Musculoskeletal System Anatomy and Function

• Musculoskeletal (MSK) system involves the anatomy, physiology, common disorders, treatments, and rehabilitation.
• MSK system explains the four common musculoskeletal disorders: fractures, carpal tunnel syndrome, Dupuytren's contracture, and osteomalacia, including their structure, function, pathophysiology, diagnosis, treatment, and rehabilitation.
• The musculoskeletal system and its disorders requires better patient care.
• Pathophysiology, diagnosis, treatment, and rehabilitation of musculoskeletal disorders requires to compare and contrast.

Musculoskeletal System Overview

• Provides support, stability, shape, and movement of the body.
• 2 systems working together to support the move of the body includes the muscular and skeletal systems.
• The MSK composed of bones, joints, muscles, tendons, ligaments, and cartilage.
• The MSK provides support, movement, protection of organs, and blood cell production.
• Bones provide structural framework.
• Joints allow movement.
• Muscles provide force for movement.
• Tendons connect muscles to bones.
• Ligaments connect bones to bones.
• Cartilage cushions joints.

Type of Bones

• Flat Bone
• Irregular Bone
• Long Bone
• Short Bone
• Sesamoid Bone

Muscular System

• Gives an individual the ability to move using their muscular and skeletal system.
• Types of muscles include Skeletal, Smooth, and Cardiac muscle

What is Fracture?

• A partial or complete break in the bone which is classified as either open or closed.
• An open fracture (compound fracture) is when the bone pokes through the skin and can be seen, or a deep wound exposes the bone through the skin.
• A closed fracture (simple fracture) is when the bone is broken, but the skin is intact.
• Fractures have a variety of names.

What Causes Fractures?

• Usually happen when more force is applied to the bone than it can take.
• Bones are weakest when they are twisted.
• Bone fractures causes can be falls, injury, or a direct hit or kick to the body.

Types of Fractures

• Comminuted is when bone fragments into multiple pieces.
• Greenstick is an incomplete fracture, common in children.
• Spiral fracture line spirals around the bone shaft.
• Transverse fracture line is perpendicular to the bone's long axis.
• Oblique fracture line Is diagonal to the bone's long axis (displaced or nonD is placed).
• Linear fracture line appears as a thin line and the bone itself doesn't move.
• Stress fractures microscopic cracks from repetitive stress.

Signs and Symptoms

• Sudden pain
• Trouble using or moving the injured area or nearby joints.
• Inability to bear weight
• Swelling
• Obvious deformity
• Warmth, bruising, or redness

How Is It Diagnosed?

• Full body physical exam
• X-ray
• MRI
• CT Scan

Types of fractures

• Pathologic fracture occurs in a weakened bone due to disease.

Treatments of Fractures

• Goal of treatment is to put the pieces of bone back in place.
• Main goals of treatment include controlling pain, giving the bone time to heal, preventing complications, and restoring normal use of the fractured area.
• Treatments of fractures include Splint/Cast, Medicine and Traction (skin or skeletal).
• Surgery is also a possible treatment.

Common Rehabilitation for Fractures

• Range of Motion Exercises
• Strengthening Exercises
• Manual Therapy
• Ultrasound Therapy
• Gait Training
• Home Exercise Program
• Key consideration for fracture rehabilitation is early intervention, individualized approach, multidisciplinary care, and follow-up care.

Carpal Tunnel Syndrome

• Carpal Tunnel Syndrome (CTS) a common condition that affects the median nerve, which runs from the forearm into the palm of the hand.
• The median nerve controls sensation and movement in the thumb, index, middle, and part of the ring finger.
• The exact cause of CTS is often unknown.
• CTS combination of factors include anatomical ones, repetitive hand motions, wrist injuries, fluid retention, and underlying medical condition

Signs and Symptoms for Carpal Tunnel Syndrome

• Typically begin gradually and worsen overtime.
• Common symptoms include numbness and tingling, pain, weakness, and nighttime symptoms

Diagnosing Carpal Tunnel Syndrome

• Typically involves the combination of a physical exam (phalanges test & Tinel sign), history and symptoms, nerve conduction studies, electromyography, and X-rays.
• Treatment for CTS depends on the severity of the symptoms and underlying cause.
• Non-surgical treatment Includes wrist splinting, over-the-counter medicines, corticosteroids injection, physical therapy, and activity modification.
• Surgery is a treatment option if non-surgical treatments fail to provide relief or if symptoms are severe.

Treatment Options for CTS

• Carpal tunnel release surgery involves cutting the transverse carpal ligament, which relieves pressure on the median nerve.
• Rehabilitation after carpal tunnel surgery is crucial for restoring hand function and preventing complications with immobility, gentle range of motion, strengthening exercises, and occupational therapy

Dupuytren's Disease

• Dupuytren's contracture, a condition that affects the palmar fascia, the fibrous tissue located beneath the skin of the palm and fingers.
• "Dupuytren's contracture" is when Nodules and pitting appear in the hand, the cord forms in the palm then the fingers bend toward the palm

Causes for Dupuytren’s Disease

• The exact cause is unknown but it is believed to be a genetic disorder
• Age, gender, genetics, ethnicity, and lifestyle factors increase the risk.
• Dupuytren's disease progresses gradually over years, with symptoms appearing in distinct phases, which include nodules, cords and contracture

Diagnosis and Treatment of Dupuytren's Disease

• A patients condition can be determined through physical examination, table top test, and ultrasound.
• A treatment for Dupuytren's disease aims to relieve symptoms and slow the progression of the condition.
• A patients condition can be solved through Observation, Non-Surgical treatment (injection & needle aponeurotomy), surgical treatment (Fasciectomy & Dermo-Fasciectomy & Percutaneous Needle Fasciotomy).
• Rehabilitation after treatment Includes hand therapy, splintering, pain management, and education, crucial for restoring hand function and preventing recurrence.

Paget's Disease

• Paget's disease of bone (osteitis deformans) is a chronic bone disorder.
• The body is characterized by an abnormal bone turnover process: excessive bone breakdown (resorption) followed by accelerated but disorganized bone formation, resulting in weakened and deformed bones.
• The exact cause of Paget's disease is unknown.
• Combination of genetic and environmental factors can lead to Paget's.
• A genetic predisposition, viral Infection, and environmental factors play a role in the likelihood for developing Paget's.

Signs and Symptoms of Paget's Disease

• Most individuals with Paget's disease are asymptomatic.
• Symptoms vary depending on the location and severity of the bone involvement.
• Common symptoms include bone deformity, fractures, headaches, hearing loss, & neurological symptoms.

Diagnosing Paget's Disease

• Is a combination of a Physical Examination; X-Rays; Bone Scan; Alkaline Phosphatase
• Treatments of Paget's disease aims to control the disease activity, minimize complications, and relieve symptoms.
• Medical care - Biphosphonates, calcitonin, and calcium and vitamin D Supplements
• Orthopedic surgery and joint replacement are possible treatment options.
• Rehabilitation Includes pain exercise, management of symptoms, weight management, and fall prevention.

Osteomalacia

• Also known as "soft bones," is a metabolic bone disorder characterized by inadequate mineralization of newly formed bone tissue.
• In this patients bones become soft and weak. Vitamin D deficiency with poor calcium absorption from the gut is the primary case of Osteomalacia
• Osteomalacia can arise from inadequate dietary intake, limited sun exposure, malabsorption disorder, certain medications, kidney disease, and phosphate deficiency.

Signs and Symptoms of Osteomalacia

• vary depending on the severity of the condition.
• Common symptoms include Bone Pain, Muscle Weakness, Fractures
• Diagnosed after a patient exam that shows gait changes, and joint/bone pain
• Deformities, Waddling Gait, and Bone Tenderness are also noted.

Diagnosis and Treatment of Osteomalacia

• Involves a physical examination with a Blood Test to assess Vit. D levels, Ca & PSO4 levels, & ALP.
• Final diagnosis may be confirmed with Imaging test, such as X-rays and Bone Biopsy
• Correcting the underlying cause of the condition and improving bone health is the goal of treatment.
• Vitamins D, calcium, phosphate, and bisphosphinates can improve patient outcome.
• Fracture Repair and orthopedic surgery may be implemented along with physical therapy:
• Resistnce training, flexibility exercise, balance exercise, occupation therapy, pain management, weight management, and fall prevention
• Rehabilitation for osteomalacia, by focusing on improving mobility, reducing pain, and preventing complications, Is a crucial aspect of recovery for regained independence and quality of life.

Test your understanding of the musculoskeletal system with these multiple-choice questions. The quiz covers the functions of bones, muscles, tendons, and ligaments. It also explores different types of bones and muscles in the human body.