Musculoskeletal System Disorders (1).pdf

Musculoskeletal System Disorders Musculoskeletal Diagnostic Tests;- Bone disorders à radiography, bone scanning Muscular disorders à electromyography (EMG), biopsy Joint disorders à radiography, arthroscopy , (MRI), examination of synovial fluid Fracture...

Musculoskeletal System Disorders Musculoskeletal Diagnostic Tests;- Bone disorders à radiography, bone scanning Muscular disorders à electromyography (EMG), biopsy Joint disorders à radiography, arthroscopy , (MRI), examination of synovial fluid Fracture ;- break in the integrity of a bone occur because of trauma, neoplasms, or increased stress on bones. charted using the # sign Types of fractures ;- Complete à bone broken, forming separate pieces Incomplete à bone only partially broken Open (compound) à skin broken Closed à skin not broken Simple à single break, maintaining alignment and position Comminuted à multiple fractures and bone fragments Compression à bone crushed or collapsed into small pieces Moza Khalifa Alsuwaidi Pathophysiology of Bone Fracture;- - Fractures starts an inflammatory response and hemostasis release of systemic edema --> cause bradykinin and clot signs of bleeding stretching of other chemical formation inflamation periosteum mediatiors may occur Healing of Bone Fracture ;- - How does the bone heal ? - Hematoma ( fibrin network is formed ) à phagocytosis cells remove debris à fibroblast lay new collagen fibers à chondroblasts form cartilage à formation of procallus à osteoblast generate new bone à procallus is replaced à new bone is formed Factors that effect bone healing ;- - Amount of damage - Proximity of bone ends - Presence of foreign material or infection - Blood supply to fracture site - Systemic factors, such as age, nutrition, anemia Moza Khalifa Alsuwaidi Complications ;- - Muscle spasms - Infections - Ischemia - Fat emboli - Nerve damage - Failure to heal or development of deformity during healing - Residual effects such as osteoarthritis Treatments of Fractures ;- Closed reduction ; procedure to reduce a broken bone without surgery Open reduction ; surgery to align and/or Insert pins, screw rods, or plates to align Compartment Syndrome ; What happen ; - Edema - Ischemia and infraction of tissue may occur because of compression of arterial blood supply. - Dead tissue may become gangrenous - Tight cast can cause compartment syndrome Moza Khalifa Alsuwaidi Dislocations ; - Separation of 2 bones at a joint - Accompanied by soft tissue damage to ligaments and tendons - If repeated may require surgery Sprains and strains ;- - Sprain à a tear in ligament - Strain à tear in a tendon - Avulsion à ligaments or tendons completely separated from bony attachments - Signs and symptoms pain , tenderness, swelling, hematoma. - Immobilization used to prevent tissue damage and promote healing - severe damage to tendon and ligament surgical repair is necessary overuse injuries à muscle tears - repetitive strain injury à develop over period of time because of repetitive movement examples ; keyboard use \ running Muscle Tears - result of a trauma or overextension or overstressing of the muscle - repeated injury will lead to replacing the structure with fibrous scar tissue Moza Khalifa Alsuwaidi degrees of muscle tears a) first degree à small amount of muscle fiber b) second degree à not complete tear c) third degree à complete tear Treatment of muscle tear RICE NSAID 3rd degree tear require surgery Moza Khalifa Alsuwaidi  Bone disorders ; Osteoporosis - Metabolized disorder characterized by ; Decrease in bone mass and density Loss of bone matrix Mineralization - affects bones consisting of high proportion of cancellous bone ( Vertebrae & femoral neck ) - Diagnosed with bone density scans & x-ray. - Can cause compression fractures of vertebrae, wrist, or hip - Signs and symptoms ; Back pain , kyphosis and scoliosis , spontaneous Occur in 2 forms ; 1. Primary à what cause it o Idiopathic o Age 50+ o Decreased sex hormones o Decreased calcium intake 2. Secondary o As a complication of another disorder Pathophysiology of osteoporosis ; Result in Lead to - Bone resorption exceeds formation à thin , fragile bone à spontaneous fracture Moza Khalifa Alsuwaidi Treatment ; - Dietary supplements à Vitamin D, calcium & protein - Weight-bearing exercise - Physiotherapy - Bisphosphonates à inhibit osteoclast activity. - Calcitonin ( nasal spray)-Analgesic - Fluoride supplement promote bone deposition Rickets and Osteomalacia - Result from deficit of vitamin D and phosphates that is required for bone mineralization - Children à weak bones \ skeletal deformities \ height below normal - Adults à soft bones that will result in compression fractures Happens because ; - dietary deficits - malabsorption - intake of phenobarbital - lack of sun exposure Moza Khalifa Alsuwaidi Osteomyelitis - infection caused by bacteria or fungi Signs and symptoms - Local inflammation and bone pain - Fever and excessive sweating - Chills - General malaise Treatment - Antibiotics - Surgery may be required Abnormal Curvatures of the Spine - Lordosis à Swayback—curving inward at the lower back - Kyphosis à Hunchback or humpback—abnormally rounded upper back - Scoliosis à S- or C-shaped—sideways curve to the spine Moza Khalifa Alsuwaidi Tumors - What are the common sites for secondary tumors ? 1. Breast 2. Lung 3. Prostate - Most primary tumors termed sarcomas are malignant ( cancerous ) Osteosarcoma o most common primary neoplasm of bone o Occurs in the shaft of long bones of the leg o Common in children, adolescents, and young adults o Bone pain at rest is a warning sign Chondrosarcomas o arise from cartilage cells o more common in adults Bone Tumors - Tumors metastasize to lungs early in the course of the disease Treatment - Excision of tumor - Surgical amputation if excision is not feasible - Chemotherapy to reduce metastasis Moza Khalifa Alsuwaidi Muscular Dystrophy (MD) - autosomal recessive disorders - Degeneration of skeletal muscle over time - Duchenne’s MD or pseudohypertrophy MD most common type that affects young boys Signs and symptoms - Duchenne’s MD (x linked ) à early motor weakness - Weakness in pelvic girdle—waddling gait, difficulty climbing stairs - Gower maneuver—pushing up to erect position - Tendon reflexes reduced - Deformities development à kyphoscoliosis - Respiratory infections - Cardiac myopathy Diagnostic tests - Identification of common genetic abnormalities - Elevated creatine kinase levels - Electromyography - Muscle biopsy - Blood test shows abnormal dystrophin levels Moza Khalifa Alsuwaidi Treatment - No curative treatment available - Moderate exercise to maintain motor function - Supportive appliances - Physiotherapy and occupational therapy - Massage - Ventilator - Research being done on genetic therapies Fibromyalgia o Cause is not known but hypothesized to be imbalance in serotonin and other neurotransmitters or sensitivity to production of substance P Characterized by ; - Pain in soft tissues - Stiffness affecting muscles, tendons, and soft tissue - No obvious inflammation or atrophy - Sleep disturbance and severe fatigue - Anxiety and/or depression may be present Treatment - Stress avoidance or reduction - Analgesic drugs - Regular exercise - Low doses of antidepressants - Pace activity and rest as needed. - NSAIDs - Applications of heat or massage - New drugs—pregabalin (Lyrica) Moza Khalifa Alsuwaidi  Joint Disorders ; Osteoarthritis What is it ? - Degenerative—wear and tear joint disease - May be the result of increased weight-bearing or lifting - Incidence increasing - Genetic component identified in research with mice Pathophysiology - Articular cartilage is damaged and the surface become rough and worn - Tissue damage will cause the release of enzymes that will disintegrate the cartilage - Subchondral bone may be exposed. - Cysts, osteophytes, or new bone spurs develop - Osteophytes and cartilage break off. - Joint space becomes narrower that will lead to Secondary inflammation of surrounding tissue - Loss of normal range of joint motion that will cause Pain with weight-bearing and use Moza Khalifa Alsuwaidi Causes - Primary form à weight-bearing, obesity, aging - Secondary form à follows trauma or repetitive use - Genetic factors thought to play a role - Weight-bearing joints most frequently affected but finger joints also involved Signs & symptoms - Aching pain with weight-bearing and movement - movement is limited. - Recreational and social activities become limited because of pain. - Walking is difficult. - Predisposition to falls - Bony enlargement of distal interphalangeal joints Treatment - Stress on joint minimized by use of adaptive devices such as a cane - Pacing activity - Mild exercise program to maintain fitness and joint function - Supports such as hand brace to facilitate movement - Orthotic Inserts in shoes - Massage - Physiotherapy - Acupuncture - Occupational therapy Moza Khalifa Alsuwaidi  - Glucosamine chondroitin supplements - Injection of synthetic synovial fluid (hyaluronic acid) - NSAIDs - Analgesics - Arthrotomy - Surgical joint replacement Rheumatoid Arthritis - autoimmune disorder - Higher incidence in women than in men - Affects all age groups - Causes chronic systemic inflammatory disease Pathophysiology - Synovitis - Pannus formation - Cartilage erosion - Fibrosis - Ankylosis Moza Khalifa Alsuwaidi Other changes that frequently occur - Atrophy of muscles - Bone alignment shifts - Muscle spasms - Contractures and deformity develop Cause - Exact cause not known - Genetic factor is present. - Familial predisposition - Some links to viral infections Signs and symptoms - Affected joints are extremely painful. - Stiffness of joints - Redness and swelling - Joint involvement includes small joints and is often bilateral. - Joint movement impaired - Deformation and fixation of the joint Moza Khalifa Alsuwaidi Systemic signs - Fatigue - Anorexia - Mild fever - Generalized lymphadenopathy - Generalized aching Treatment - Balance between rest and activity - Heat and cold applications - Physical and occupational therapy - NSAIDs - Glucocorticoids for severe inflammation - Analgesia for pain - Disease-modifying antirheumatic drugs, such as gold salts, methotrexate, hydroxychloroquine - Biological response–modifying agents, such as infliximab, rituximab, anakinra Moza Khalifa Alsuwaidi Gout - known as gouty arthritis - Results from deposits of uric acid and crystals in the joint, causing inflammation - Formation of tophus ( large hard nodule of urate crystals ) that will cause local inflammation that occur after the first exposure - Uric acid and crystals form because of inadequate renal excretion, chemotherapy, metabolic abnormality, and/or genetic factors - Inflammation causes redness, swelling, and pain. - Treated by reducing uric acid levels with drugs and dietary changes - Diagnosed by examination of synovial fluid and blood tests Ankylosing Spondylitis - Chronic, progressive, inflammatory condition - Affects sacroiliac joints, intervertebral spaces, costovertebral joints - More common in men age 20 to 40 years - Cause has not yet been determined—thought to be an autoimmune disorder with a genetic basis Moza Khalifa Alsuwaidi Signs - lower back pain, - morning stiffness - pain when lying down - spine becomes rigid systemic signs - fatigue - fever - weight loss - uveitis Treatment - drugs to relieve pain - daily exercise - Physiotherapy - occupational therapy Moza Khalifa Alsuwaidi  Other Inflammatory Joint Disorders Bursitis - Inflammation of the bursae associated with bones, muscles, tendons, and ligaments of various joints Most common cause - Repetitive motion on a particular joint Diagnosis - Physical examination - Ultrasound and/or MRI Treatment - Rest - Anti-inflammatory drugs Synovitis - Inflammation of the synovial membrane - Movement of joint is restricted and painful Diagnosis - Swollen, red, and warm joint - Analyzing synovial fluid (for signs of infections) Moza Khalifa Alsuwaidi Treatment - Anti-inflammatory drugs - Identification and treatment of underlying cause Tendinitis - Irritation or inflammation of the tendon Manifestation - Dull ache and mild swelling Cause - Single trauma or repetitive motion Diagnosis - Made by physical examination Treatment - Rest, application of ice - Pain relievers—maybe anti-inflammatory drugs - Physical therapy Moza Khalifa Alsuwaidi