altered musculoskeletal func

Contractile tissue:

Contractile tissue:

structures involved in contraction of muscle;

• Muscle belly

• Tendon

• Bony insertion (enthesis)

Inert or noncontractile tissue

no ability to contract or relax

• Joint capsules

• Ligaments

• Bursae,

• Fasciae,

• Dura mater & Nerve roots

Soft-Tissue Injuries:

contractile/inert tissue

altered range of motion around joint

pain, edema, adhesion, fibrosis

Ligament Injuries

from loading xs of physiologic range of motion

Ligament Injuries:

manifests

pain with weight bearing,

acute swelling,

“popping” sensation

Joint Capsule Injuries

lead to

^vascularity & fibrous tissue → thick capsule

Joint Capsule Injuries:

factors that prevent full range of motion

edema in joint → scar in lax capsule

Joint Capsule Injuries:

altered synovial fluid flow

prevent fluid diffusion of cartilage →

compress & distend

Joint Capsule Injuries:

Adhesive Capsulitis (Frozen Shoulder)

inflam w/swell & distend of joint capsule

prolonged no use → thickening of capsule

Adhesive Capsulitis (Frozen Shoulder)

manifests

lose movement

^pain at night

Adhesive Capsulitis (Frozen Shoulder)

prevention

avoid long periods of not using

Internal Joint Derangement

Tears of menisci/ligaments → instability of joint.

Fasciae

connective tissues of the body arranged in sheaths that envelop muscles.

Fasciae: trauma causes

edema & scar

joint restriction.

Bursae

pockets of connective tissue lined w/synovium

• in between muscles or between muscle or tendon and bone.

Bursae are found in areas of

^friction

Bursae if inflammed

bursitis (v painful)

Irritation or entrapment of a nerve causes

pain that radiates along structures innervated by that nerve. Example: herniated disk

Injuries to Nerves, Nerve Roots, or Dura Mater

manifests

pain,

altered sensation (numbness and tingling),

motor weakness,

diminished reflexes

Injury to Tendons

range from mild, complete tear, rupture

• when stress on tendon > fibers can take

Tendonitis:

inflam tendon w/in sheath

• from infection, direct injury, repetitive motion (Tennis elbow)

  • Contractile Soft Tissue

Muscle and Tendon Strains

minor tear to complete rupture

• from abnormal muscle contrac

• mild, moderate, severe

Blunt Trauma (of contractile soft tissue)

bleeding → muscle belly;

• inability to contract muscle;

• coagulate and calcify;

• myositis ossificans

Soft-Tissue Healing After Trauma

disrupt circ & lymph → hemorrhage, fluid loss, cell dies

• clotting

• inflam → histamine → edema

• can take 40+ wks

Soft-Tissue Healing After Trauma

Norepi

constricts vessels

• serotonin & platelets prolong vasoconstrict

Wound Repair

• inflam prep for repair

• granulation forms

• tensile strength from collagen

• revasc

  • close/contract

wound repair

reepithelialization

on wound surface to make basement membrane

Bones

Protect internal organs,

mineral homeostasis,

produce blood cells,

muscle attachment

facilitate body movement

Bones are _______ with a capacity for repair

vascular

types of bone

cortical

cancellous

Cortical (compact) bone

forms the cortex (outer shell) of bone;

• when tension stress exceeds tolerance → fracture on convex side of bend

Cancellous (spongy) bone

found in interior of bone & has spongy appearance

• structural support but doesn’t tolerate compression

fracture

Break in continuity of a bone, an epiphyseal plate, or a cartilaginous joint surface

• Trauma may occur to adjacent tissue

types of fractures are classified by

orientation of break:

• transverse,

• longitudinal,

• oblique,

• spiral

Comminuted fracture:

more than one fracture line & more than two bone fragments

Impacted fracture:

telescopes/drives one fragment into another

Greenstick fracture:

incomplete break (ex. In kids)

Stress fracture:

Failure of one cortical surface of the bone

Nondisplaced fracture:

fragments remain in alignment and position;

Displaced fracture:

ends of fracture fragments are separated

Depressed fracture:

fragment below level of bone surface

Complete fracture:

break through entire bone;

Incomplete fracture:

break only buckles or cracks

• open/compound when skin is penetrated;

• closed/simple when skin is not broken

avulsion fracture

clean break of the patella

cortical bone fracture

bleeding

hematoma

osteoblasts invade

callus

remodel

Cancellous fracture healing occurs mainly by

internal callus.

Cancellous fracture healing

rich blood supply

prevents necrosis

Cancellous fracture healing

osteogenic cells form

primary woven bone (spongy)

→ replaced by lamellar bone

Cancellous fracture healing is ___ than cortical

faster

• more blood supply

complications of fractures

delayed healing

osteonecrosis

osteomyelitis

fat emboli

deep vein thrombosis

Delayed union of fracture

3 to 6 months after fracture,

bone pain & tenderness increasing beyond expected healing period.

Malunion of fracture

improper alignment of fracture fragments

Nonunion of fracture

Not healed by >6 months

Osteonecrosis:

Compromised circulation

Osteomyelitis:

Severe pyogenic infection of bone & local tissue

Osteomyelitis:

caused by organisms reaching bone thru

blood

soft tissue

directly

Osteomyelitis:

thru adjacent soft tissue

Caused by burns,

sinus disease,

trauma,

malignant tumor necrosis,

periodontal infection,

infected pressure ulcer

Osteomyelitis:

direct infection

causes open fracture,

penetrating wounds,

surgical contamination,

insertion of prostheses, metal plates, or screws

Hematogenous osteomyelitis

from infection thru blood from elsewhere in body

• most common

• in kids <16 or elderly

• Staph aureus

Hematogenous osteomyelitis

manifests

kids: high fever, pain at bone involvement

adults: fever, malaise, anorexia, night sweats, and weight loss

If osteomyelitis not managed

necrotic bone can separate from healthy bone into dead segments called sequestrum

Fat emboli syndrome:

Fat is released from bm & lodges in lung blood vessels

Dislocation:

displacement of bone from normal position

• joint surfaces completely lose contact

Subluxation refers to

displacement of a bone from normal position

• joint surfaces lose partial contact

Dislocations and Subluxations

lead to

tissue damage

pain

loss of mobility

change length

Scoliosis

lateral curve of spine (S or C)

• nonstructural resolves w/bend

• structural has vertebral rotation

Scoliosis

manifests

Asymmetry of shoulders, hips, chest wall;

possible respiratory problems

metabolic bone diseases

osteoporosis

rickets & osteomalacia

paget disease

Osteoporosis

• most common metabolic disease

  • bone reabsorb (osteoclast) > (osteoblast) bone forming

Osteoporosis

etiology

low estrogen

low Ca

disuse

Osteoporosis effect on bones

Trabeculae decreased,

width & mass decreased;

fragile bone → fractures

Osteoporosis

Cancellous bone lost ___ than cortical bone

faster

osteoporosis

manifests

Shortened stature,

muscle wasting,

back muscle spasms,

difficulty bending over

osteoporosis

diagnosis

based on bone mineral density measured by DXA

• T < -2.5

rickets and osteomalacia

vitamin D deficiency

soft/weak bones

rickets

in kids

osteomalacia

in adults

rickets and osteomalacia

manifests

Kyphosis,

genu valgum (knock knee),

genu varum (bowleg);

pain in adults

rickets and osteomalacia

etiology

low vita D & phosphorus supplements

pagets disease

slow progressive metabolic disease

• xs osteoclast func→then xs osteoblast func

• genetic or viral infection

pagets disease

manifests

Painful bone deformities

bone fractures

sarcoma

malignant tumor

carcinoma

metastatic tumor spread to bone

• from breast, prostate, lung, kidney

common sites of bone neoplasms

vertebral bodies,

pelvis,

proximal ends of the femur and humerus,

ribs

benign tumors

osteochondroma

chondroma

osteoid osteoma

giant cell tumor

Osteochondroma

Cartilage-containing;

asymptomatic;

long bones

• benign

Chondroma

Cartilage-containing;

often in bones of hands and feet

• benign

Osteoid Osteoma

Often found in tibia and femur;

persistent dull pain

• benign

Giant cell tumor (osteoclastoma)

Richly vascularized tumor;

fast-growing;

femur and tibia

• benign

Malignant Bone Tumors

osteosarcoma

chondrosarcoma

ewing sarcoma

multiple myeloma

Osteosarcoma

Extremely malignant bone-forming & most common;

destructive

Form bone/osteoid by tumor cells

Osteosarcoma

mostly in

kids & YA

osteosarcoma

Located in the

femur, tibia, fibula, humerus and flat bones of the pelvis, skull, scapula, ribs, or spine

Chondrosarcoma

• Malignant cartilage-forming tumor that

• slow

• 30 to 60 years of age

Chondrosarcoma

tends to develop in the

pelvic and shoulder girdles

proximal ends of long bones

Ewing Sarcoma

• 3rd most common prim sarcoma

• rapid growth, malignant

  • 5-25 years old

Ewing Sarcoma

happens in

long bones

Ewing Sarcoma

composed of and spreads to

dense small cells w/round nuc

metastasize to lungs

Multiple Myeloma

• slow malignant w/prolif of single clone plasma cells

• elderly

• bone pain

  • Ig in urine & serum

Multiple Myeloma

affects

kidneys

immune

circ system