MS Diseases

Fibromyalgia

 Chronic pain condition associated with stiffness and tenderness

• Affects muscles, tendons, joints

• Restless sleep, depression, fatigue, anxiety 

• Very common 

• Fatigue is a very common symptom

• No exact cause

  • Appears linked with pain signals 

  • Elevated levels of nerve growth factor called substance P

  • Serotonin is low

• Pain for at least 3 months

Lordosis (saddleback)

Exaggerated inward curvature of spine

• Occurs from added pressure such as pregnancy, obesity, or large tumors

• May cause no symptoms

  • Lower back pain 

Kyphosis (hunchback)

Abnormal outward curvature of spine

• As curve progresses → mild pain, fatigue, spine tenderness, decreased mobility

• Affects thoracic region (upper middle back)

• Can be developmental in children

  • Scheurmann disease (adolescent kyphosis)

Scoliosis

 Lateral (sideways) curve of spine

• Uneven shoulder/hip height

  • One scapula higher than the other

• Idiopathic 

Osteoarthritis

Type of arthritis resulting from breakdown and eventual loss of cartilage in one or more joints 

• Most common form of arthritis

• Result of normal wear and tear in joints 

  • Common in older adults

• Common in knees and hips

  • Very common location is the base of thumbs 

• Joint soreness, aching, stiffness in the morning, edema, crepitation (clocking sound) 

Lyme Disease

Infectious disease caused by Borrelia burgdorferi (spirochete bacterium)

• Transmitted through bite from a deer tick

  • Bacteria injected into body, tick takes blood meal

• Can affect skin, joints, heart, nervous system

• Red, itchy rash with red circle like a bullseye

• Early symptoms (1-4 wks)

  • Bull’s eye rash, flu-like symptoms, joint pain

• Late symptoms

  • Bell’s palsy (facial paralysis)

  • Encephalitis, meningitis causing headaches

• Generally curable

Bursitis

 Inflammation of a bursa

• Tenderness, pain when moving affected part

• Shoulder most commonly affected

• Point tenderness present

• Caused by excessive friction between bursae and surrounding tissue

• Systemic diseases infection can be a cause 

Osteomyelitis

Serious infection of bone requiring aggressive antibiotics

• Inflammation, swelling, localized heat, pain, tenderness over affected bone

• As infection progresses, subperiosteal abscess develops 

  • Causes pressure and fracture

  • Fractured bone pieces may end up causing a sequestrum (dead tissue)

•  Upper ends of humerus and tibia

• Staphylococcus aureus responsible for 90% of infections

Gout

Chronic disorder of uric acid metabolism 

• Manifests as acute form of arthritis 

• Deposits of uric acid forms hard nodules in tissues 

• Involves overproduction of uric acid and urate salts

  • Leads to high levels causing joint deformity 

• Affects first metatarsal joining of great toe

• Causes severe pain

• Caused by deficiency of enzymes to completely metabolize purines in food for excretion from kidneys

  • Buildup of uric acid in bodily tissues 

    • Uric acid: breakdown product of purines that are in foods 

Paget Disease

Chronic bone disorder resulting in enlarged, deformed bones from irregular breakdown/formation of bones

• Causes bones to weaken

• Bone pain, arthritis, deformities, fractures 

• Occurs in two stages

1. Vascular stage: bone tissue breaks down

   1. Spaces left are filled with blood vessels and fibrous tissue instead of new bone

2. Sclerotic stage: highly vascular fibrous tissue hardens

   1. Becomes similar to bone but is fragile

• Common sites are pelvis and tibia

• No symptoms 

• No cause 

Marfan Syndrome

Group of inherited conditions featuring abnormal connective tissue

• Weakness of blood vessels

• Excessive flexibility of extremities

• Abnormally long extremities and digits (fingers and toes)

• Tall, slender (arachnodactyly)

• Elongated head 

• Asymmetric skull  

• Scoliosis 

• Joints are hyperextensible

• Caused by autosomal dominant genetic disorder

  • Affected gene is on long arm of chromosome 15

Bone Tumors

Any abnormal growth in bone

• Chondrogenic (from cartilage)

• Osteogenic (from bone)

• Fibrogenic (from fibrous tissue)

• Pain, soft tissue swelling, pathologic fracture 

• Radiographic findings

  • Osteosarcoma has a “sunburst appearance” 

  • Ewing sarcoma lesion has “onion skin”

  • Chrondrosarcomas (lobular pattern)

• Weakens bone and makes it easy to fracture (pathologic fracture)

• Osteosarcoma is most common 

Muscle Tumors

• Skeletal muscle tumors often are a painless lump of a few weeks/months duration

  • Erythema (redness) of overlying skin

• From skeletal muscle (striated tissue) or smooth muscle tissue (radiation exposure)

• Often benign 

Osteoporosis

Loss of normal bone density leading to porous bone “like a sponge”

• Silent disease until a bone break

• Spontaneous fractures or posture changes 

• Most common metabolic bone disease

• Caused by imbalance between breakdown of old bone tissue and production of new bone

  • Primarily originate from hormonal or dietary factors 

Osteomalacia and rickets

Bone disease characterized by defective mineralization 

• Bones become soft, flexible, and deformed

• When disorder impacts children, it impacts growing skeleton and is called “rickets”

• General fatigue, stiffness, painful bones

  • As it progresses, fractures, bowing of legs, shortening of spine

• Caused by deficiency of vitamin D

  • Essential for bone formation 

Hallux valgus (bunions)

Localized area of enlargement of inner portion of first metatarsophalangeal (MTP) joint at base of big toe

• Inflammation, pain 

• Causes overcrowding of toes

  • Development of hammer, claw, or mallet toes 

• Result of foot disorder called hallux valgus

  • Great toe is positioned towards midline of body

  • Associated with rheumatoid arthritis 

  • Flatfoot and bad footwear

Hallux rigidus

Stiff big toe that develops as result of cartilage degeneration of first MTP joint

• Pain and loss of motion 

• MTP joint becomes painful, stiff, swollen

• Caused by injury or arthritis (osteoarthritis) or constant wear and tear 

Hammer toe

Toe bends upwards like a claw because of abnormal flexion of PIP joint 

• Can occur in any one of four lesser toes

• Often in second toe and with hyperextension of MTP joint

• Can lead to formation of corn at top of affected toe and callus at the sole

• Associated with rheumatoid arthritis

Fractures

Broken bones caused by stress on bone

• Pain, swelling, tenderness, inability to move

• From external forces

Colles fracture

Distal head of radius

• Result from a fall in which person breaks fall with extended arm

Humerus fracture

Displacement of bone of upper arm 

Pelvis fracture

Result of severe trauma

• Motor vehicle accident or fall

• Can occur with osteoporosis 

Fractured hip

• Result of fall 

• Occurs most often from osteoporosis in older women 

Femoral shaft fracture

• More common in young adults

• Result of severe direct impact 

Tibia fracture

• Strong force on lower leg

• Causes soft tissue damage 

Vertebral fracture in neck

• Result of acceleration or deceleration trauma

• Spine can be affected by landing directly on buttocks

Basilar skull fracture

• Skull on fracture of the floor of cranial vault

• Massive trauma of head from accident

LeFort Fracture

• Bilateral horizontal fracture of the maxilla 

  • Face is forced against steering wheel

Pott fracture

Lower part of fibula fractured

Clavicular fracture 

• Fracture of clavicle (collar bone)

• Common sports injury

Strain

Injury of tendon, muscle, or other tissue from over use or excessive stretching

Sprain

Acute tear of ligament (first, second, or third degree)

• May include blood vessel damage and nerve damage 

• First degree: mild stretch/tear

• Second degree: partial tear or ligament, moderate pain, swelling

• Third degree: complete rupture, severe pain, function loss

• 2-4 weeks of healing

Dislocation

Forcible displacement of bone from its joint, loss of function 

• Appears misshapen 

• Painful and becomes edematous, ecchymotic (bruising), and immovable (swollen)

• Cause is severe injury that exerts enough force to tear joint ligaments  

Adhesive capsulitis (frozen shoulder)

Shoulder is significantly limited in its ROM as a result of inflammation, scarring, thickening, shrinkage of capsule that surrounds joint

• Stiff and painful

  • Normal movement impossible

• Localized or spreads

• Can disrupt sleep 

• Become gradually worse during first few months and becomes uncomfortable for a couple months

  • Gradual improvement period does occur

• Pain subsides but immobility stays 

• Caused by inflammation of capsule of joint with secondary tearing

  • After injury or problem like bursitis 

Severed Tendon

Tendon torn into two sections preventing muscle from performing its function of moving a body part

• Pain, inflammation, immobility 

• Caused by injury or laceration

• Involves forearm, hand, calf, or foot

Shin Splints

Painful condition involving inflammation of periosteum (extensor muscles in lower leg) and surrounding tissue

• Inflammation, edema, pain, tenderness along inner tibia 

  • Pain worsens with exercise and disappears with rest

• Caused by overuse and pronation (foot rotates in, stress on calves)

Plantar fasciitis

 Inflammatory response at the bottom of heel bone where plantar fasciitis attaches 

• Pain worsens 

  • Worst when getting out of bed and taking first steps in the morning 

• Thick, fibrous material at the bottom of the foot

• Caused when fascia is placed under tension (running)

  • Causes inflammatory response 

Ganglion

Benign, sacklike swelling or cyst that is filled with jellylike fluid

• Formed from tissue that lines a joint or tendon

• Develops on back of wrist as a single smooth lump 

  • Under skins surface 

• Most are about size of a pea

• Caused by minor injuries but is usually unknown cause 

Torn Meniscus

Meniscus: semilunar cartilage found in knee joint

• Two menisci within the joint, a medical and a lateral 

Tear is a crack or fissure in the meniscus resulting from wear or injury

• Acute pain on full weight bearing, “giving away” sensation, clicking, can’t flex knee

• From sports injuries and abnormal bending 

Rotator Cuff Tears

Four tendons of rotator cuff, formed by muscles of shoulder, surround head of humerus and stabilize it 

• Infraspinatus muscle rotates humerus externally

• Subscalpularis muscle rotates humerus internally

Tears in any tendons limit shoulder function 

• Snapping sound and acute pain 

• Caused by acute trauma and changes with age

  • Calcium deposits may develop and may cause tendons to tear and rupture