AP Review

bones

classified by shape (long/flat) and composition (cortical/cancellous)

joints

where two or more bones meet; classified by structure and movement

• cartilaginous

• fibrous

• synovial

• amount of movement (synarthrosis=no movement like skull sutures)

cortical vs cancellous bone

• cancellous: found in long bones and surrounded by compact bone

• compact (cortical) surrounds spongy bone

diaphysis and epiphysis

• epi- long ends of the bone

• dia- shaft of the bone (contains periosteum/endosteum)

functional classification (movement) of joints

• synarthrosis: immovable (sutures of skulls(

• diarthrosis: freely movable (hips, knees)

• amphiarthrosis: slightly movable (pelvis,vertabra)

common symptoms of bone diseases

• pain, swelling, decreased mobility

• fractures cause pain due to disruption of periosteum

• muscle disorders: -weakness (muscle atrophy if weakness persists)

diagnostic tests

-xrays (primary tool in bone/joint disorders diagnosis)

-CAT scans/MRI are secondary

-arthroscopy: primary procedure to diagnose joint injuries and treat arthritis

-Bone Mass Density: dual energy x ray for osteporosis

-blood studies: can diagnose metabolic disorders (vitamin d, calcium that impacts bone)

-ultrasonography: identify inflammation in joints/tendon tears

-electromyogram: used for diagnosis of muscle disorders

diagnostic test: CAT/CT scans

• specialized x rays in tube scanner

• detailed x rays that cut area of concern into slices (tomogram)

MRI

• large magnet to make electromagnetic images (does not use radiation)

• issues of claustrophobic

• more detaiked, and usually for nervous system

arthroscopy

• camera to look into knee joint

• instruments are inserted into knee joint and damaged tissues

arthrocentesis procedure

• 10 min medical procedure, often guided by ultrasound to remove synovial fluid for diagnostic purposes

• treat pain/swelling

• sterilize area and apply local anesthetic

BMD screening

• confirm low bone mass and diagnosis of osteoporosis

• DEXA scan: measure bone thickness and take measurements at spine, hips and wrist

-2.5 and lower indicates osteoporosis Prescence

diseases of musculoskeletal system

• vary from mild to severe

• spinal deformities

• -kyphosis : hunchback, exaggerated curvature of thoracic spine

• -lordosis: exaggerated anterior curve of lumbar spine

• -scoliosis: lateral curvature of spine

spinal deformities

• more commonly progresses slowly, until symptoms arises

• etiology can be due to congenital defects, poor posture, bone disease and growth disorders

• kyphosis mostly seen in postmenopausal osteoporotic women

• lordosis compensate for increased size of abdomen

spinal deformities symptoms + diagnosis

• back pain and fatigue

• diagnosis by physical exam, confirmed by x ray

• PFTs may be needed if breathing affected

• mri needed if tumor or infection

spinal deformities treatment and prevention

• eliminate/treat factors, bracing and spinal surgery

• if untreated, can progress to life threatening condition where cardiac and respiratory function are compromised

• no known prevention

spinal deformities: more about scoliosis

• affects both sexes, but girls more severe (90% of scoliosis cases)

• screening involves observation of spine as patient leans foward

• treatment: bracing and surgery

spinal deformities of scoliosis symptoms

• uneven shoulders

• one hip higher than other

• asymmetry of back and visible curve

disease of the musculoskeletal system: osteoporosis and osteomyelities

• metabolic bone disease cause by porosity and lead to bone mass decrease

• causes major orthopedic problems in approximately 1/3 of women

osteoporosis etiology

1. age related osteoporosis affects bone men and women equally

2. mobility issues/conditions

3. combination of factors (estrogen, calcium, exercise decrease)-post menustral

weight bearing exercise for osteoporosis

• works against force of gravity

• impact sends signal to bone, stimulating osteoblasts

• types of exercise: walking, hiking (daily lifestyle activites)

osteoporosis diagnosis and treatment

• confirmed by physical exam, bone densitometry (measurement of bone thickness)

• no cure

• use of medication, decrease alcohol/caffeine intake, no smoking, daily weight bearing exercise, increase vitamin D and calcium intake

osteoporosis prevention

• bone mass is built before age 30

• exercise daily, eat a balanced diet, limit alcohol/caffiene

• will enter menopausal years with max bone mass

osteomyelitis etiology

• inflammation of bone commonly by infection

• infection by staphylococcus aureus (found on skin)

• bacteria can enter th ebone thru wone, or from skin/throat infection

• bone is made by dynamic material

osteomyelitis treatment and how it happens

symptoms: - sudden onset of high fever

-chills

-tenderness over affected bone

-leukocytosis/bacteremia

can follow a traumatic injury or following bone surgery (hardware implaced causes infection)

osteomyelitis diagnosis and treatment

• physical exam, elevated WBC, blood test for inflammation (ESR), xray/imaging, bone biopsy

• treatment: high dose iv antibiotics

• affected bone debrided surgically

• any hardware in vicinity of infection will be removed

who is mostly affected by osteomyelitis?

• nervous system affected by diabetes.hard to feel wound in feet for patients

• mostly goes unnoticed until sevre

osteomyelitis prevention

• acute myelitis can become chronic if not taking proper antibiotics

• prevent osteomyelitis by properly treating and cleansing wounds

• those with artificial joints should take preventiv antibiotics prior to any surgery

osteoarthritis

• degenerative process wearing out joint

• can start at age 18 but more common in older population (80 and older)

• etiology:-unknown cause

• -sport injuries speed up wear and tear on joints commonly seen in younger ppl leading to OA

osteoarthiris risk factors

-age

-sex

-obesity

-joint injuries

-genetics

-joint overuse/repetitive stress

OA symptoms

• chronic, dull ache that worsens with activity or weight bearing

• characterized by localized joint pain, morning stiffness and reduce ROM develop gradually in knees, hips and hands

• commonly affects weight bearing joints and those used for repetitive tasks (knees, hips spine and hands)

OA findings on physical exam

• Heberden’s nodes/ bouchards nodes: bony swellings indicating hand osteoarthritis

• Herbderd’s appears on top finger joint (distal, DIP) and Bouchard’s on middle joint

• Heberden’s more common, Bouchard’s associated with severe OA

• both caused stiffness, pain and reduced finger mobility

stages of knee osteoarthritis

1. minimum disruption 10% cartilage loss

2. joint space narrowing, cartilage break down, occurrence of osteophytes (bone spurs)

3. moderate joint space reduction, gaps in cartilage can expand reaching bone

4. joint space reduced, 60% OF CARTILAGE IS LOST, large osteophytes

what does OA affect

• wear aways cartilage at the ends of bones where they meet to form a joint

• cartilage is worn away, exposes areas of raw bone, new bone forms in and around the joint, causes the bone ends to thicken, leading to a decrease in joint motion

OA on xray

• x ray may reveal spurs and small patches of cartilage present

• bone on bone condition, and patient can be considered for knee replacement surgery

OA treatment

• knee replacement procedure

• OA knee replacement

diseases of musculoskeletal system- fractures

• fractures can be caused by trauma or pathologic

• Types: -stress (weight bearing) vs pathologic (weakness from disease)

• based on condition of overlying skin (open vs closed)

• based on condition on fragments: displaced (fragments out of position), nondisplaced (fragments in current position); comminuted (broken into two or more pieces); compression (bone mashed down)

• impacted (bone ended forced over the end); avulsion (ligament/tendon pulls a small piece if bone away from main bone)

• position of fracture line:longitudinal, transverse, oblique, spiral and stellate

fractures: comminuted

• severe break bone shatters into three or more pieces

• symptoms: intense pain, swelling and deformity

• caused by high impact trauma

• treatment: ORIF surgery, longer recovery time

• ORIF: procedure to repair severe bone fractures; open area, realign fracture bone, followed by securing it, using hardware

colles fracture vs smith fracture

• dorsal displacement of distal fragment (pushes ulna toward dorsal side): ex. when falling palm is faced down

• ventral displacement of distal fragment (toward palm side)

potts fracture

• type of ankle fracture characterized by a break in one or more bony prominences on sides of ankle (malleoli)

• often occurs in combination with other injuries (sprained ankle, foot fractures, ankle, lower leg)

spiral fracture: what it is and treatment

• severe bone break caused by twisting force, create a corkscrew shaped fracture line

• common in long bones (tibia, fibula, humerus) due to skiing, soccer, fractures often require 3-6 months to heal

• treatment: immobilization in cast/splint

strains and sprains: strain

• overstretching injury of muscle (tend to be less serious than a sprain)

• lumbar strain from lifting too much weight, lifting improperly

• symptoms: soreness, pain, tenderness

• diagnosis: by history and physical exam; may reveal swelling

• treatment: rest, analgesics, antiinflammatories, Pt MAY be needed

sprain; symptoms, diagnosis, and treatment

• traumatic injury to joint with partial/complete tearing of ligaments

• symptoms: varying degrees of swelling, pain, heat along with redness

• diagnosis: history and physical exam; xrays may be needed to r/o fracture

• treatment: mild sprains can be treated via RICE; brace may be needed

ankle sprains

• Grade 1: mild, minimal swelling

• Grade 2: moderate, partial tear, recovery 3-6 weeks

• Grade 3: severe, complete year recovery 8+ weeks

inversion ankle sprains vs eversion vs ankle sprains

• makes up majority sprains (70-85%)

• stretches outer lateral ligaments, can occur when landing awkwardly

• eversion: less common but more serious

• high sprains: caused by a rotational-type injury mechanism; longer recovery time

dislocation

• complete separation of bone from its normal position in a joint/nojoint contact

• causes pain/joint deformity

• cannot relocate without treatment

subluxation

• partial separation of bone from its normal position in a joint/partial joint contact

• joint surfaces still touch but are misaligned (split that can relocate)