Transcript
8/10/2019 Musculoskeletal Diseases and Disorders
1/52
Musculoskeletal Diseases and
Disorders
Arif Pandega,MD
8/10/2019 Musculoskeletal Diseases and Disorders
2/52
Musculoskeletal System Bones
Long, short, flat, irregular
Compact, spongy
Joints
Bursae
Muscles Tendons
Ligaments
8/10/2019 Musculoskeletal Diseases and Disorders
3/52
Disorders of Bone Spinal deformities
Herniated intervertebral discsOsteoporosis
Osteomyelitis
Pagets Disease (osteitis deformans) Fractures
8/10/2019 Musculoskeletal Diseases and Disorders
4/52
Spinal DeformitiesLordosis
Abnormal inward or anterior curvature
Accentuation of normal curve of lumbar spine
Frequently gradual onset
Affects lumbar spine
Also called swayback
8/10/2019 Musculoskeletal Diseases and Disorders
5/52
8/10/2019 Musculoskeletal Diseases and Disorders
6/52
8/10/2019 Musculoskeletal Diseases and Disorders
7/52
8/10/2019 Musculoskeletal Diseases and Disorders
8/52
Spinal DeformitiesEtiologies
Posture, leg length differences, congenital, epiphyseal
growth disturbance, trauma, tumors, infection, arthritis,
TB, endocrine abn, aging
S/S: usually backache, fatigue, abnormal
appearance or fitting of clothes
Treatment: PT, exercise, braces, surgery, pain
relief
8/10/2019 Musculoskeletal Diseases and Disorders
9/52
Herniated Intervertebral DiscsDisc Anatomy
Annulus fibrosis
Nucleus pulposis
Herniation
Nucleus pulposis pushes through annulus into spinal
canalRupture
Pieces of the disc are free in the spinal canal
8/10/2019 Musculoskeletal Diseases and Disorders
10/52
8/10/2019 Musculoskeletal Diseases and Disorders
11/52
8/10/2019 Musculoskeletal Diseases and Disorders
12/52
OsteoporosisMetabolic disorder of bones
Less bone mineral (calcium) than normal
Over 10 million in US affected
Post-menopausal females most commonly
Bones are brittle, porous, easily brokenMore prone to pathological fracture
8/10/2019 Musculoskeletal Diseases and Disorders
13/52
8/10/2019 Musculoskeletal Diseases and Disorders
14/52
OsteoporosisEtiology:
Genetics, calcium intake & dietary, sedentary lifestyle,
estrogen, vit D, or adrenal deficiency, steroid use,
alcoholism, etc
S/S: often asymptomatic until pathological fx.
Treatment: calcium supplements, meds(antiresorptive, restorative of lost bone, etc)
8/10/2019 Musculoskeletal Diseases and Disorders
15/52
OsteomyelitisAcute or chronic bone infection
Inflammation, edema, circulatory problems
More common in children
Etiology:
Trauma most commonly with bacterial invasion from
the skin Infection may also spread from adjacent tissues or
blood supply
8/10/2019 Musculoskeletal Diseases and Disorders
16/52
8/10/2019 Musculoskeletal Diseases and Disorders
17/52
OsteomyelitisRisk factors:
Diabetes, orthopedic hardware, splenectomy & SSA,
hemodialysis, IV drug users
S/S: may be asymptomatic for years
Treatment:
Long-term antibiotics, sometimes surgical debridement
8/10/2019 Musculoskeletal Diseases and Disorders
18/52
Pagets DiseaseOsteitis Deformans
Chronic metabolic bone disease
High rate of bone turnover (reabsorption & deposition)
Thicker but softer bone is the result
Patients typically over 40 YOAOne or many bones
Usually lower torse involve
8/10/2019 Musculoskeletal Diseases and Disorders
19/52
8/10/2019 Musculoskeletal Diseases and Disorders
20/52
Pagets DiseaseEtiology: Unknown
S/S: graduation onset of swelling & pain
Treatment:
PT, pain management, surgery
Medications (biphosphonates or calcitonin)
Joint replacements
8/10/2019 Musculoskeletal Diseases and Disorders
21/52
Fractures Closed/simple
Open/compound
Greenstick
Displaced
Comminuted
Segmental
Spiral
Pathological
8/10/2019 Musculoskeletal Diseases and Disorders
22/52
22
Pathology Part 2
Types of fractures
Complex Incomplete Comminuted Greenstick
Simple (closed) Compound (open) Colles Impacted
8/10/2019 Musculoskeletal Diseases and Disorders
23/52
8/10/2019 Musculoskeletal Diseases and Disorders
24/52
8/10/2019 Musculoskeletal Diseases and Disorders
25/52
OsteoarthritisMost common form of arthritis
Chronic inflammation causing degeneration and
new bone formation
Weight-bearing joints most common
Knees, hips
Common in older patients (over 55 YOA)
In over 70 YOA, females more frequently affected
8/10/2019 Musculoskeletal Diseases and Disorders
26/52
8/10/2019 Musculoskeletal Diseases and Disorders
27/52
8/10/2019 Musculoskeletal Diseases and Disorders
28/52
Rheumatoid ArthritisChronic, systemic, polyarticular inflammatioy
disease
Destruction (erosion) of bone & cartilage
Causes ankylosis (fibrous fusion of joints, immobile)
Exacerbations and remissions unpredictable
Affects mostly females
Increasing risk with advancing age
8/10/2019 Musculoskeletal Diseases and Disorders
29/52
Rheumatoid Arthritis (RA)Etiology: autoimmune, genetics
S/S: symmetric pain, swelling of hands & fingers,
also other LE joints, systemic (fever, fatigue, wt.Loss)
Dx testing: Rheumatoid factor blood test
Treatment:Antiinflammatories, PT, antimetabolites, antirheumatic
drugs
8/10/2019 Musculoskeletal Diseases and Disorders
30/52
GoutGouty arthritis
Chronic uric acid metabolism disorder
Uric acid crystals deposited in joints
Tophi formation (urate compounds) around joints
Acute, severe episodes of arthritis
Mostly male patientsOther associated problems:
Kidney stones, renal failure, hyperuricemia
8/10/2019 Musculoskeletal Diseases and Disorders
31/52
GoutEtiology:
Metabolic, renal, some genetics
S/S:Severe signs & symptoms of inflammation
Big toe is classical site
Treatment:Pain relief, antiinflammatories, colchicine, diet low in
purines, alopurinol
8/10/2019 Musculoskeletal Diseases and Disorders
32/52
Muscles & Connective Tissue
Diseases Sprains & strains
Bursitis & tendonitis
Carpal Tunnel Syndrome
Myasthenia Gravis (MG)
Polymyositis Systemic Lupus Erythematosus (SLE)
Duchennes Muscular Dystrophy
8/10/2019 Musculoskeletal Diseases and Disorders
33/52
Sprains & Strains Sprain
Ligamentous tearing/stretching after a tortion injury
Strain
Tearing/stretching of tendon or muscle
Etiology: trauma or overuse
S/S: localized pain, swelling, limitation of motion
Treatment: supportive, pain relief
8/10/2019 Musculoskeletal Diseases and Disorders
34/52
8/10/2019 Musculoskeletal Diseases and Disorders
35/52
Bursitis & TendonitisBursitis
Inflammation of fluid-filled bursae near joints
Shoulder, hip, elbow, knee
Tendonitis
Inflammation of tendon or tendon-muscle attachement
Shoulder, wrist, Achilles, hamstringEtiology: trauma, excessive use, other diseases
S/S: pain, swelling, LOM, fluid accumulation
8/10/2019 Musculoskeletal Diseases and Disorders
36/52
Bursitis & TendonitisTreatment
Varies with anatomic location & degree of disability
Anti-inflammatories & pain relievers, splinting,
exercise, orthotics, steroid injections, PT
8/10/2019 Musculoskeletal Diseases and Disorders
37/52
Carpal Tunnel SyndromeCompression of median nerve within the carpal
tunnel of the wrist
Common syndrome with repetitive use work
Involves pain, sensory & motor symptoms
Etiology: edema within the carpal tunnel, causing
inflammation of the nerve & other structures there
8/10/2019 Musculoskeletal Diseases and Disorders
38/52
Carpal Tunnel Syndrome S/S:
Wrist pain, burning or tingling paresthesias, numbness
Weakness of hand grasp
Tinels sign
Treatment:
Wrist immobilization, anti-inflammatories
Rarely surgery
8/10/2019 Musculoskeletal Diseases and Disorders
39/52
Myasthenia GravisRare, autoimmune disorder of the neuromuscular
junction
Antibodies against the acetylcholine receptors
(post-synaptic)
Chronic, progressive disease causing sporadic
weakness of the skeletal muscles
Most common in females, ages 20-40 YOA
8/10/2019 Musculoskeletal Diseases and Disorders
40/52
Myasthenia Gravis (MG)Reduced muscle strength & longer recovery time
with repeated use
Symptoms late in the day
Bulbar (eye & facial) muscles involved first
Facial expression, drooping lids, etc.
Thymomas in 15% MG patients
75% have some thymic abnormality (hyperplasia)
8/10/2019 Musculoskeletal Diseases and Disorders
41/52
MGDiagnostic testing:
Tensilon test (edrophonium challenge will increase
muscle strength)Treatment:
Oral anticholinergic meds (pyridostigmine,neostigmine), immune suppressives, cholinesteraseinhibitors like edrophonium
Prognosis: normal life expectancy in moderntimes
8/10/2019 Musculoskeletal Diseases and Disorders
42/52
PolymyositisChronic, idiopathic inflammatory disease of
connective tissues and muscles
Exacerbations & remissions
May have skin involvement (dermatomyositis)
females more than males
Bimodal peak of onset: 5-15 YOA & 50-70YOA
8/10/2019 Musculoskeletal Diseases and Disorders
43/52
Polymyositis S/S: sudden or slow weakness of muscle group over
weeks to months
Often have trouble arising from sitting or raising arms abovehead, also voice changes
Fever, fatigue, weight loss
Skin: lilac-colored rash of eyelids, nose and face
Dx via EMG & muscle biopsy
Treatment: immune suppressive
8/10/2019 Musculoskeletal Diseases and Disorders
44/52
Systemic Lupus ErythematosusLupus or SLE
Multisystem, autoimmune, inflammatory disease
due to antibodies against cell nuclei
Females outnumber male patients ( 9 to 1)
Genetics may also be involved
Arthralgias are first complaint in most patients
8/10/2019 Musculoskeletal Diseases and Disorders
45/52
SLEOrgan involvement:
Skin, renal, CNS, GI, blood, musculoskeletal, CV,
pulmonary, vascular endothelium (Raynauds)
Four criteria at any time:
Malar rash or discoid rash, photosensitivity, arthritis,
renal disease, neuro, skin, hematologic, or immunedisorders, +ANA blood test
8/10/2019 Musculoskeletal Diseases and Disorders
46/52
SLETreatment:
Anti-inflammatories, pain relief, immune suppressives
8/10/2019 Musculoskeletal Diseases and Disorders
47/52
Duchennes Muscular Dystrophy Inherited, x-linked, recessive disorder
Seen only in males
Occasionally no family history
Rapidly progressive wasting of skeletal muscles
First in lower extremity & pelvis, then generalizes
Usually appears by 6 YOACause of death: respiratory insufficiency usually
by 25 YOA
8/10/2019 Musculoskeletal Diseases and Disorders
48/52
Duchennes Muscular DystrophyAt first muscles appear larger
Due to fat and CT infiltration
Then atrophy (wasting, decrease in size)
Then scarring & contractures
Cardiomyopathy present in almost all cases
8/10/2019 Musculoskeletal Diseases and Disorders
49/52
NeoplasmsOsteogenic sarcoma
Chondrosarcoma
Malignant giant-cell tumor
8/10/2019 Musculoskeletal Diseases and Disorders
50/52
Osteogenic SarcomaMost common bone cancer
3rdmost common cancer in adolescence
Slightly more males
Risk factors: radiation therapy, genetics
Treatment: surgical, but mets later in 80%Most in long bones
Femur, tibia, humerus (in that order)
8/10/2019 Musculoskeletal Diseases and Disorders
51/52
Chondrosarcoma 2ndmost frequent primary bone cancer (25%)
Malignant tumor of cartilage
Mostly over 40 YOA (mostly geriatric)
Affects pelvis, femur, humerus, ribs
8/10/2019 Musculoskeletal Diseases and Disorders
52/52
top related