WM420 Lect 6 Musculoskeletal.pdf

Lecture 6 Musculoskeletal System Diseases and Disorders Neighbors/Tannehil-Jones, Human Diseases, 5th Edition. © 2019 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Anatomy and Physiology Bones and joints Bones...

Lecture 6 Musculoskeletal System Diseases and Disorders Neighbors/Tannehil-Jones, Human Diseases, 5th Edition. © 2019 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Anatomy and Physiology Bones and joints Bones provide framework and support o Classified by shape and composition Joints o Where two or more bones meet Muscle structure, movement, and heat Neighbors/Tannehil-Jones, Human Diseases, 5th Edition. © 2019 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Common Signs and Symptoms Bone and joint diseases: o Pain, swelling, decreased mobility, and deformity Muscle disorders: o Weakness Neighbors/Tannehil-Jones, Human Diseases, 5th Edition. © 2019 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Diagnostic Tests X-rays Computed axial tomography (CAT) scans Magnetic resonance imaging (MRIs) BMD–DEXA(dual-energy X-ray absorptiometry) o Including calcium and phosphorus Ultrasonography Electromyography Neighbors/Tannehil-Jones, Human Diseases, 5th Edition. © 2019 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Diseases of the Bone (1 of 2) Vary from mild to severe More common as adults age Neighbors/Tannehil-Jones, Human Diseases, 5th Edition. © 2019 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Diseases of the Bone (2 of 2) Spinal deformities: A. Kyphosis Curvature of thoracic spine B. Lordosis Exaggerated anterior or inward curve of lumbar spine C. Scoliosis Lateral curvature of spine Neighbors/Tannehil-Jones, Human Diseases, 5th Edition. © 2019 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Diseases of the Bone Osteomyelitis o Inflammation of bone caused by staphylococcal infection (most common cause) Osteoporosis o Metabolic bone disease causing porosity and leading to decrease in bone mass Osteomalacia o Softening of the bones – defective mineralization of preformed osteoid Rickets o Defective mineralization of the growth plate o The leading cause of rickets worldwide is solar vitamin D deficiency and/or dietary calcium deficiency collectively termed as nutritional rickets. Neighbors/Tannehil-Jones, Human Diseases, 5th Edition. © 2019 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Fracture Complications Compartment syndrome o is an increased pressure in a compartment, usually the muscle fascia in the case of fractures. o This pressure impinges on the nerves and blood vessels present within the compartment, potentially compromising the distal extremity. o Compartment syndrome requires prompt identification and treatment to prevent permanent tissue damage. o Clinical manifestations: excruciating pain beyond what would be expected given the injury. o Diagnosis: by measuring pressures inside the muscle fascia. o Treatment: includes removing the cast (if present) and performing an immediate fasciotomy to relieve the pressure. Neighbors/Tannehil-Jones, Human Diseases, 5th Edition. © 2019 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Fracture Complications Fat Embolism occurs when fat has an opportunity to enter the bloodstream (e.g., during surgery). o Fatty marrow can enter the bloodstream after a fracture to one of the long bones. o Fatal if the emboli travel to vital organs such as the lungs, brain, or heart. o Prevented with early immobilization of the fracture. Neighbors/Tannehil-Jones, Human Diseases, 5th Edition. © 2019 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Fracture Complications Osteomyelitis refers to an infection of the bone tissue. o often goes undetected, can take months to resolve, and o can result in bone or tissue necrosis. o Treatment: potent antibiotic therapy (often delivered on a long-term basis) and surgery (e.g., debridement). Neighbors/Tannehil-Jones, Human Diseases, 5th Edition. © 2019 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Fracture Complications Osteonecrosis, or avascular necrosis, is death of bone tissue due to a loss of the blood supply to that tissue. o It can result from displaced fractures or dislocations. o often requires surgical replacement of the necrotic bone and/or joint. Neighbors/Tannehil-Jones, Human Diseases, 5th Edition. © 2019 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Diseases of the Joints (1 of 3) Most occur as slow process Rheumatoid Arthritis - Inflammation Osteoarthritis o Degenerative process – “wearing out of joint” Neighbors/Tannehil-Jones, Human Diseases, 5th Edition. © 2019 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Diseases of the Joints (2 of 3) Rheumatoid arthritis o Autoimmune disorder affecting joints and connective tissue of entire body Rheumatoid vs. Osteoarthritis o Osteoarthritis affects working joints/weight bearing joints – hip, knee, thumb o Rheumatoid can affect all joints – more symmetrical Neighbors/Tannehil-Jones, Human Diseases, 5th Edition. © 2019 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Diseases of the Joints (2 of 3) Gout Metabolic error in breakdown of certain protein foods caused by a condition known as hyperuricemia - too much uric acid in the body. The body makes uric acid when it breaks down purines, which are found in your body and the foods you eat. Symptoms Pain Swelling Redness Stiffness Deformity Inflammation Limited range of motion Uric acid crystals in polarized light, showing negative birefringence, with yellow color when aligned parallel to the axis of the red compensator, and blue when aligned perpendicularly to it. Diseases of the Joints Temporomandibular joint (TMJ) syndrome Severe headaches and pain in jaw Causes Bruxism- Teeth grinding and/or clenching can irritate the soft tissue surrounding the joint causing the muscles, tendons, and ligaments to become inflamed. Missing teeth Arthritis Traumatic injury to the head and neck region Dislocation of the ball and socket of the TMJ Family history Stress Poor posture Overuse of the jaw such as excessive gum chewing Diseases of the Joints (3 of 3) Hallux valgus Deformity affecting metatarsophalangeal joint of big toe Also known as bunion Diseases of Muscle and Connective Tissue Muscular dystrophy (MD) o Inherited, genetic disorder affecting skeletal muscles Ganglion cyst o Fluid-filled benign tumor on tendon sheath near wrist Tetanus o Also known as lockjaw o An acute, infectious, life-threatening disease o is a bacterial infection (Clostridium tetani) characterized by muscle spasms. In the most common type, the spasms begin in the jaw and then progress to the rest of the body. Neighbors/Tannehil-Jones, Human Diseases, 5th Edition. © 2019 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Neoplasms (1 of 2) Primary neoplasms of musculoskeletal system uncommon o Typically secondary, metastasizing from lungs, breast, and prostate o Symptoms and Signs 1. Pain, swelling or tenderness near the affected area 2. Bone pain 3. Unexplained tiredness 4. Fever with no known cause 5. Losing weight without trying Neighbors/Tannehil-Jones, Human Diseases, 5th Edition. © 2019 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Neoplasms (2 of 2) Osteosarcoma Most common primary tumor of bone Rhabdomyosarcoma Very rare, highly malignant tumor of skeletal muscle Trauma (1 of 2) Main cause of problems in musculoskeletal system Fractures o Break in bone o Types: Stress – Pathologic Open (compound) – Closed (simple) Complete – incomplete – greenstick Displaced – comminuted – compression Longitudinal, transverse, oblique, spiral Neighbors/Tannehil-Jones, Human Diseases, 5th Edition. © 2019 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Trauma - Fractures Types: Intracapsular – extracapsular Intertrochanteric – femoral neck – subcapital Colles’ Fx - radius Pott’s - bimalleolar ankle Fxs due to eversion Treatment of Fractures Immobilization Closed reduction – no surgery Open reduction Traction Neighbors/Tannehil-Jones, Human Diseases, 5th Edition. © 2019 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Strains and Sprains (1 of 2) Strain o Overstretching injury of muscles or tendons o Lower back & hamstring muscles o Treatment: Rest Moist heat Analgesics Anti-inflammatories Neighbors/Tannehil-Jones, Human Diseases, 5th Edition. © 2019 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Strains and Sprains (2 of 2) Sprain o Traumatic injury to joint involving overextending or tearing of ligaments o Ankle sprain is most common o Treatment (RICE): Rest Ice Compression Elevation Neighbors/Tannehil-Jones, Human Diseases, 5th Edition. © 2019 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Dislocation and Subluxation Neighbors/Tannehil-Jones, Human Diseases, 5th Edition. © 2019 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Low Back Pain Very common disorder May be acute or chronic Treatment: o Moist heat o Analgesics o Anti-inflammatories o Muscle relaxants Neighbors/Tannehil-Jones, Human Diseases, 5th Edition. © 2019 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Herniated Nucleus Pulposus Herniated disk, ruptured disk, slipped disk, or bulging disk Pressure on spinal nerve may cause pain in sciatic nerve Treatment same as low back pain Bursitis (1 of 2) Inflammation of bursae or small fluid-filled sac near joints o Bursae help reduce friction during movement Symptoms: o Severe pain Limits motion Neighbors/Tannehil-Jones, Human Diseases, 5th Edition. © 2019 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Bursae/Tendon Sheaths Associated with synovial joints Found in areas of high friction ○ Protects the tendons from rubbing against the bone Bursae o Flattened fibrous sacs lined with a synovial membrane o Contains thin film of synovial fluid o Common where ligaments, tendons, muscle, skin, bones rub o Reduces friction between adjacent structures Tendon sheaths o Elongated bursa o Wraps completely around the tendon subjected to friction Olecranon Bursitis Inflammation of the bursa located between the olecranon and the skin Causes include infection, trauma, overuse injury, continuous pressure injury Symptoms/signs ○ ○ ○ ○ Pain Swelling Redness Fluctuant mass over the point of the elbow ○ Decreased range of motion Bursitis (2 of 2) Treatment ○ Rest, ice, antibiotics (infection), aspiration, compression wrap o Moist heat o Analgesics o Anti-inflammatory agents Neighbors/Tannehil-Jones, Human Diseases, 5th Edition. © 2019 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Tendonitis Inflammation of tendon or connective tissue that attaches muscle to bone May occur in any tendon Treatment: o o o o o Ice Analgesics Anti-inflammatories Exercises Surgery Neighbors/Tannehil-Jones, Human Diseases, 5th Edition. © 2019 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Capsule and Cartilage Articular Capsule ○ Runs from the scapula, outer rim of glenoid up to coracoid process, encircles the origin of the long head of the biceps then attaches to the humerus ○ Many folds and loose and blends with rotator cuff muscles ○ Bathed in synovial fluid to allow for smooth motion Glenoid labrum ○ Fibrocartilaginous ring ○ Creates a snug fit for the humeral head Adhesive Capsulitis/Frozen Shoulder Disorder of the joint capsule ○ Capsule thickens and adhesions form plus a decrease in synovial fluid production Women>men Age range 40-70 Increased risk in DM 1 & 2, hypothyroidism, hyperthyroidism, cardiac disease, Parkinson's disease Incidence in general population 3-5% Incidence in those with diabetes 20% Pathophysiology/History/Physical Exam History ○ Possible injury, surgery, tendonitis previously, disease process ○ Dull aching pain located on the outer shoulder and upper arm ○ Difficulty with activities of daily living (can’t wash hair, put on shirt) Signs on physical examination ○ Tenderness to palpation over rotator cuff muscles, trapezius due to tightness ○ Decrease in both active and passive range of motion (PROM>AROM) ○ Severely limited motion Treatment ○ Massage, acupuncture, physical therapy, stretching, sometimes surgery, management of metabolic disorder Rotator Cuff Muscles of the Shoulder SITS muscles 1.Supraspinatus m 2.Infraspinatus m 3.Teres minor m 4.Subscapularis m Rotator Cuff Pathology Impingement syndrome (supraspinatus tendon) ○ Bony pressure on the tendon as arm is raised Tendinitis ○ Inflammation in the tendon ▪ Overuse common Tears ○ Disruption of the fibers of the tendon ▪ Injury, impingement or chronic tendinitis Strain of the muscles ○ Exercise or injury 1.Repetitive Stress 2.Carpal Tunnel Syndrome 3.Rheumatoid Arthritis 4.Sudden Accidents 5.Ganglion Cysts 6.Osteoarthritis 7.Kienbock’s Disease Carpal Tunnel Syndrome (1 of 2) Most common peripheral nerve entrapment disorder Caused by trauma, repetitive motions, pregnancy, hypothyroidism, inflammation Leading to compression of the medial nerve as it travels through the carpal tunnel Transverse ligament runs from the pisiform to the scaphoid along the palmar surface of the wrist Symptoms - pain, numbness and tingling into thumb, index and middle fingers, decreased grip, heaviness, feeling of fullness in the hand, decreased opposition Carpal Tunnel Syndrome (2 of 2) Treatment: o Rest o Splint o Anti-inflammatories o Physical therapy o Surgery Neighbors/Tannehil-Jones, Human Diseases, 5th Edition. © 2019 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Knee Disorders Torn meniscus o Attached to top of tibia and provides cushion for distal femur Cruciate ligament tears o Located inside knee joint o Two ligaments cross to stabilize knee Neighbors/Tannehil-Jones, Human Diseases, 5th Edition. © 2019 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Shin Splints (1 of 2) Overuse injury to periosteum and extensor muscles of lower leg Occur routinely with sudden increase in activity or new exercise routine Shin Splints (2 of 2) Treatment: o Rest o Analgesics o Anti-inflammatories o Heat o Ice Neighbors/Tannehil-Jones, Human Diseases, 5th Edition. © 2019 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Plantar Fasciitis (1 of 2) Also known as calcaneal spur or heel spur Treatment: Rest Ice Analgesics Anti-inflammatories Rare Diseases: De Quervain’s Tenosynovitis Tendonitis affecting thumb Inflammation of the sheath surrounding the extensor pollicis brevis and abductor pollicis longus tendons Pain along the radial aspect of the thumb increased with thumb motion and grasping. Can cause weakness and a sticking sensation Causes can be repetitive motions and trauma Treatment is rest, splinting, anti-inflammatories, stretching, injection, acupuncture Finkelstein’s test for DeQuervain’s Patient performs ulnar deviation of the clenched wrist while holding the opposed thumb. Positive with symptom exacerbation Rare Diseases Tuberculosis of bone Develops in tissue cavities; causes bone weakness and pain Paget’s disease Chronic metabolic bone disease affecting bone formation Bone remodeling abnormality Myasthenia gravis Autoimmune disorder characterized by muscle weakness and fatigue ptosis Effects of Aging Decreased bone density – osteopenia, osteoporosis Decreased muscle strength and mass Changed vertebral disks and compression of vertebrae Results in changes in height and spine curvature