Disorders of the Skeletal System: Trauma, Infections, & Neoplasms

What are the most common causes of Musculoskeletal Injury in each age group?

Childhood:

• Falling, bicycles & sports

Adults under 45:

• Trauma (motor vehicle accidents)

Adults over 65:

• Falling

Acute Sports Injuries

Sudden trauma

• Injuries to soft tissue and/or bone

Overuse Sports Injuries

Chronic & repetitive

• High levels of stress without sufficient recovery time

Contact Sports Injuries

Brain, Neck, Spine injuries

• Growth Plates if a child is before puberty

Extrinsic Risk Factors: training methods, equiptment

How do you diagnose a skeletal (bone) injury?

X-Ray

How do you diagnose a soft tissue injury?

MRI or CAT Scan

Contusions

Soft Tissue Injury

• Muscle bruises

• Etiol: skin over injury is fine, ruptured blood vessels & damaged muscle cells

• S/S: Eccymotic (black & blue), swelling, inflammation

• Tx: MICE

Hematomas

Soft Tissue Injury

• WORSE than contusions (wider area & deeper injury)

• S/S: pain and swelling take longer to subside

• Tx: MICE

What is a Joint?

Where two bones meet

Strains

Tendons (muscle-tendon units)

• stretching or partial tear

• Etiol: inflammatory response

• S/S: decreased muscle function, pain, swelling, stiffness

• Tx: M.I.C.E

Sprains

Ligaments (bone to bone)

• WORSE than Strain (less blood flow than tendon)

• Ankle is most common, Knee 2nd

• Etiol: abnormal or excessive movement of joint

• S/S: rapid swelling, discoloration, limitation of function

• Tx: MICE

Congenital Dislocation

Dislocation at hip or knee

Traumatic Dislocation

Caused by falls, blows, or rotational injuries

Pathologic Dislocation

Caused by Rheumatoid Arthritis (RA), Neuromuscular Disease (ND), or Paralysis

Dislocation

Bones have separated at a joint

• Dx: X-ray (bone)

• S/S: Deformity, pain, limited movement

• Tx: Manipulation (return bone to correct position), Closed surgery (doesn’t break skin), Open surgery (breaks skin)

Shoulder & Rotator Cuff Injury

(“Pitcher’s Arm”)

Overuse Injury

• Etiol: overuse or direct trauma

• Dx: MRI

• S/S: pain, tenderness, difficulty abducting or rotating arm

• Tx: Anti-Inflammatories, Corticosteroid Injections, PT, Surgical repair

Ligamentous Injuries (Knee)

WORST - MOST SERIOUS

Pop or tearing sensation + sudden pain

• S/S: inability to bear weight, pain, swelling

• Tx: MICE + immobilization, ROM, surgical repair

Meniscus Injury (Knee)

Rotational injury from sudden or sharp pivot

• S/S: swelling, pain, knee instability/locking

• Tx: Immobilization, quad exercises, Surgery (if torn)

Patellofemoral Pain Syndrome

(“Runners Knee”)

Most common cause of anterior knee pain

• Etiol: Imbalances in forces controlling patella

• S/S: Pain

• Tx: Rest, PT

Hip Dislocation

LIFE THREATENING

• Etiol: severe trauma

• S/S: severe pain, inability to move lower extremeties

• Tx: Reduction surgery to repair dislocation (closed first, then open)

Hip Fracture

Mostly caused by falls (proximal femur is usually involved)

• Risk Factors: age, muscular atrophy (physical inactivity), Osteoporosis

• Dx: X-ray

• S/S: severe pain, inability to move, swelling & bruising

• Tx: Surgery, Biphosphonates (increases osteoblasts - heals bone)

Greenstick Fracture

Bone only breaks on one side

• COMMON IN KIDS (10 & under)

Compression Fracture

Vertebrae of spine collapses

• COMMON IN OLD WOMEN

• Cause: Osteoporosis

Fractures

Broken Bone

• S/S: pain & tenderness, swelling, loss of function/mobility

• Dx: X-ray

• Tx: Splint, Reduction with Fixation Device (closed or open), Immobilization, rehab

Local Shock

Temporary window that fracture can be Reduced with little to no pain

• 30 minutes from time of fracture

Fixation Device

Used to realign a fracture (broken bone)

Malunion

Bone Healing with deformity (improper alignment)

• Tx: Bone Grafts, Electrical Stimulation (stimulates osteoblasts)

Delayed Union

Failure of bone to heal within the normal time period

• Tx: Bone Grafts, Electrical Stimulators (stimulates osteoblasts)

Nonunion

Bone stopped healing & never fully repaired

• Tx: Bone Grafts, Electrical Stimulation (stimulates osteoblasts)

Fracture Blisters

Skin overlying fractured bone

• places with less scar tissue (tattoos hurt the most)

• Tx: soft dressings, surgery

• DO NOT POP

Compartment Syndrome

Cast is placed before inflammation has stopped

• Compresses blood vessels (low BF)

• May lead to Necrosis

• S/S: severe pain beyond initial injury

• Tx: Remove cast, Fasciotomy to cut surrounding tissue (last resort)

Fat Embolism Syndrome

Fat from bone marrow enters bloodstream & blocks blood vessels

• Follows long bone trauma

• S/S: rash, dyspnea (shortness of breath), altered mental state

• Tx: treat symptoms util fat is reabsorbed

Osteomyelitis

Abscess on bone

• Etiol: Bacterial (staph) or Fungal (open wounds, bone fractures)

• Dx: MRI shows abscess

• S/S: Edema (swelling from fluid), Erythema (redness), warmth

• Tx: Antibiotics (bacterial, Antifungals (Fungal), Surgical drainage or Debridement (remove dead tissue), Bone Graft, Amputation

Osteonecrosis

Dead bone tissue from lack of blood supply

• Etiol: Ischemia (low BF) or Infarction (no BF) to bone, Fat Embolism

• S/S: Asymptomatic (early), Pain (late)

• Tx: Joint Replacement (must replace)

Bone Tumors

Benign & Malignant neoplasms can develop from:

• Chrondogenic (cartilage)

• Osteogenic (bone)

• Fibrogenic (supporting elements)

3 S/S: Pain, Mass, Impaired function

Benign Bone Tumor

• Slow-growing

• Doesn’t disrupt surrounding tissue

• Tx: Surgery or radiation

Malignant Bone Tumor

Osteosarcoma (most common)

• Starts in bone & moves elsewhere

• S/S: pain, localized swelling, fractures (tumor will grow)

• Tx: Cancer treatment (chemo, radiation, etc.)