortolani (Reduction ) Test
  and Barlow (Dislocation ) Test ,are the most
  reliable methods in the new born .
• The treatment methods also vary according to
  the age of the patient .

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CONG.TALEPES EQUINO VARUS(CLUB FOOT)

• This is a structural deformity of the foot seen
  at birth
• The whole foot is plantar flexed (Equinus) ,
  inverted (Varus) .
• The etiology is not known, but a genetic factor
  plays a role in this deformity.
• Three types are described Postural ,True and
  Arthro-grypotic or Teratologic.
• In true congenital clubfoot , the bones of the
  foot are abnormal in shape and size and in
  their relation to each other .
• Treatment may be conservative , by manipulation
  POP or surgical

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INFLAMMATORY DISORDERS

• RHEUMATIC INFLAMMATIONS
• ACUTE BACTERIAL INFLAMMATION
• CHRONIC BACTERIAL INFLAMMATION

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RHEUMATIC INFLAMMATIONSRHEUMTOID ARTHRITIS

• This is a chronic , systemic , polyarticular
  disease with widespread affection of connective
  tissue . It occurs all-over the world . Females
  are more affected than males .
• The etiology is not well known , but auto-immune
  reaction is evident , and genetic factor plays a
  role .
• The major characteristics are Chronicity
  Multiplicity , (Polyarthritis) , inflammation of
  many joints .
• The disease is progressive . If untreated ,
  it causes irreversible damage to the articular
  cartilage and bone , resulting in joint deformity
  , disability and crippling .

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Pathology

• The initial pathology is Synovitis (Inflammation
  of synovial membrane ) , which becomes thickened
  and infiltrated by mononuclear cells ,with
  accumulation of synovial fluid .
• The second stage is Pannus formation ,which is a
  thickened synovial membrane with villous
  projections spreading along the cartilage surface
  , eroding and thinning it .
• The third stage is Fibrous Ankylosis , due to
  progressive fibrosis and destruction of the
  cartilage and bone with further restriction of
  motion .
• The fourth stage is Bony Ankylosis , due to
  fusion of the joint by bridges of bone across the
  joint space .

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Diagnosis

• Clinical picture includes pain in multiple joints
  , swelling , warmth and stiffness after periods
  of inactivity especially after awakening in the
  morning .Late in the disease , the joints become
  deformed and crippled .
• Extraarticular manifestations include a variety
  of lesions which affect connective tissue
  throughout the body , like subcutaneous nodules
  ,pulmonary and cardiac involvement,ocular changes
  ,nervous system,vasculitis and periarticular
  fibrous tissue manifestations .
• Diagnosis depends on clinical , radiological ,and
  laboratory tests . Most important is Rheumatoid
  Factor ANA Tests

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ACUTE BACTERIAL INFECTION

• Acute Septic Arthritis
• This is septic inflammation affecting joints and
  caused by
• pathogenic micro-organisms.The most common
  causative
• organisms in adults are gonococci , staphylcocci
  ,pneumo
• cocci, colon bacilli and salmonellae.
• In children staphylococcus aureus, B-hemolytic
  strepto-
• cocci , pneumococci, haemophylus influnzae and
  various
• gram-ve bacilli .
• Clinically there is fever, the joint is painful
  with marked
• tenderness, hotness, redness and swelling . Skin
  lesions
• may appear in the form of pustules
  

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METABOLIC BONE DISEASESGOUT

• Gout is a group of metabolic disorders, due to
  error in protein metabolism,leading to deposition
• of urate crystals in the tissues and
  inflammatory
• reaction causing pain ,swelling and tissue
  destruction .

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DEGENERATIVE BONE DISEASESOSTEOARTHRITIS

• Osteoarthritis is a degenerative process, which
• affects joints of both sexes at old age.The
  actual
• aetiology is not known ,but it is thought to
  be a
• matter of wear and tear due to aging (primary
  OA), however it can occur in younger age group
• due to specific reasons (secondary OA) .

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Thank you