patho lecture 11

adult ms disorders pt 2

soft tissues: myofacial compartment syndrome

compromised function of nerves, mm and vessels within a closed myofacial compartment 2 degrees increased interstitial pressure

facia doesnt stretch so increase in pressure :(

soft tissues: 2 types of myofacial compartment syndrome

1. acute: fracture

2. chronic: running 1 mile and pain, then when they’re resting it go away (shin splints dont go away w rest)

soft tissues: myofacial compartment syndrome common areas?

lower leg, forearm, thigh, and foot

soft tissues: myofacial compartment syndrome clinical predisposition?

-fractures

-severe contusions

-crash injuries

-trauma (dropping weight)

soft tissues: myofacial compartment syndrome risk factors?

burns 

circumferential wraps/ dressings (too much compression)

casting/immobilization

soft tissues: myofacial compartment syndrome s+s?

-pain (excrusiating, fx pain will go away w meds…this will not)

-paresthesia distal to area of involvement 

-passive stretching increases pain

soft tissues: myofacial compartment syndrome tx?

surgery to relieve pressure

untreated= ischemia, irreversible mm loss, functional disability (amputation, foot drop) 

soft tissues injuries: subluxation is?

-partial disruption (not fully dislocated but moved)

mobile joints most affected (bc they have room)

GHJ most common

acromial clavicular joint

sacroiliac

elbows in peds

soft tissues injuries: dislocation is?

complete disruption (out of socket)

mobile joints most affected

GHJ is most common

(can be late manifestation of chronic condition)

soft tissues pathologies: what is heterotopic ossification?

bone formation in non osseous tissue (soft tissue = mm or tendons)

soft tissues pathologies: when does heterotopic ossification happen?

-after trauma, mm are injured, fx, spinal cord injury

-surgery- commonly seen in total hip

-hereditary for exists although rare

soft tissues pathologies: what is myositis ossification?

bone formation in soft tissues after in mm after trauma

soft tissues pathologies: what is neurogenic heterotopic ossification?

bone formation in soft tissues after a neurologic injury

soft tissues pathologies: what is heterotopic ossification risk factors?

patient hx

gender (males higher risk)

soft tissues pathologies: what is heterotopic ossification pathology?

-Pluripotent mesenchymal stem cells differentiate into osteoblasts (Differentiation begins early after trauma/ surgery, peaks at 32 hours)

-Histologically similar to reformation of bone in fractures

–Histologically different structure

soft tissues pathologies: what is heterotopic ossification clinical manifestations?

depends

pain and loss of motion

progressive loss of joint function

soft tissues pathologies: what is heterotopic ossification classification grades?

class 1

class 2

class 3 and 4

soft tissues pathologies: what is heterotopic ossification class 1?

slight ossification, no ROM limitation

soft tissues pathologies: what is heterotopic ossification class 2?

presence of HO, mild ROM limitations

soft tissues pathologies: what is heterotopic ossification class 3 and 4?

presence of HO w/ anklyosis preventing motion

soft tissues pathologies: what is heterotopic ossification prevention, diagnosis, tx:

prevention: radiation tx, meds, traumatic injury avoidance, no rough passive stretching!!

diagnosis: pt hx and x ray

tx: preventative measures, surgical resection, rehab

soft tissues pathologies: what is mixed connective tissue disease (MCTD)

overlap connective tissue disease

overlapping syndrome of more than one rheumatic disease can include CREST

CREST = ?

C

R

E

S

T

soft tissues pathologies: mixed connective tissue disease (MCTD) risk factors:

autoimmune disease (Hypergammaglobulinemia, + rheumatoid factor, High titer ANA’s))

gender= females higher risk

soft tissues pathologies: mixed connective tissue disease (MCTD) etiology and pathogenesis:

normal cells modify itself to fight infection and immune system thinks it not self

soft tissues pathologies: mixed connective tissue disease (MCTD) diagnosis and tx:

diagnosis: high titers of ANAs in blood work

tx: drug therapy (corticosteroids)

prognosis= good

soft tissues pathologies: what is polymyalgia rheumatica (PMR)

an inflammatory disorder that causes muscle pain and stiffness, especially in the shoulders, neck, and hips, and primarily affects older adults (usually over age 50)

bed mobility and sit to stand transfers are most notable affected

soft tissues pathologies: what is polymyalgia rheumatica (PMR) risk facotrs?

-age >70 yrs

-caucasian

-gender= female more likely

-common (1 in 200)

soft tissues pathologies: what is polymyalgia rheumatica (PMR) etiology?

-unknown

• genetic factor (HLA-DR4)

• infection

• autoimmune malfunction

-no histological abnormalities

• characteristice aching and stiffness = jt inflammation

soft tissues pathologies: what is polymyalgia rheumatica (PMR) clinical manifestation:

-gradual onset

-becomes evident suddenly

-symptoms often bilateral 

-commonly misdiagnosed (osteoarthritis)

-possible dev to giant cell arteritits (send to emergency)

what does a long term high dose use of predisone cause?

osteoporosis, mm and bone weakness, high glucose

slide 17 

do

soft tissues pathologies: what is rhabdomyolysis?

rapid breakdown of skeletal mm tissue 2 degrees mechanical, physical or chemical traumatic injury,  resulting in creatine phosphokinase enzyme release

soft tissues pathologies rhabdomyolysis affects what?

kidneys

soft tissues pathologies: what is rhabdomyolysis causes?

physical: prolonged high fever, electric current, excessive physical exertion (cant make enough atp)

mechanical: crash injury, burns, compression, compartment syndrome

chemical; meds, excessive alcohol, electrolyte imbalance 

soft tissues pathologies: what is rhabdomyolysis risk factors and etiology?

-high dose of statins

-performance athletes taking herbal supplements

-strenuous exercise

soft tissues pathologies: what are clinical manifestation of rhabdomyolysis ?

-statin induced

-strenuous exercise induced 

• hot and humid weather, analgesics, viral/bacterial infection, alcohol consumption/dehydration

-change in urine color to brown

-massive skeletal mm necrosis

soft tissues pathologies: rhabdomyolysis diagnosis tx and prognosis?

diagnosis: abnormal kidney function, elevated creatine phosphate kinase, urine dipstick, pos for blood

tx: rehydration, restoration of electrolyte balance, dialysis may be nexessary

prognosis can be good if fixed quickly

soft tissues pathologies: what is myofacial pain syndrome?

overuse or mm stress syndrome marked by the presence of trigger points within mm bands; characteristics pattern of trigger point and referred pain

ex. traps sore when pushed but gives headache

soft tissues pathologies: myofacial pain syndrome etiology and risk factors:

sudden overloading/overstretching of mm

direct impact trauma 

postural faults (rounded shoulders)

sitting for a long time (glutes)

soft tissues pathologies: what is myofacial pain syndrome pathogenesis?

dysfunction of motor end plates

motor end plate dysfunction attributed to an excessive release of acetulcholine (ACh) from presynaptic motor nerve terminal

-ach triggers mm contraction, excessive ach causes contraction and no relaxation, nociceptors are now active and there is crosstalk btwn sensory and nociceptors. 

soft tissues pathologies: what happenes in a mm w myofacial pain syndrome?

shortening of affected mm causes nodule

nodule in the center = CTrP: central trigger point

ATrP= attachment trigger points

soft tissues pathologies: what are myofacial pain syndrome clinical manifestation?

palpation myofacial bands= causes pain, you can feel nodule

may cause reduced ROM of joints, weakness of involved mm

soft tissues pathologies: diagnosis of myofacial pain syndrome?

clinical exam and palpation, no actual imagining or anything

soft tissues pathologies: tx for myofacial pain syndrome:

desensitize TrPs

injections

ice

laser

manual pressure

change posture

soft tissues pathologies: prognosis of myofacial pain syndrome?

responds well to local intervention

active TrPs may revert

joint pathologies: what is osteoarthritis?

slow degenerative jt disease origination in the cartilage and affecting the underlying bone, soft tissue, and synovial fluid

really common jt disease under age of 50 in men

joint pathologies: what are the 2 classifications of osteoarthritis?

1. primary OA: unknown cause 

2. secondary OA: known cause

joint pathologies: classifications of osteoarthritis…what is primary OA?

unknown cause, happens over time due to aging and wear and tear

joint pathologies: classifications of osteoarthritis…what is secondary OA?

has known cause: results from another underlying condition, injury or mechanical factor 

joint pathologies: risk factors of osteoarthritis?

-serious injury

-high intensity, contact sports

-generalized lig laxity 

-mm weakness of any kind can lead to OA

-age

joint pathologies: pathogenesis of osteoarthritis?

too much load, bone thickens to help

cracking + not smooth

In OA, chondrocytes fail → collagen breaks down → proteoglycans decrease → cartilage loses shock absorption → bone takes more load → bone thickens and forms osteophytes.

joint pathologies: clinical manifestations of osteoarthritis?

-bony enlargement

-limited ROM

-crepitus in motion

-tenderness on pressure

-joint effusion

-gel phenomenon (stiffness and difficulty moving after a period of rest, goes away in less than 30 mins)****

in OA, what is heberdens nodes?

happens at DIP

in OA, what is bouchards nodes?

happens at PIP

joint pathologies: prevention and diagnosis, of osteoarthritis?

prevention: healthy lifestyle, moderate exercise, education

diagnosis: hx, physical exam, xrays (there is a grading scale) and lab testing

what is a predictor of OA of knee?

weak quads

joint pathologies: OA treatment:

-depends on pt, cause and extent

-begins w conservative care

-meds- traditional analgelsics and NSAIDS

-viscosupplementation- shot w hyaluronic acid, doesnt last long

-surgery

joint pathologies: what is rheumatoid arthritis?