Patho Final - Musculoskeletal Disorders

Contusion/Bruise

Ruptured blood vessels

Hematoma

Pooled blood presses on nerve endings

Strain

Injured muscle

Sprain

Injured joint ligaments or capsule

Dislocation

Displacement of joint articulation structures

What is worse: sprain or strain

Sprain

S/S of fracture

• Pain

• Tenderness at the site if bone disruption

• Swelling

• Loss of fx

• Deformity of the affected part

• Abnormal mobility

How does bone healing work?

• Hematoma formation and fibrin network fills it

• Callus formation of soft tissue callus

• Bony callus formation

• New tissue remodeled into normal shape-remodeling

Complications from injury

• Skin injury

• Muscle injury and swelling

• Fracture blisters → compartment syndrome

• Fat droplets in blood vessels (fat metabolism syndrome)

2 structures in chronic osteomyelitis

• Sequestrum: infected dead bone separated from living bone

• Involucrum: sheath of new bone surrounding dead bone

What is the most common malignancy found in bone?

Metastatic bone disease

Osteonecrosis is caused by ischemia to bone due to:

• Bone fracture

• Thrombosis or embolism

• Vessel injury

• Compartment syndrome inside bone (increased intraosseous pressure)

Different postures of scoliosis

• Elevated shoulder and prominent hip

• Right rib hump

• Left lumbar hump

Causes of scoliosis that have to do with structure

• Congenital

• Neuromuscular

• Idiopathic

Why are bone formation and breakdown balanced?

• Replace damaged bone

• Maintain the amount and density of bone

What is osteopenia?

Imbalance between bone formation and bone breakdown

Causes of osteopenia

• Decrease in bone formation

• Inadequate bone mineralization

• Excessive bone deossification

In osteoporosis there are ____ osteoclasts than osteoblasts

More

Osteoporosis leads to a decrease in…

• Bone mineral density (BMD) or mass

• Cancellous (spongy) bone death

• Bone matrix and mineralization

Is there more bone resorption our formation in osteoporosis?

Bone resorption

What helps people with osteoporosis?

• Exercise

• Increased Ca and vitamin D in diet

• Estrogen receptor stimulators

Osteomalacia

• Not a loss, but a softening

• Bone isn’t mineralized properly; it isn’t rigid

• In more adult women than men

Causes of osteomalacia

• Ca absorption

• Phosphate

• Vitamin D or resistance to it

Osteomalacia results in…

• Bone pain and tenderness

• Fractures

Piaget Disease

• Regions of excessive bone turnover (overactive osteoclasts)

• New bone is disorganized

• Deformation (bowing) and fracture are common

Activity Tolerance / Intolerance

Amount of physical activity a person can perform w/o injury or excessive exertion / not having enough energy physically or physiologically to complete tasks

Fatigue

Normal/abnormal physical response - subjective symptom

Acute physical fatigue

• Rapid onset associated w/ increased activity

• Relieved with rest

• Decreases with conditioning

Chronic physical fatigue

• Associated w/ medical conditions especially cancer

• Symptom management

Rheumatoid arthritis

• Autoimmune

• Synovial inflammation and joint architecture destruction

• Possible genetic predisposition

• Rheumatoid factor: antibody against IgG fragments in most patients

• Pannus

Pannus

Destructive vascular granulation tissue → destructive to adjacent cartilage and bone

S/S of joint with rheumatoid arthritis

• Red

• Painful

• Swollen

• Warm

Systemic Lupus Erythematosus (SLE)

• Type III hypersensitivity rx

• Autoantibodies against self molecules in plasma, cytoplasm, cell surface, cell nucleus - antinuclear antibodies (ANA)

S/S of systemic lupus erythematosus

• Baldness

• Oral ulcers

• Butterfly rash

• Polyarthritis

What can systemic lupus erythematosus damage?

• Arthralgia, arthritis (joint pain)

• Skin (butterfly rash)

• Renal involvement (glomerulonephritis → BUN/Cr)

• Pleural effusions, pleuritis

• Cardiovascular disease (pericarditis, coronary heart disease, HTN)

Spondyloarthropathies

Ankylosing spondylitis → spinal infusion

Systemic Sclerosis (Scleroderma)

• Autoimmune disease

• Fibroblast activation - Fibrosis

• Extensive fibrosis throughout the body

• Affects skin and internal organs (thickening)

• Limited and diffuse clinical subsets

Osteroarthritis

• Degenerative joint disease

• Cartilage contains more water, less collagen

• Cartilage become weak, rough, eroded

• No longer protects the surface of the bone

• Damaged joint cartilage tries too heal itself

• Creating osteophytes or spurs

Manifestations of osteoarthritis

• Asymmetrical

• Hand, knee, hip (could be anywhere)

• Worse w/ activity; relieved with rest

• “Gelling” - difficulty initiating movement after inactivity

• Crepitus (audible)

• Joint locking

• Joint enlargement

• Joint instability

• Advanced stages make ADL’s difficult

Gout Syndrome

• Increased serum uric acid → crystals precipitate in the joint in the joint (Tophi) → inflammation

• Acute gouty arthritis

• Gouty Nephropathy

• Uric acid kidney stones

Treatment for gout syndrome

Allopurinol

Objectives of gout Tx

• Termination and prevention of the acute attacks of gouty arthritis

• Correction of hyperuricemia (Allopurinol)

• Inhibition of further precipitation of sodium urate

• Absorption of urate crystal deposits already in the tissues