Musculoskeletal system (week 8)

Bursae

­Sacs that are enclosed and have small amount of lubricating fluid in them

­Located wherever a tendon passes over bone or muscle, a muscle passes over a bone, or a ligament passes over another structure

Periosteum

Covers the bone except the articular surfaces

­Many pain nerve endings

Bone Composition

­Collagen

­Elastin

­Ground substance

Purpose of bones

­Supports the body

­Provides attachments for muscle

• ­Allows movement to occur

­Protects vital organs

• ­Bones of rib cage and spine

bone cells

Osteocyte

• bone cells

Osteoblasts

• cells that produce new bone

Osteoclasts

• reabsorb bone

growth of bone- length and thickness

Endochondral bone growth (length)

Long bones

Intramembranous growth (thickness)

Flat bones

 Osteoarthritis (OA)

Osteophytes – bony spurs that develop at the margins of the arthritic joint

• Interfere with joint movement

• Can break off and lodge in the joint causing synovitis

Trendelenburg gait pattern – hip abductors can’t maintain a level pelvis in 1 legged stance; so if standing on left leg with weak hip abductors, the pelvis will drop on the right if the right leg is lifted

OA of the knee

Genu valgum – knock knee 

Genu varum (bow legs)

Caused by osteoarthrosis, RA, ricketsMay need corrective surgery

OA of the hands

­Heberden’s nodes – DIPs

­Bouchard’s nodes – PIPs

OA of the feet

 Hallux valgus (bunions)

Spondylosis

Degenerative disease affecting the intervertebral discs of the spine

Spondylosis ­PT intervention

patient education, postural reeducation, strengthening , flexibility, decrease pain

Spondylosis ­Medical intervention

focus on decrease pain and neuro symptoms (radiculopathy or myelopathy); decompression surgery or cortisone injections

Spondylosis ­Prognosis

- varies

Spondylosis ­S&S

“lipping” of vertebral bodies, loss of disc height, loss of Ca+, osteophytes, referred pain, weak neck muscles, headache, decrease sensation along dermatome of nerve root 

Spondylosis ­Etiology

aging, posture, injury

Infective (Septic) arthritis

Etiology: Virus, bacterial, or metabolic disorder

­Bacterial infection from puncture trauma, infected wound, or septicemia

­Most common – staph, strep, pseudomonas

Hemophilic arthritis

Specific to hemophiliacs

­Hemarthrosis – bleeding in the joint that causes deterioration of the articular cartilage that leads to arthritis

Lyme disease

­Infection that affects multiple body systems

Lyme disease ­PT intervention

decrease pain, gentle resistive low impact exercise, Tai-Chi, meditation, joint mobility, patient education

Lyme disease ­Medical intervention

pulsed antibiotics (Doxicycline), anti-inflammatory diet, vitamins

Lyme disease ­Prognosis

joint problems similar to arthritis, most often the knee

Lyme disease ­S&S

initial flu-like symptoms,fever, chills, fatigue, numbness, tingling, confusion, weakness, pain and swelling in the joints, skin rash that looks like a “bull’s eye”

Lyme disease Etiology

bite of a deer tick

Surgical intervention for arthritis

­Arthrodesis

• joint fusion

­Hemiarthroplasty

• ­one-sided replacement of a joint

­Total Joint arthroplasty

­Meniscectomy

• ­removal of damaged meniscus and fragments floating in the joint

­Osteotomy

• ­cut is made in the bone to realign it to correct a deformity like genu varus

Osteoporosis

decreased bone density and strength; bone looks like Swiss cheese; mainly affects the spine, pelvis, and hip

Rickets

 deficiency of vitamin D, calcium, or phosphate in childhood; bowing of long bones

 Osteomalacia - “Bone softening”

­weak bones resulting in fractures

­pathological-tumors

­metabolic condition of bones due to deficiency of vitamin D, calcium, or phosphate absorption in adulthood

­Malabsorption problems due to Crohn’s or partial gastrectomy

 Legg-Calvé-Perthes Disease - AKA Avascular necrosis  ­Etiology

possibly trauma

 Legg-Calvé-Perthes Disease ­PT intervention

gait training for NWB gait, strengthening, increase ROM

 Legg-Calvé-Perthes Disease Medical intervention

brace that keeps legs in abduction and IR; traction and bed rest or surgery

 Legg-Calvé-Perthes Disease ­Prognosis

– OA if detected after age 8

 Legg-Calvé-Perthes Disease ­S&S

flattening of the head of the femur or collapse of the femoral head;

gradual limp, pain and stiffness, groin pain, anterior thigh and knee pain, atrophy, palpable tenderness over hip, decreased ROM with abduction and internal rotation

Paget’s disease

 healthy bone is replaced by a solid structure that decreases the strength of bone

Osteomyelitis

bone infection usually staph

Osteosarcoma

­ 

­Tend to develop in long bones

­Pain in the area, edema, erythema, stiffness of  the joint closest to the lesion 

Osteoblastoma is

­Usually in the spine , rare bone tumor

Osteochondroma

­Most common benign tumor of bone

­Occurs in children

­Most often in distal femur, proximal tibia, proximal humerus

Multiple myeloma

­malignant tumor of plasma cells in bone marrow

­May spread fast or slow to many bones in the body

­Usually diagnosed after age 65

Multiple myeloma ­PT intervention

functional activity, improve quality of life, strengthening

Multiple myeloma ­Medical intervention

chemo, radiation treatment, stem cell transplant

Multiple myeloma ­Prognosis

varies, if Stage III, not good, survival rate at 5 years is 33%

Multiple myeloma ­S&S

often no early indications; bacterial infection, bone pain, fatigue, pathological fracture, renal disease, anemia;  mainly affects the spine, skull, pelvis

Multiple myeloma Etiology

unknown

Cartilage tumors

abnormal growths of tissue within the cartilaginous structures of the body

Genetic abnormalities

Talipes Equinovarus (clubfoot)

Achondroplasia - Dwarfism, reduction in growth of the long bones with a normal sized head and torso

 Developmental Dysplasia of the Hip (DDH)

­Head of femur dislocates from the acetabulum

 Developmental Dysplasia of the Hip (DDH) Medical intervention

infants are checked at birth, can be put in a spica cast to maintain abduction for several months after birth and this will keep the femoral head in the acetabulum

 Developmental Dysplasia of the Hip (DDH) Prognosis

early detection will have a good outcome; if not detected, will need joint replacements later in life

 Developmental Dysplasia of the Hip (DDH) ­S&S

if not diagnosed, shortening of the affected leg due to hip dislocation, ER, develops a Trendelenburg gait due to weak hip abductors, spinal scoliosis and increased lumbar lordosis, OA of hip and spine develop later

 Developmental Dysplasia of the Hip (DDH) Etiology

due to hip ligament laxity or shallow shape of acetabulum 

­PT intervention  Developmental Dysplasia of the Hip (DDH)

teach parents how to handle child at home in spica cast; if an adult, teach mobility, strengthening and same procedures as arthroplasty