Musculoskeletal System PDF

THE MUSCULOSKELETAL SYSTEM Methods of Examination of the Musculoskeletal System: 1. Plain films, AP, lateral obliques, special projections 2. Ultrasound Assessment of joint effusion) 3. CT scan. Best for measuring bone density 4. MRI 5. Radionuclide studies 6. Ang...

THE MUSCULOSKELETAL SYSTEM Methods of Examination of the Musculoskeletal System: 1. Plain films, AP, lateral obliques, special projections 2. Ultrasound Assessment of joint effusion) 3. CT scan. Best for measuring bone density 4. MRI 5. Radionuclide studies 6. Angiography 7. Arthrography 8. Fistulography 9. Discography 10. Arthroscopy (surgical procedure Skeletal trauma: Sructural break in the normal continuity of bone. Types: Simple (closed) Compuond (opened) Fracure lines: Green stick. Transverse or linear fractures Spiral fracture Comminuted fracture Green stick 1  Spiral fracture Comminuted fracture Angulated fracture 2 Complications: Local complication. General complication. Complications of fractures: Union problems Malunion and cross union. Delayed union. Non union. Sudeck’s atrophy. Transient osteoprosis. Sub periosteal heamatomas. Myositis Ossificans,ligamentous injury. (pellegrini-Stieda) Compartment syndrome. Arterial injury Joint injury. Neuropathic arthropathy (charcot’s joint), Avascular necrosis Non united fracture 3  Malunited fracture Union problems: Malunion Angulation Shortening Cross union Causes of union problems: Inadequate fixation Interposition of soft tissue Infection Bad general condition Spondylolisthesis Forward displacement of one vertebra over another one Stage I: Vertebra above shifts 25% of its body anterior or forward over the vertebra below Stage II: 50% of body shifted Stage III: 75% of the body shifted Stage IV: 100% of body shifted 4  Spondylolithesis Degenerative ( Facet arthropathy ) Lytic ( pars inter articularis break) BONE AND JOINT INFECTIONS 5  Osteomyelitis Infection of the medullary bone that results in progressive inflammatory destruction of bone Etiology Heamatogenous spread (children) Direct inoculation of micro organism(truma-surgery Acute osteomyelitis. Chronic osteomyelitis Brodies abscess Radiologically: First sign localizes soft tissue swelling. In infants and children the earliest osseous finding is metaphyseal area of bone destruction. Destruction of the epiphyseal ossification center may occur Involucrum: Periosteal new bone formation in a solid or cloaking pattern. Sequestrum: Detached necrotic bone (after 30 days). Cloaca: formation.defect in the cortex through which dead bone gets out. Acute osteomyelitis 6 Chronic osteomyelitis 7  Metabolic And Endocrine diseases of bone Physis: Composed of four distinct zones of cartilage: Germinal zone=small cells adjacent to epiphyseal plate. Proliferating zones = flat cells Hypertrophic zone =vaculated cells Zone of provisional calcification Hyperparathyroidism: Uncontrolled production of parathyroid hormone Etiology -Primary: Adenoma, hyperplasia, carcinoma. -Secondary: Diffuse adenomatous hyperplasia as a compansatory mechanism in any state of hypocalcemia -Tertiary: autonomous PTH adenoma in patients with chronically overstimulated hyperparathyroid glands. Action: Defect in mineralization (increased volume of uncalcified osteoid tissue) due to Incresed number of osteoclast Renal osteodystrophy Etiology: Glomerular disease. Tubular disease. Pathology: A-Vit D inactivation. B-Deminished phosphate filteration 2ry HPT C-A &B Radiological picture: Bone resorption: Bone softening Subperiosteal Brown tumor Subchondral Osteosclerosis Cortical Soft tissue calcification Trabecular (salt and pepper skull) Erosive arthropathy Subligmamentous Periosteal new bone formation 8  Hyperparathyroidism Cortical tunneling Primary Hyperthyroidism 9 Subperiosteal bone resorptipon Secondary degenerative arthritis 10 ▪ Brown tumor Trabecular resorption (salt and pepper) 11  Renal osteodystrophy Refers to radiographic osseous changes in patients with renal failure. Radiological features. Changes of osteomalacia. Osteopenia and cortical thinning. Looser’s zones uncommon. Changes of hyperparathyroidism. Subperiosteal resorption. Ruger jersy spine. Brown tumours. Other manifestations: Renal stones. Peptic ulcer Calcific pancreatitis Soft tissue calcifications Chondrocalcinosis. Renal osteodystrophy Rugger jersy spine 12  Rickets Improper mineralization of the growth plate. Osteomalacia during enchondral bone growth. Age 4-8 months. Zone of provesional calcification does not form Failure of osteoid mineralization Etiology: Abnormality in Vit D metabolism; ▪ Vit D deficiency. ▪ Defective conversion of Vit D to 25 OH D3in the liver. ▪ Defective conversion of 25 OH D3 to 1,25 in kidney Abnormality in phosphate metabolism ▪ Phosphate deficiency ▪ Disorders of renal tubular reabsorption of phosphate ▪ Hypophosphatemia with non endocrine tumors. ▪ Hypophosphatesia Ca defeciency 13 Radiological features: Poorly mineralized epiphyseal centres with delayed appearance Irregular widening of the epiphseal end plates Cupping and fraying of the metaphysis Cortical spurs projecting at right angles of the metaphysis Coarse trabeculations Bowing of long bones Frontal bossing Periosteal reaction may be present 14  Acromegaly Excess GH due to eosinophilic adenoma/ hyperplasia Gigantism in children 15  GOUT Deposition of monosodium urate monohydrate crystals in poorly vascularized tissues Age more than 40 years. 90% of patients are males. Etiology: Uric acid overproduction.(10%) o Primary enzyme defect (Idiopathic) o Secondary increased nucleic acid turn over Uric acid under excretion. o Primary (Unknown cause) o Secondary 16 Stages: Asymptomatic Acute gouty arthritis: mono or oligo-articular occasionally polyarticular. Chronic tophaceous gout Radiological manifestation: Soft tissue :Tophi, juxta-articular eccentric soft tissue,helix of ear. Bursitis (pathognomic) olecranon,prepatellar. chondrocalcinosis Joints. Effusion, Bone 17