HPEX 353 Chapter 9: Musculoskeletal Diseases and Disorders

What is the Musculoskeletal System made up of?

Bones, joints, ligaments, muscle, and tendons

Types of bone

•Compact: dense, hard tissue found in the shafts of long bones.

•Spongy (cancellous): less dense, found at the end of long bones.

What does muslces help with?

Muscles hold the skeleton and create physical movement of the body

Three types of muscles

•Skeletal/Voluntary: Movement is consciously controlled.

•Smooth/involuntary: not consciously controlled

•Cardiac: combination of both. Involuntary contract.

Description of Herniated Vertebral Disk

The Nucleus pulposus of an intervertebral disk protrudes through the wall of the disk and into the spinal canal, where it presses on spinal nerves and causes pain and instability

**May be related to intervertebral join degeneration or minor trauma (heavy lifting, age, excessive body weight may increase risk).

Symptoms of Herniated Vertebral Disk

•Paresthesia

•Coughing, sneezing, or bending

causes pain

•sciatica

Treatments of Herniated Vertebral Disk

•Physical therapy

•Exercise

•Surgery

Medical Diagnosis of Herniated Vertebral Disk

•Straight leg raise

•X-ray, CT scan, MRI

•Myelography

Description of Lordosis, Kyphosis, and Scoliosis

Abnormal inward curvature of the lumbar or lower spine.

•Lordosis: lower spine or lumbar area

•Kyphosis: upper thoracic vertebrae

•Scoliosis: spine, either left or right

**Associated with congenital spinal defects, posture, discrepancy in leg lengths, growth retardation, generative arthritis or neuromuscular conditions.

Symptoms of Lordosis, Kyphosis, and Scoliosis

•Chronic Fatigue

•Backache

Medical Diagnosis of Lordosis, Kyphosis, and Scoliosis

•X-rays of the spine

Treatments of Lordosis, Kyphosis, and Scoliosis

•Physical therapy

•Exercise

•Surgery

Description of Osteoporosis

Metabolic bone disease

•Proportion of bone mineral to bone matrix normal. Bone composition abnormal

•Bones become brittle, porous and vulnerable. Decrease calcium and phosphate in bones

•Women over age 50, postmenopausal

•Hereditary? Possible other factors: Calcium intake, diet, alcohol consumption, Vit D deficiency, estrogen deficiency, etc.

Symptoms of Osteoporosis

** Asymptomatic

•Fractures

•Bone pain (lower back)

•Loss of height

•Kyphosis

Medical Diagnosis of Osteoporosis

•DEXA

•Blood test for mineral content

Treatment of Osteoporosis

•Increase intake of Ca, P and multivitamins

•Exercise

Description of Osteomyelitis

Chronic inflammatory process of the joints and bones that results in degeneration of joint cartilage and bones.

•Common in adults over 70

•Idiopathic (autoimmune? environmental?) and trauma related

Symptoms of Osteomyelitis

•Joint pain

•Swelling

•Crepitation

Medical Diagnosis of Osteomyelitis

•Physical examination

•X-ray

Treatment of Osteomyelitis

**uncured

•Anti-inflammatories

•Physical activity restriction

•Local heat

•Physical therapy

Description of Rheumatoid Arthrititis

Chronic, systemic, inflammatory disease affecting the synovial membranes of multiple joints.

•Autoimmune disease (genetic predisposition)

Symptoms of Rheumatoid Arthrititis

•Joint pain

•Malaise

•low-grade fever

•Fatigue

•Weight loss

Medical Diagnosis of Rheumatoid Arthrititis

•Rheumatoid factor blood test

•ESR (Erythrocyte Sedimentation Rate)

•CBC

•Synovial fluid analysis

X-ray

Treatment of Rheumatoid Arthrititis

•Antiinflammatory drugs

•Corticosteroids

•Surgery

Description of Gout/Gout Arthritis

**Chronic disorder of uric acid metabolism

•Uric acid (crystals) appear in the synovial fluid of joints (tophi)

•Men (> 30 yo) > Women (menopause)

•Metabolic (genetic) and/or renal (renal problem to clear uric acid)

•Risk factors: obesity, alcohol consumption, aspirin, low thyroid function

Symptoms of Gout/Gout Arthritis

•Sudden onset of joint pain (*big toes)

•Hyperuricemia (high urea in the blood)

•Tophi

•Renal dysfunction

Medical Diagnosis of Gout/Gout Arthritis

•Identification of urate crystals in joint fluids

•Urinalysis (*hyperuricemia)

•ESR

•X-rays (damage joints) and physical examination

Treatments of Gout/Gout Arthritis

•Bed rest

•Local heat or cold

•Analgesics

•Corticosteroids (oral or IM)

•Diet + fluids

•Anti uric acid

(allopurinol,

febuxostat,

or pegloticase)

Prognosis of Gout/Gout Arthritis

•Good

•Complications:

• Kidney stones

• Renal damage

• Hypertension

Description of Carpel Tunnel Syndrome

Compression of the median nerve in the wrist (carpal tunnel).

•Sensory and motor changes in the hand

•Associated with an overuse and incorrect use of the hands and fingers causing inflammation or fibrosis of the tendons

Symptoms of Carpel Tunnel Syndrome

•Wrist pain

•Burning feeling

•Weakness and numbness

Medical Diagnosis of Carpel Tunnel Syndrome

•Inability to clench the fist

•Tinel sign (tingling on fingers

during light tapping)

Treatments of Carpel Tunnel Syndrome

•Resting the wrist/splint

•Ergonomic modifications of the workplace

•Surgery

Description of Plantar Fasciitis

**Irritation of the plantar fascia ligament (on the bottom of the foot)

•Inflammation, swelling and pain when standing or walking

•Associated with straining and tearing of the fascia (due to high arches, obesity, pregnancy, standing/walking/running for long periods of time, excessive pronation.

Symptoms of Plantar Fasciitis

•Pain and stiffness of the feet

Medical Diagnosis of Plantar Fasciitis

•Physical examination

•Tenderness and swelling

•X-rays to rule out other injuries

Treatments of Plantar Fasciitis

•Anti-inflammatories

•Corticosteroids

•Ice

•Rest

•Physical therapy

•Surgery

Description of Myasthenia Gravis (I)

** Chronic, progressive, neuromuscular disease that produces increasingly sporadic weakness and exhaustion of skeletal muscles.

•Autoimmune response resulting in the disappearance of receptors for the neurotransmitter acetylcholine

•More common un women (age 20-40)

•Tumors of thymus glands also present in 15% cases

•Aggravated by menses, emotional stress and infections

Symptoms of Myasthenia Gravis (I)

•Skeletal muscle weakness

•Fatigue

•Blepharoptosis (drooping eyelids)

•Double vision

•Dysphagia * difficulty swallowing

•Dysphasia * difficulty speaking

•Myasthenia crisis (respiratory distress)

Medical Diagnosis of Myasthenia Gravis (I)

•Neurological examination

•Electromyography

•*IV of edrophonium (if muscle function improvement)

•MRI or CT scan to verify the presence of thymus abnormalities

Treatments of Myasthenia Gravis (I)

**Symptomatic

• Anticholinesterase drugs

• Thymectomy

• Corticosteroids

Prognosis of Myasthenia Gravis (I)

•Unexplained, spontaneous remissions

•Lifelong condition with exacerbations

•No known cure

Description of Systemic Lupus Erythematosus (SLE)

**chronic, inflammatory connective-tissue disorder (auto-immune).

•Most common: Women & 15-45

•Unknown (genetic? Environmental? Hormonal?)

Symptoms of Systemic Lupus Erythematosus (SLE)

•Weight loss

•Fatigue

•Fever

•Butterfly rash (~50%)

•Photosensitivity

•Muscle problems

• Arthralgia

• Arthritis

•Joint deformities

•Nausea

•Vomiting

•Diarrhea

•Raynaud phenomenon

•Oral ulcerations

•Patchy alopecia

•Pericarditis

Medical Diagnosis of Systemic Lupus Erythematosus (SLE)

•CBC

•ESR

•Anti-Nuclear Antibody (ANA) Test

•Leukocytes in bone marrow

Treatments of Systemic Lupus Erythematosus (SLE)

•Anti-inflammatories

•Corticosteroids

Prognosis of Systemic Lupus Erythematosus (SLE)

•Complications:

• Cardiovascular

• Renal

• Neurological

• Infectious

Description of Fibromyalgia

**Chronic condition characterized by pain the muscles, ligaments and tendons due to absence

•Women (>80%) middle age

•Unknown etiology (genetics, emotional distress, trauma, illness)

• Neurotransmitters imbalance that facilitates pain transmission

Symptoms of Fibromyalgia

•Constant Pain

•Dull muscle ache

•Tender points

• Head

• Shoulders

• Elbows

• Hips

• Knees

•Fatigue (*Chronic fatigue syndrome)

•Cognitive difficulties (fibro fog)

•Depression % PTSD

Medical diagnosis of Fibromyalgia

*Difficult to diagnose

• Widespread pain (>3 mo)

• Rule out other conditions

Treatment of Fibromyalgia

•Analgesics (manage pain)

•Antidepressants *Savella

•Physical therapy, sleep improvement

Description of Duchenne Muscular Dystrophy

**Congenital muscular dystrophy characterized by progressive bilateral wasting of skeletal muscles

•Early childhood and can cause death within 10-15 y

•X-linked recessive disorder (*males at greater risk than females)

•Impaired in dystrophin (muscle strength and flexibility)

Symptoms of Duchenne Muscular Dystrophy

•Muscle weakness (*legs 1st)

•Fatigue

•Muscle deterioration

Medical Diagnosis of Duchenne Muscular Dystrophy

•Family history

•Muscle biopsy

Treatments of Duchenne Muscular Dystrophy

•Physical therapy/exercise

•Orthopedic appliances

•Steroids (prednisone)*