Gout and Fibromyalgia Quiz

Musculoskeletal Function Alterations - Nursing 302

• Musculoskeletal injuries encompass a range of conditions impacting the body's structure and function.

• Fractures: Fracture is a break in the continuity of a bone. Classifications include complete/incomplete, closed/open, comminuted, linear, oblique, spiral, transverse, greenstick, torus, bowing, pathological, stress, and fatigue fractures.

Fracture Healing

• Direct Healing: Primarily occurs when surgical fixation repairs the broken bone. Intramembranous bone formation is characteristic, devoid of callus formation.

• Indirect Healing: Common with casts or nonsurgical treatments. Intramembranous and endochondral bone formation take place, and callus forms. The bone gradually remodels to its original shape.

Fracture Manifestations and Treatments

• Manifestations: Unnatural alignment, swelling, muscle spasms, pain, tenderness, impaired sensation, and decreased mobility. Often involves transient numbness due to nerve trauma.

• Treatment: Immobilization, closed manipulation, traction, open reduction, internal fixation, and/or external fixation are common strategies.

Dislocations and Subluxations

• Dislocation: Displacement of one or more bones in a joint, involving complete loss of contact between articular cartilage.

• Subluxation: Partial loss of contact between articular surfaces. Often associated with fractures, muscle imbalance, rheumatoid arthritis, or other instabilities.

Support Structures (Strains, Sprains, and Avulsions)

• Strain: Tearing or stretching of a tendon or muscle.

• Sprain: A tear or injury to a ligament.

• Avulsion: Complete separation of a tendon or ligament from its bony attachment site.

Support Structures (Cont.)

• Tendon and ligament injuries typically lack sufficient strength for 4-5 weeks after the injury.

• Accompanied by soft tissue swelling, changes in tendon/ligament contour, and potential dislocation/subluxation of bones. Rehabilitation is critical for restoring function.

Tendinopathy, Epicondylopathy, and Bursitis

• Tendinopathy: Inflammation of a tendon.
• Epicondylopathy: Inflammation of a tendon at its bony attachment. Examples include tennis and golfer's elbow, reflecting the location of the affected tendon.
• Bursitis: Inflammation of a bursa. A bursa is a fluid-filled sac that cushions areas where tendons or muscles move over bones. Inflammation is often caused by overuse or excessive pressure.

Muscle Strain

• Sudden, forceful movements causing muscle stretching beyond its capacity.
• Often involves tendons.
• Muscle strain heals in three phases: destruction, repair, and remodelling.

Myositis Ossificans

• Heterotopic calcification (ossification) due to trauma, surgery, or burns.
• Occurs to the musculo-skeletal system or central nervous system.
• Soft tissue calcification causes stiffness and/or extremity deformity.

Rhabdomyolysis

• Rapid muscle breakdown releasing myoglobin into the blood.
• Serious complications include hyperkalemia, cardiac arrhythmia, or acute kidney failure.
• Diagnosed when the creatine kinase (CK) level is five to ten times the upper limit of normal.

Compartment Syndrome

• Pressure buildup in a muscle compartment.
• Can be caused by disruptions in vascular supply.
• Muscle ischemia leads to edema, pressure increase, and possible muscle infarction, resulting in neural injury.
• Clinically, this is monitored with “6 Ps”.
• Surgical intervention is indicated if pressure reaches 30 mm Hg.

Malignant Hyperthermia

• Hypermetabolic reaction triggered by certain anesthetics.
• Primarily due to a mutation impacting skeletal muscle ryanodine receptors (RyR1).
• Key characteristics include hypermetabolism, high body temperature, muscle rigidity, rhabdomyolysis, and if untreated, death.
• Pre-operative evaluation is critical for potential risk assessment.
• Muscle contraction testing can help predict risk.

Osteoporosis

• Poor bone mineralization leading to an increased fracture risk.
• Old bone resorbed faster than new bone formed results in decreased bone density.
• May involve alterations in bone microarchitecture, making bones more vulnerable to fractures.

Osteoporosis (Cont.)

• Potential causes include endocrine dysfunction (e.g., hormone imbalances), medications, vitamin D deficiency, underlying diseases, low physical activity, and abnormal BMI.
• Fractures are a common complication.

Osteoporosis (Cont.)

• Postmenopausal osteoporosis is a subtype affecting middle-aged and older women. It often results from reduced estrogen levels and/or secondary causes. Imbalance between osteoclast and osteoblast activity is also a factor.

Osteoporosis (Cont.)

• Secondary osteoporosis results from other conditions. Hormonal imbalances and certain medications are involved.

• This form can be regional, confined to a segment of the appendicular skeleton, possibly transient, or associated with conditions causing disuse/reduced activity.

• Glucocorticoid-induced osteoporosis is a type of secondary osteoporosis, where glucocorticoid use accelerates osteoclast survival (inhibiting osteoblast function).

• Age-related bone loss is thought to be complex, potentially influenced by physical activity levels.

Osteomalacia

• Delayed mineralization of osteoid, leading to soft bones. Common symptoms include pain, bone fractures, and vertebral collapse.

• Typically results from vitamin D deficiency

• Treatment varies depending on the cause/etiology.

Paget's Disease

• Also called osteitis deformans, involves chronic accelerated bone remodeling.
• Causes enlargement and softening of affected bones, most commonly impact vertebrae, the skull, sacrum, sternum, pelvis, and femur.
• Symptoms are often mild or absent in the early stage.
• Evaluation is dependent on radiographic findings.

Osteomyelitis

• Bone infection, frequently caused by Staphylococcus aureus bacteria.
• Hematogenous Osteomyelitis: Infection spreads through the bloodstream, originating from various sites including cutaneous/ skin, sinus, ear, and dental infections.
• Vague symptoms: include fever, malaise, anorexia, weight loss, and pain.

Osteomyelitis (Cont.)

• Contiguous Osteomyelitis: Infection spreads to adjacent bone from existing infection sites like open fractures or surgical procedures.
• Symptoms show signs of soft tissue infection including low-grade fever, lymphadenopathy, local pain, and swelling.

Osteomyelitis (Cont.)

• Brodie Abscesses: Subacute or chronic osteomyelitis characterized by circumscribed pus-filled lesions in long bones' ends.
• Treatment involves antibiotics, surgical debridement, and/or hyperbaric oxygen therapy.

Osteoarthritis

• Joint disease characterized by damage to articular cartilage, inflammation, new bone formation at joint margins, subchondral bone changes, and synovitis (which can range from mild to severe).
• Prevalence increases with age.
• Risk factors; age, joint trauma, mechanical stress, and obesity.

Osteoarthritis (Cont.)

• Characteristics: Damage to articular cartilage, new bone formation at joint margins, and alterations to subchondral bone. Joint capsule thickening may also be present.

• Manifestations: Localized pain (aggravated by activity), stiffness (lessened by activity), joint enlargement, tenderness, limited range of motion, muscle wasting (in some cases), and/or deformity.

Osteoarthritis (Cont.)

• Conservative Treatment: Exercise & weight loss are initial treatment strategies. Pharmacologic options include analgesics and anti-inflammatory drugs, along with nutritional supplementation.

• Surgical Treatment: Used to correct malalignment, improve joint movement, or replace a diseased joint with an implant.

Classic Inflammatory Joint Disease

• Inflammatory damage or destruction in the synovial membrane or articular cartilage.

• Systemic signs of inflammation. May be infectious or non-infectious.

Rheumatoid Arthritis

• Inflammatory, autoimmune joint disease impacting the synovial membrane, a common connective tissue of joints.
• Systemic autoimmune connective tissue damage is more extensive than osteoarthritis.
• Symptoms are similar to osteoarthritis, but can be more widespread, affecting multiple joints.
• Strong genetic predisposition.

Rheumatoid Arthritis (Cont.)

• Pathogenesis: Synovial fluid cell activation, induced inflammatory cytokines (TNF-a, IL-1β, IL-6, IL-7, and IL-21) mediating cartilage and bone destruction, conversion of synovium to pannus (thickened granulation tissue).

Rheumatoid Arthritis (Cont.)

• Systemic Manifestations: Onset is often insidious, with general inflammation, fever, fatigue, anorexia, weight loss, generalized aching and stiffness, leading to painful, tender, and stiff joints.

• Similar features of osteoarthritis: The clinical picture may mimic osteoarthritis in some ways, which can make early diagnosis difficult.

• Specific Diagnosis: Frequently involves antibodies (ACPA or RF).

• Treatment: Early intervention with disease-modifying antirheumatic drugs (DMARDs) can effectively manage symptoms and progression.

Ankylosing Spondylitis

• Inflammatory arthropathy affecting vertebrae, and sacroiliac joints that stiffens and fuses affected joints.
• A systemic autoimmune inflammatory disease.
• Primarily impacts the enthesis.
• The end result in ankylosing spondylitis is fibrosis, ossification, and fusion of joints.

Ankylosing Spondylitis (Cont.)

• Cause: Unknown; strong association with HLA-B27 antigen.

• Pathogenesis: Inflammatory cells infiltrate the fibrocartilage in joints (especially sacroiliac and vertebrae). Scar tissue progressively ossifies and calcifies.

• Early Symptoms: Low back pain, stiffness, potentially progressing to joint fixation.

• Manifestations: Low back pain, stiffness, restricted motion loss of lumbar curvature (lordosis), increased spine concavity (kyphosis).

• Diagnosis: Sacroiliitis on imaging is often a key diagnostic indicator.

• Treatment: NSAIDs, physiotherapy to maintain skeletal mobility, and prevent contractures are common treatment approaches.

Gout

• Syndrome caused by either the overproduction or underexcretion of uric acid.
• Excess uric acid crystallizes in joints and soft tissues, leading to inflammation (known as gouty arthritis).
• Linked closely to purine metabolism.

Gout (Cont.)

• Risk Factors: Male sex, increasing age, high intake of alcohol, red meat, fructose, and certain medications.

• Clinical Stages: Asymptomatic hyperuricemia, acute gouty arthritis, and in some cases, chronic tophaceous gout.

• Manifestations (acute gouty attack): Severe pain (especially at night), hot, red, tender joints, signs of systemic inflammation (e.g., increased sedimentation rate, fever, leukocytosis).

• Other manifestations: Include increase in serum urate concentration (hyperuricemia), recurrent attacks of monoarticular arthritis, deposits of monosodium urate in tissues, renal disease and formation of renal stones.

Secondary Muscular Dysfunction

• Contractures: Muscle fiber shortening. Caused by failure of the calcium pump activity (even with sufficient ATP level). Common associations include stress-induced muscle tension, neck/back pain, headaches, and anxiety.
• Disuse atrophy: Muscle atrophy from prolonged inactivity (e.g., bed rest, casting, or nerve damage). Prevention strategies include regular isometric and passive exercises.

Fibromyalgia

• Chronic widespread diffuse pain, fatigue, and tender points.
• Vague symptoms.
• Increased sensitivity to touch.
• Absence of inflammation.
• Severe sleep disturbances and fatigue.
• Often high incidence of anxiety and depression.

Fibromyalgia (Cont.)

• Cause: Often involves autoimmune factors and potential CNS dysfunction and amplification of pain pathways (central sensitization). Genetic factors also play a role, affecting serotonin, catecholamines, and dopamine.

• Manifestations: Diffuse and persistent pain, often burning or gnawing, tender points, and profound fatigue.

• Diagnosis: Canadian guidelines are used to clinically diagnose through rigorous tender point assessments.

Chronic Fatigue Syndrome

• Neuroimmunoendocrine disorder characterized by cognitive impairment, severe postexertional fatigue, non-refreshing sleep, reduced physical activity impacting daily living.
• Diagnosed by exclusion of physical and psychological issues.

Muscle Membrane Abnormalities

• Inherited disorders involve altered skeletal muscle sodium and chloride channels, often leading to myotonia (delayed muscle relaxation post contraction).

• Periodic paralysis involves episodes of symptomatic flaccid weakness.

Metabolic Muscle Diseases

• Endocrine disorders and hormonal imbalance effects often present with muscle weakness/ symptoms.

• Diseases impacting energy metabolism (e.g., McArdle's disease—myophosphorylase deficiency, Acid maltase deficiency—Pompe's disease, or myoadenylate deaminase deficiency—MDD) impact muscle function.

• Lipid deficiencies.

Inflammatory Muscle Diseases (Myositis)

• Infectious/non-infectious inflammation of muscles (myositis).
• Viral, bacterial, parasitic, and autoimmune forms. Idiopathic subtypes including polymyositis, dermatomyositis, and inclusion body myositis. These conditions often involve symmetrical proximal muscle weakness and pain.

Inflammatory Muscle Diseases (Myositis) (cont.)

• Often associated with an increased risk of malignancy.
• Treatment strategies target the inflammatory process, such as immunosuppressive drugs.

Toxic Myopathies

• Muscle weakness, pain, and swelling resulting from alcohol abuse.
• Other causes involve lipid-lowering agents, antimalarial drugs, steroids, thiols, and narcotics.
• Rhabdomyolysis (acute muscle fiber necrosis) is a severe complication, possibly leading to myoglobinuria and acute kidney failure.

Bone Tumors

• Origin & Types: Bone tumors can originate from various tissues of bone (osteogenic), cartilage (chondrogenic), fibrous tissue, marrow, and vascular tissue.

• Malignant Characteristics: Malignant bone tumors often possess increased nuclear-to-cytoplasmic ratios, irregular borders, excess chromatin, and prominent nucleoli; increasing mitotic rates (cell division).

Bone Tumors (Cont.)

• Patterns of Bone Destruction: Malignant bone tumors may exhibit distinctive patterns, including "geographic," "moth-eaten," and/or "permeative" areas of bone destruction on images (e.g., X-rays). Symptoms are often vague and may be mistaken for benign conditions.
• Specific Bone Tumors: Osteosarcoma is a highly frequent malignant bone forming tumor often arising from areas of long bones; Chondrosarcoma originates from cartilage and infiltrates the spongy bone. Fibrosarcoma, derived from fibrous tissues is often located at the metaphyses of long bones. Myelogenous tumors, including giant cell tumors from marrow cells are categorized as a specific subtype.

Muscle Tumors (Rhabdomyosarcoma)

• Rhabdomyosarcoma is a highly malignant tumor, typically originating from striated muscles, often in the head, neck, or genitourinary tract.
• Anaplastic, Embryonal and Alveolar subtypes are common presentations