Ch. 17 Bone, Joint, ST Diseases - Student Copy(1) - Tagged

CH. 17: BONE, JOINT, AND SOFT TISSUE DISEASES AND DISORDERS

• Giomara McBee, PTA, MS, BS

• Keiser University

OBJECTIVES

• Review the process of bone formation, maturation, resorption, and remodeling.

• Discuss the role of mechanical stress in stimulating bone growth, repair, and strength.

• Outline diseases affecting bone, articular cartilage, and joint spaces impacting movement and function.

• Discuss diseases affecting soft tissue that impact movement and function.

BONE COMPOSITION

Types of Bone

• Trabecular Bone

  • Also known as spongy or cancellous bone.

  • Comprises about 20% of the adult skeleton; only 15-25% is calcified.

  • Contains bone marrow, fat, and blood vessels.

• Cortical Bone

  • Also called compact bone, forms the outer substance of bone mass.

  • Found mainly in the shafts of long bones accounting for about 80% of skeletal mass; 80-90% calcified.

  • More active with greater turnover and resorption rates in bones rich in trabeculae.

BONE REMODELING

• Enable renewal of bone through the actions of osteoclasts and osteoblasts.

• Osteoclasts: cells that reabsorb bone.

• Osteoblasts: cells that synthesize new bone (called osteoid).

• Purpose: maintain skeleton strength and integrity, replace older damaged bone, and source of vital minerals.

OSTEOPOROSIS

Overview

• Occurs when new bone formation is slower than resorption, often linked to declining osteoblast function.

• Results in decreased bone mass and microdamage to bone structure.

• Importance of mechanical loads from physical activity to maintain bone density and strength (Wolff’s law).

Types of Osteoporosis

• Primary Osteoporosis:

  • Most common; occurs in any gender and age, often associated with menopause; etiology is unknown.

• Secondary Osteoporosis:

  • Linked to medications or conditions such as endocrine disorders, alcoholism, malnutrition, etc.

• Common fracture sites include vertebral bodies, hips, ribs, radius, and femur. Silent vertebral compression fractures can occur without injury. Avoid spinal flexion exercises due to risk of vertebral compression fractures (VCF).

SIGNS AND SYMPTOMS OF OSTEOPOROSIS

• Symptoms include loss of height, changes in posture, back pain, and increased fracture risk.

• Muscular pain or spasm may occur; the presence of fractures is common. No cure exists, prevention is essential.

COMMON TESTS FOR OSTEOPOROSIS

• Bone Mineral Density Testing:

  • Evaluates mineral content in bone; indicates fracture risk with T-scores.

  • T-score interpretations:

    • -2.5 or lower: Osteoporosis

    • -1.0 to -2.5: Osteopenia (low bone mass)

    • -1.0 or higher: Normal/low risk.

• X-rays can be used to diagnose fractures.

PREVENTION AND MANAGEMENT OF OSTEOPOROSIS

• Key suggestions:

  • Optimize calcium intake.

  • Get sunlight exposure.

  • Engage in regular physical activity.

  • Limit carbonated drinks.

  • Ensure adequate nutrition.

  • Employ aquatic therapy, balance assessment, and fall prevention strategies.

• Psychosocial support and medications include: Selective estrogen receptor modulators (Evista), bisphosphonates, nasal calcitonin, hormone replacement therapy.

OSTEOMALACIA/RICKETS

• Progressive condition where new bone matrix mineralization is insufficient, leading to bone softening.

• Deficiencies in calcium, vitamin D, and phosphate are primary causes.

• Pseudo fractures (Looser’s zones): areas with excessive osteoid; can result from healing microfractures.

SIGNS AND SYMPTOMS OF OSTEOMALACIA/RICKETS

• Symptoms include bone pain and tenderness, muscular weakness, postural deformities such as increased thoracic kyphosis, and waddling gait.

• Management varies based on the causative factors.

PAGET’S DISEASE

Overview

• A metabolic bone disease that often demonstrates an autosomal dominant inheritance pattern.

• Characterized by abnormal bone remodeling: increases in resorption and disorganized new bone formation replacing normal marrow with fibrous tissue.

• Typically affects the axial skeleton; progression is slow.

Clinical Manifestations

• Initial bone pain and skeletal deformities that progress slowly.

• Symptoms may include tinnitus, fatigue, abdominal pain, constipation, and excessive kyphosis.

MANAGEMENT

• Pharmacotherapy may include inhibitors to decrease bone turnover, enhance bone density, and reduce fracture risk.

• Muscle strengthening can minimize complications, improve cardiovascular health, and maintain joint motion. Avoid high-impact and flexion activities.

FRACTURE

• Defined as a defect in the continuity of a bone, can range from a small crack to complex fractures.

• Categorized into:

  • Traumatic Fracture: Sudden impact (e.g., falls, accidents).

  • Stress/Fatigue Fracture: Develops from rhythmic repetitive stress.

  • Pathological Fracture: Occurs in bones weakened by other conditions (e.g., osteoporosis).

TYPES OF FRACTURES

• Avulsion Fracture: Fragmentation at tendon attachment sites due to forceful stretch.

• Closed Fracture: Fragments remain intact under the skin.

• Open (Compound) Fracture: Bone protrudes through the skin.

• Stable (Nondisplaced): Fragments remain aligned.

• Unstable (Displaced): Fragments misaligned.

• Spiral Fracture: Shaped like an "S" due to twisting forces.

SIGNS AND SYMPTOMS OF FRACTURES

• Point tenderness at injury site, pain during resistive motions, possible edema.

• Management may involve immobilization, casting, or surgical intervention.

COMPLICATIONS OF FRACTURES

• Malunion: Inadequate healing in an unsatisfactory position.

• Delayed Union: Takes longer than expected to heal.

• Nonunion: Failure to heal, leading to a pseudoarthrosis.

HETEROTOPIC OSSIFICATION/MYOSITIS OSSIFICANS

• Benign abnormal bone formation in soft tissues, usually post-trauma.

• Can develop after various injuries, causing symptoms like pain and loss of motion.

OSTEONECROSIS

• Also known as avascular necrosis; results in cellular death in bone and marrow.

• Often affects the femoral head; may require surgical intervention.

LEG-CALVE-PERTHES DISEASE

• Avascular necrosis of the femoral epiphysis in children aged 3-12.

• Symptoms include antalgic gait, groin pain, and decreased mobility.

OSGOOD-SCHLATTER’S SYNDROME/SINDING-LARSEN-JOHANSSON SYNDROME

Overview

• Associated with patellar tendon traction on tibial tuberosity, common in active adolescents.

Symptoms and Management

• Symptoms include localized pain and tenderness, management includes rest and activity modification.

OSTEOARTHRITIS

• Degenerative joint disease primarily affecting cartilage, leads to inflammation and degradation of joint structures.

• Symptoms include bony enlargement, limited ROM, morning stiffness, and pain with activity.

MANAGEMENT OF OSTEOARTHRITIS

• Management strategies include weight loss, aquatic therapy, and assistive devices.

• No known cure; treatment focuses on symptom management.

RHEUMATOID ARTHRITIS

• A chronic systemic inflammatory disease often autoimmune in nature affecting various body systems.

• Symptoms involve joint swelling, stiffness, deformities, and systemic effects.

MANAGEMENT

• Relies on medications, body mechanics education, and surgical options for managing function and symptom control.

ANKYLOSING SPONDYLITIS

• Inflammatory arthritis affecting the axial skeleton leading to joint fusion; characterized by persistent back pain and stiffness.

MANAGEMENT

• Focuses on reducing inflammation, maintaining mobility, and improving posture.

SPONDYLOLISTHESIS

• Notable for vertebral slippage caused by degeneration. Symptoms include back pain that worsens with exercise.

SPINAL STENOSIS

• Narrowing of spinal spaces leading to nerve interference; treated with physical therapy and possible surgery.

GOUT

• A metabolic disorder characterized by high uric acid levels leading to acute inflammatory arthritis.

• Commonly presents with sudden joint pain, particularly in the big toe.

MANAGEMENT

• Focuses on correcting uric acid levels and managing arthritis symptoms through NSAIDs and lifestyle modifications.

MYOPATHY

• Non-specific muscle weakness due to underlying diseases; characterized by weakness, pain, and fatigue.

MYOFASCIAL PAIN SYNDROME

• Resulting from overuse or stress, marked by sensitive trigger points in muscles.

RHABDOMYOLYSIS

• A rapid breakdown of muscle tissue leading to kidney damage; managed through hydration and addressing electrolyte imbalances.

SOFT TISSUE INJURIES

• Includes strains, sprains, and dislocations with specific signs and management protocols.

SIGNS AND SYMPTOMS OF INJURIES

• Pain, swelling, and impaired range of motion; management varies based on the type and severity.

ACHILLES TENDON RUPTURE

• Occurs from extensive tension on the tendon; presents with sudden pain and inability to perform plantar flexion.

ADHESIVE CAPSULITIS

• Characterized by limited shoulder motion due to inflammation. Managed through stages from synovial inflammation to restoration of motion.

BICIPITAL TENDONITIS AND IMPINGEMENT SYNDROME

• Result from repetitive activities, leading to pain and inflammation.

MENISCUS TEAR

• Commonly associated with knee injuries; characterized by joint pain and swelling.

PATELLOFEMORAL SYNDROME

• Involves pain at the anterior knee due to various structural issues; management includes activity modification.