msk disorders

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Alterations of Musculoskeletal Function : 

Alterations of Musculoskeletal Function 1

Musculoskeletal Injuries : 

Musculoskeletal Injuries 2 Fractures A fracture is a break in the continuity of a bone Classifications Complete or incomplete Closed or open Comminuted Linear Oblique Spiral

Fracture Classifications : 

Fracture Classifications 3 Transverse Greenstick Torus Bowing Pathologic Stress Fatigue and insufficiency Transchondral

Fractures : 

Fractures 4

Bone Fractures : 

Bone Fractures 5 A broken bone can cause damage to the surrounding tissue, the periosteum, and the blood vessels in the cortex and marrow Hematoma formation Bone tissue destruction triggers an inflammatory response Procallus formation

Callus Formation : 

Callus Formation 6

Bone Fractures : 

Bone Fractures 7 Manifestations Unnatural alignment, swelling, muscle spasm, tenderness, pain, impaired sensation, and possible muscle spasms Treatment Closed manipulation, traction, and open reduction Improper reduction or immobilization Nonunion, delayed union, and malunion

Treatment : 

Treatment 8

Treatment : 

Treatment 9

Treatment : 

Treatment 10

Bone Fractures : 

Bone Fractures 11 Dislocation Temporary displacement of two bones Loss of contact between articular cartilage Subluxation Contact between articular surfaces is only partially lost Dislocation and subluxation are associated with fractures, muscle imbalance, rheumatoid arthritis, or other forms of joint instability

Support Structure Injuries : 

Support Structure Injuries 12 Strain Tear or injury to a tendon Sprain Tear or injury to a ligament Avulsion Complete separation of a tendon or ligament from its bony attachment site

Tendinopathy and Bursitis : 

Tendinopathy and Bursitis 13 Tendinitis Inflammation of a tendon Tendinosis Painful degradation of collagen fibers Bursitis Inflammation of a bursa Skin over bone, skin over muscle, and muscle and tendon over bone Caused by repeated trauma Septic bursitis is caused by a wound infection

Tendinopathy and Bursitis : 

Tendinopathy and Bursitis 14 Epicondylitis Inflammation of a tendon where it attaches to a bone Tennis elbow (lateral epicondylitis) Golfer’s elbow (medial epicondylitis)

Tendinitis and Epicondylitis : 

Tendinitis and Epicondylitis 15

Muscle Strain : 

Muscle Strain 16 Sudden, forced motion causing the muscle to become stretched beyond its normal capacity Local muscle damage Muscle strains can also involve the tendons

Myositis Ossificans : 

Myositis Ossificans 17 Complication of local muscle injury Inflammation of muscular tissue with subsequent calcification and ossification of the muscle “Rider’s bone” in equestrians “Drill bone” in infantry soldiers Thigh muscles in football players

Rhabdomyolysis : 

Rhabdomyolysis 18 Rhabdomyolysis (myoglobinuria) is a life-threatening complication of severe muscle trauma with muscle cell loss Crush syndrome Compartment syndromes

Osteoporosis : 

Osteoporosis 19 Porous bone Poorly mineralized bone Bone density Normal bone 833 mg/cm2 Osteopenic bone 833 to 648 mg/cm2 Osteoporosis <648 mg/cm2

Osteoporosis : 

Osteoporosis 20 Potential causes Decreased levels of estrogen and testosterone Decreased activity level Inadequate levels of vitamins D and C, or Mg++ Demonstrated by reduced bone mass/density and an imbalance of bone resorption and formation Bone histology is usually normal but it lacks structural integrity

Osteoporosis : 

Osteoporosis 21

Osteoporosis : 

Osteoporosis 22

Osteoporosis : 

Osteoporosis 23

Osteoporosis : 

Osteoporosis 24 Perimenopausal osteoporosis Iatrogenic osteoporosis Regional osteoporosis Postmenopausal osteoporosis Glucocorticoid-induced osteoporosis Age-related bone loss

Osteomalacia : 

Osteomalacia 25 Deficiency of vitamin D lowers the absorption of calcium from the intestines Inadequate or delayed mineralization Bone formation progresses to osteoid formation but calcification does not occur; the result is soft bones Pain, bone fractures, vertebral collapse, bone malformation

Paget Disease : 

Paget Disease 26 Also called osteitis deformans Excessive resorption of spongy bone and accelerated formation of softened bone Disorganized, thickened, but soft bones Most often affects the axial skeleton Thickened bones can cause abnormal bone curvatures, brain compression, impaired motor function, deafness, atrophy of the optic nerve, etc.

Osteomyelitis : 

Osteomyelitis 27 Osteomyelitis is most often caused by a staphylococcal infection Most common cause is open wound (exogenous); also can be from a blood-borne (endogenous) infection Manifestations Acute and chronic inflammation, fever, pain, necrotic bone Treatment Antibiotics, débridement, surgery, hyperbaric oxygen therapy

Osteomyelitis : 

Osteomyelitis 28

Bone Tumors : 

Bone Tumors 29 May originate from bone cells, cartilage, fibrous tissue, marrow, or vascular tissue Osteogenic, chrondrogenic, collagenic, and myelogenic Malignant bone tumors Increased nuclear/cytoplasmic ratio, irregular borders, excess chromatin, a prominent nucleolus, and an increase in the mitotic rate

Bone Tumors : 

Bone Tumors 30

Inflammatory vs. Noninflammatory Joint Disease : 

Inflammatory vs. Noninflammatory Joint Disease 31 Differentiated by: Absence of synovial membrane inflammation Lack of systemic signs and symptoms Normal synovial fluid analysis

Osteoarthritis : 

Osteoarthritis 32 Degeneration and loss of articular cartilage, sclerosis of bone underneath cartilage, and formation of bone spurs (osteophytes) Also referred to as degenerative joint disease Incidence increases with age Primary disease is idiopathic

Osteoarthritis : 

Osteoarthritis 33 Osteoarthritis is characterized by local areas of damage and loss of articular cartilage, new bone formation of joint margins, subchondral bone changes, and variable degrees of mild synovitus and thickening of the joint capsule Manifestations Pain, stiffness, enlargement of the joint, tenderness, limited motion, and deformity

Osteoarthritis : 

Osteoarthritis 34

Osteoarthritis : 

Osteoarthritis 35

Inflammatory Joint Disease : 

Inflammatory Joint Disease 36 Commonly called arthritis Characterized by inflammatory damage or destruction in the synovial membrane or articular cartilage and by systemic signs of inflammation Fever, leukocytosis, malaise, anorexia, and hyperfibrinogenemia Infectious or noninfectious

Rheumatoid Arthritis (RA) : 

Rheumatoid Arthritis (RA) 37 Inflammatory joint disease Systemic autoimmune damage to connective tissue, primarily in the joints (synovial membrane) Similar symptoms to osteoarthritis Presence of rheumatoid factors (RA or RF test) Antibodies (IgG and IgM) against antibodies Joint fluid presents with inflammatory exudate

Rheumatoid Arthritis (RA) : 

Rheumatoid Arthritis (RA) 38 Pathogenesis CD4 T helper cells and other cells in the synovial fluid become activated and release cytokines Recruitment and retention of inflammatory cells in the joint sublining region Viscous cycle of altered cytokine and signal transduction pathways Possible immune complex deposition and inflammatory cytokine release RANKL release and osteoclast activation Angiogenesis in the synovium

Rheumatoid Arthritis (RA) : 

Rheumatoid Arthritis (RA) 39 Evaluation (4 or more of the following) Morning joint stiffness lasting at least 1 hour Arthritis of three or more joint areas Arthritis of the hand joints Symmetric arthritis Rheumatoid nodules Abnormal amounts of serum rheumatoid factor Radiographic changes

Rheumatoid Arthritis (RA) : 

Rheumatoid Arthritis (RA) 40

Gout : 

Gout 41 Metabolic disorder that disrupts the body’s control of uric acid production or excretion Gout manifests high levels of uric acid in the blood and other body fluids Occurs when the uric acid concentration increases to high enough levels to crystallize Crystals deposit in connective tissues throughout the body When these crystals occur in the synovial fluid, the inflammation is known as “gouty arthritis”

Gout : 

Gout 42 Gout is related to purine (adenine and guanine) metabolism Affected patients can have accelerated purine synthesis, breakdown, or poor uric acid secretion in the kidneys Mechanisms for crystal deposition Lower body temperatures, decreased albumin or glycosaminoglycan levels, changes in ion concentration and pH, and trauma

Gout : 

Gout 43 Clinical stages Asymptomatic hyperuricemia Acute gouty arthritis Tophaceous gout

Gout : 

Gout 44

Gout : 

Gout 45

Disorders of Skeletal Muscle : 

Disorders of Skeletal Muscle 46 Contracture Muscle fiber shortening without an action potential Caused by failure of the sarcoplasmic reticulum (calcium pump) even with available ATP Stress-induced muscle tension Neck stiffness, back pain, clenching teeth, hand grip, and headache Associated with chronic anxiety

Disuse Atrophy : 

Disuse Atrophy 47 Reduction in the normal size of muscle cells due to prolonged inactivity Bed rest, trauma, casting, or nerve damage Treatment Isometric movements and passive lengthening exercises

Muscle Tumors : 

Muscle Tumors 48 Rhabdomyosarcoma Malignant tumor of striated muscle Usually muscles of the tongue, neck, larynx, nasal cavity, axilla, vulva, and heart Highly malignant with rapid metastasis Types Pleomorphic, embryonal, and alveolar

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