McCance 45- from notes - Musculoskeletal System and Fractures

Musculoskeletal System Overview

• The musculoskeletal system comprises bones, muscles, cartilage, tendons, and ligaments
• Provides the body with structure, support, stability, and facilitates movement

Musculoskeletal Injuries

Fractures

• Fractures are classified as either complete or incomplete
• Also classified as open (skin broken) or closed (skin intact)
• Fracture types include comminuted, linear, oblique, spiral, transverse, impacted, pathologic, avulsion, and greenstick

Fracture Healing

• Fracture healing happens in three overlapping phases
  • Inflammatory (3-4 days)
  • Repair (capillary ingrowth, granulation tissue, callus formation)
  • Remodeling (callus resorbed, trabeculae formed over months to years)

Clinical Manifestations

• Impaired function, unnatural alignment, swelling, muscle spasm, tenderness, pain, and impaired sensation are clinical manifestations

Treatment

• Treatment involves closed reduction or open reduction (surgical realignment with hardware)

Dislocations and Subluxations

• Dislocation is the complete loss of contact between two bones
• Subluxation is the partial loss of contact between two bones

Pathophysiology

• Dislocations are caused by muscle contractions or fluid within the joint

Clinical Manifestations

• Limitation of motion, tenderness, and deformity are clinical manifestations

Common Sites

• Common dislocation/subluxation sites include the shoulder, elbow, wrist, finger, hip, and knee

Sprains and Strains

• Sprain is an injury to a ligament
• Strain is an injury to a tendon
• Avulsion is the complete separation of a tendon or ligament from its bony attachment

Pathophysiology

• Inflammatory process begins; collagen forms parallel to stress lines in 3-4 days

Clinical Manifestations

• Pain, functional limitation, swelling, contour changes, and possible dislocation/subluxation are clinical manifestations

Tendinopathies and Bursitis

• Tendinopathy is inflammation of a tendon, usually caused by tissue degeneration rather than inflammation
• Bursitis is inflammation of the bursae (synovial fluid-filled sacs between tendons, muscles, and bony prominences)

Clinical Manifestations

• Tendinitis causes swelling, limited movement, and pain
• Bursitis can compromise joint movement

Common Sites for Bursitis

• Common bursitis sites are the shoulder, hip, knee, and elbow

Muscle Strains

• Local muscle damage often from sudden, forced motion

Treatment

• Treatment Includes ice, rest, analgesia, and progressive exercise

Muscle Injuries

Rhabdomyolysis

• Rapid muscle breakdown releases intracellular contents into the bloodstream

Causes

• Caused by trauma, medications, toxins, electrolyte imbalances, and genetic disorders

Complications

• Complications include hyperkalemia, metabolic acidosis, acute renal failure, and DIC

Clinical Manifestations

• Muscle pain, weakness, and dark urine are clinical manifestations

Evaluation

• Serum creatine kinase (CK) level is the most important measurement for evaluation

Treatment

• Maintaining adequate urinary flow and preventing kidney failure are treatment focuses with rapid IV hydration

Bone Disorders

Osteoporosis

• Characterized by low bone mineral density, impaired bone structure, and increased fracture risk

Risk Factors

• Factors include inadequate calcium, vitamin D deficiency, lack of exercise, low body mass, and family history

Pathophysiology

• Involves an imbalance between bone resorption and bone formation

Evaluation

• Includes bone density testing and FRAX assessment

Treatment

• Focuses on preventing fractures and maintaining bone function with calcium, vitamin D, weight-bearing exercise, and medications

Osteomalacia

• Inadequate mineralization of bone matrix (osteoid) commonly due to calcium, phosphate, or vitamin D deficiency

Pathophysiology

• Abnormalities in spongy and compact bone

Treatment

• Adjusting serum calcium and phosphorus, administering vitamin D, and dietary supplements are treatments

Paget Disease

• Increased metabolic activity in bone with abnormal and excessive bone resorption and formation (remodeling)

Pathophysiology

• Begins with excessive resorption of spongy bone and deposition of disorganized bone

Clinical Manifestations

• Skull thickening, bone/joint pain, and bone deformity can be clinical manifestations

Osteomyelitis

• Bone infection, most often caused by bacteria

Types

• Exogenous (from outside the body) or hematogenous (from within the body)

Pathophysiology

• Characterized by inflammation, vascular engorgement, edema, leukocyte activity, and abscess formation

Clinical Manifestations

• Bone pain, fever, and signs of local inflammation are clinical manifestations

Treatment

• Surgical debridement, bone biopsy, and antibiotic therapy are treatments

Joint Disorders

Osteoarthritis (OA)

• A common age-related disorder of synovial joints

Pathophysiology

• Characterized by loss of articular cartilage

Clinical Manifestations

• Pain, stiffness, and reduced range of motion are clinical manifestations

Rheumatoid Arthritis (RA)

• A chronic, systemic autoimmune disease that causes inflammation of connective tissue, primarily in joints

Pathophysiology

• Inflammatory cytokines convert the synovium into a thick, abnormal layer of granulation tissue known as pannus

Clinical Manifestations

• Joint pain, tenderness, swelling, and stiffness, as well as systemic manifestations such as fever, fatigue, and weight loss are clinical manifestations

Ankylosing Spondylitis (AS)

• A chronic inflammatory disease affecting the spine and sacroiliac joints

Pathophysiology

• Involves inflammation and eventual fusion (ankylosis) of the vertebrae

Clinical Manifestations

• Includes back pain, stiffness, and restricted spinal movement

Gout

• An inflammatory response to excessive uric acid results in monosodium urate crystals in and around joints

Pathophysiology

• Uric acid crystallization in synovial fluid triggers the release of chemokines and interleukins, resulting in acute inflammation

Clinical Manifestations

• Hyperuricemia, recurrent attacks of monoarticular arthritis, tophi, renal disease, and renal stones are clinical manifestations

Skeletal Muscle Disorders

Secondary Muscular Dysfunction

• Muscular symptoms arise from causes unrelated to the muscle itself

Contractures

• Lack of full passive range of motion of a joint due to muscle, connective tissue, or soft tissue limitations

Stress-Induced Muscle Tension

• Associated with chronic anxiety and stress

Fibromyalgia (FM)

• A chronic musculoskeletal syndrome characterized by widespread pain, fatigue, and tender points

Pathophysiology

• Unclear, but genetic factors, neuroendocrine/stress alterations, and abnormal pain responses are implicated

Clinical Manifestations

• Chronic pain, fatigue, headaches, and irritable bowel syndrome are clinical manifestations

Chronic Fatigue Syndrome (CFS)

• A debilitating disorder characterized by profound fatigue, musculoskeletal pain, cognitive impairment, and unrefreshing sleep

Pathophysiology

• The exact etiology and pathophysiology remain unknown

Clinical Manifestations

• Fatigue, muscle pain, noninflammatory joint pain, headaches, and memory/concentration problems are clinical manifestations

Muscle Membrane Abnormalities

• Defects in the muscle membrane

Myotonia

• Delayed muscle relaxation after contraction is caused by a hyperexcitable membrane

Periodic Paralysis (PP)

• A group of muscle diseases caused by dysfunction of ion channels, leading to episodes of muscle weakness

Metabolic Muscle Diseases

• Disorders caused by genetic mutations impacting muscle metabolism

Pathophysiology

• Altered energy production leads to exercise intolerance, fatigue, and painful muscle cramps

Inflammatory Muscle Diseases (Myositis)

• Viral, bacterial, and parasitic infections can produce inflammatory changes in skeletal muscle

Polymyositis (PM)

• Inflammation of connective tissue and muscle fibers, mediated by T cells

Dermatomyositis (DM)

• Similar to polymyositis but also involves cutaneous manifestations

Muscle Tumors

• Rare and can be benign (rhabdomyoma) or malignant (rhabdomyosarcoma)

Rhabdomyosarcoma

• A rare malignant tumor of striated muscle; common soft tissue sarcoma in children/adolescents