Diseases and disorders of muscoskeletal system Flashcards
What is the purpose of the skeletal system?
sturdy framework and protect internal organs and the central nervous system.
how does muscoskeletal system work?
Bones are held together at joints, some of which
permit movement of the skeletal framework.
Skeletal muscles attach to the bones via tendons.
When muscle tissues contract, they shorten and move the skeleton at joints.
Thus, the muscles that span a joint bring about action at that joint.
Groups of muscles may have opposite or antagonistic actions on a joint (one group
of muscles extends (straightens) the knee, while
another group flexes (bends) the knee
other muscles stabilize joints, preventing undesired movement
What is bone made of?
calcium and phospate (minerals) (hardness and rigidity) embedded in collagen (protein) (flexibility)
osteocytes (mature bone cells)
ocsteoblasts (bone-forming cells)
osteoclasts (bone-resorbing) receive nutrients by an organized system of bv
types of bone?
either long, flat or irregularly shapped
most r covered with a layer of bone tissue called compat bone (cells, minerals, proteins and bc r arranged in regular, organized fashion)
spongy bone (cintains many bone marrow-filled speace, found at ends of long bones and is the site of blood cell formation )
parts of the bone?
long bones found in arms and legs have hollow cavity (medullary cavity) filled with yellow bone marrow primarily consisting of fat
- growth plate ( = growth of long bones) (area of cartilage near end of bone where new bone is formed, pushing ends apart from each other until full growth is achieved which is when cartilage turns into bone, called ossification)
periosteum ( highly vascular layer of fibrous connective tissue covering surface of bones and contains cells capapble of forming new bone tissue + site of attachment for tendons)
What are joints?
- articulating site btwn bones
- degree of movement + ROM depends on type of joint + bone shape and connective tussie
- shoulder is most freely movable joint but is most easily dislocated
Tissue comprising a joint?
- ligaments: for hoints that freely move, strong bc strangs of collagen (joint capsule consisting of ligaments and connective tissue surrounds the bone ends)
- synovial membrane: secretes synovial fluid, inner surface of capsule, lubricates joints
- bursae: sacs of synovial fluid r situated near some joints like shoulder and knee, where the reduce friction during movement
What is skeletal muscle?
aka voluntary muscle
firmly attached to bones by tendon
- some voluntary muscles (like those responsible for facial expression) r attached to soft tissue
- consists bundles of muscle fibers (muscle cells) held together by connective tissue
- when stimulate by nerves at myoneural junction, muscle fibers contract and bc muscles r attached to bones, shortening of muscles moves bone
What is smooth and cardiac muscle?
smooth - found in walls of internal organs and walls of blood vessels
cardiac - involuntary striated muscle and is only in heart
diagnostic tests and procedures of muscoskeletal system?
- x-ray & CT for fractures, joint dislocations, bone deformities, calcification
- MRI to visualize joints, bones and shoft tissue
- arthroscopy to visualize inside of a joint cavity
- aspiration of joint fluid for microscopic and chemical analusis
- electromyography to measure electrical activity of muscles and reveals some abnormalities of muscle function
- biopsy
What is osteomyelitis?
- uncommon bacterial infection of bone, mostly after bone trauma or in diabetics
- most common in upper ends of humerus and tibia, lower end of femur and occasionally vertebrae
- caused by staphylococcus aureus (90%) and next is streptococcal bacteria (rarely viruses and fungi), bloodborne pathogens r deposited in metaphyseal area of bone
- in children and infants osteomyelitis can develop as a secondary infection to streptococcal pharyngitis (strep throat0
s/s of osteomyelitis?
- purulent mateiral called subperiodsteal abscess may develop, causing pressure and eventualfracturign of small pieces of bone
- inflammation
- swelling
- pain
- redness
- localized heat
- chills
- fever
- leukocytosis
- sweating
- malaise
how to diagnose and treat osteomyelitis?
diagsnoe - history and physical exam, bone biopsy, WBC count, MRI and CT (xray wont reveal early infection), and blood culture, ESR
treatment - antibiotics, maybe surgery to remove nectroci bone tissue, increase intake of proteins and vitamin A, B, and C
prevention - treat infections and compound fractures
What is tuberculosis of bone?
rare and assoicated with pulmonary tuberculosis
occurs when bacteria spread from lungs to bones
affects bones include ends of long bones and ertebra
can be treated with antibiotics although straisn of Mycobacterium tuberculosis have devloped multiple drug resistance, surgery may be able to correct bone deformities
prevention: treat pulmonary tuberculosis
What is required for proper bone formation and maintenece
calcium and phospourous (calcium can only be absorbed if digestive tract has vitamin D so no vitamin D - soft, malformed or fragile bones)
What is osteoporosis?
- porous bone that is abnormally fragile and susceptible to fracture
- 80% of thiose affected by osteoporosis r women
- etiology is idiopathic but associated with aging
- most common metabolic bone disease (imbalance between breakdown of old bone tissue and production of new bone), hormonal or dietary factors or disue, trauma, radiaiton treatments, malabsorption, smoking, alcohol abuse, calcium-wasting nephropathy, immobility, chroni disease (RA), lack of estrogen andtestosterone, use of certain meds
risk factors for osteoporosis?
- Low bone mass
- Low calcium intake
- Female
- Vitamin D deficiency
- Small frame
- Sedentary lifestyle
- Family history
- Cigarette smoking
- Postmenopausal
- Excessive alcohol use
- Hysterectomy
- Caucasian or Asian
- Amenorrhea
Osteoporosis affects ___% of all Caucasian women over age ___, and more than __ of Caucasian women over age __ have low bone density, which elevates their risk for developing osteoporosis.
20% over 50
more than 1/2 over 50
s/s of osteoporosis?
no ss until bone veaken enough to fracture
- weightbearing bones of vertebrae and pelvis r susceptible to fracutre
- accumulate compression fracture in thes ebones = decrease in height and bending of spine and compressed vertebrae can press on spinal nerves = great pain
how to diagnose and treat osteoporosis?
diagnose - pt history and bone density tests, hormone imbalances, kidney disease, diet inadequeacy, intestinal malabsorption, blood serum studies, radiography, urinalysis, CT, bone scanning, dual energy x-ray absorptiomentry (DEXA), bone biopsy
treat - no cure so prevention by lifelong diet rich in calcium and vitamin D along with weightbearing exercise = development of dnse and strong bone and slows progression of disease, avoid smoking and alc and caffeine consuupmtion should be minimized. may need meds to promote calcium uptake in bones, estrogen replacement
What is rickets?
rare disease of infancy or early childhood i nwhich bones do not properly ossify = bones that r soft, bend easily and become deformed
how to prevent rickets?
- vitamin D- fortified milk and exposure to sunlight (sunglight converts dehydrocholesterol in skin to vitamin D)
treatment is sunlight exposure
and treatment with vitamin D concentrate
What is osteomalacia + etiology, diagnose and treat?
- softening or decalcification of bones in adults
- rare in US, most prevalent in Asia among women who have had multiple births, eat cereal- based diet, little exposure to sunlight
- caused by inadequate dietary vitamin D and dietary deficiency of calcium or phosphourous (or could be from inadequate exposure to sunlight, with prevents body from synthesizing its own vitazmin D, intestinal malapsorption of vitamin D)
- diagnose with blood test (serum calcium serum alkaline phosphatase, vitamin D levels, and ESR), radiographic studies, bone scanning and possibly bone biopsy
- treated with vitamin D supplements and adding adequate caclim ad phosphrous to diet
s/s of osteomalacia?
- bowing of legs
- chest deformity
- muscle weakness
- wt loss
- bone pain
- bones of vertebral column, legs and leovis readily bend and fracture under mild stress
- general fatigue
- progressive stiffness
- tender, painful bones
- backaches
- muscle twitches and cramps
- difficulty standing up
- fracture
What is Paget’s disease/
aka osteitis deformans
- overproduction of bone, particularly in skull, vertebrae and pevlis
- rare worldwide and affefcts approx 2.5 M ppl (mostly men ove 40) in US
- begins with bone softenining, then bone overgrowth (new bone is abnormal and tends to fracture easily) which causes skull to enlarge, pressing on cranial nerves and impairs vision and hearing,in spina colum = curvatures and in legs = deformities
- another complication is osteogenic sarcoma
how to diagnose and treat paget’s disease?
diagnose - examination, x-ray, bone scan and bone and possibly bone marrow biopsy, blood work (show elevated serum concentration of alkaline phosphatase), urinalysis reveals elevated hydroxyproline concentration
treat - analgeics, antiinflammatory drugs, cytotoxic agents, calcitonin and etidronate (reduce bone resorption) and mithramycin (decreases calcium)
What is scoilosis?
- abn lateral curvature of spine usually first ientified during childhood
- may be caused by fusion of vertebrae during development, neuromuscular abn, weak or asymmetric back muscle development or idiopathic
- s/s r lower back pain and fatigue, SOB on exertion (in women first indicator is often unequal bra strap lengths)
- cause is mostly idiopathic, could be caused by deformties of bertebrae, uneven leg lengths, muscle degeneration, paralysis from disase, poliomyelititis, cerebral palsy and uscular dystrophy
how to diagnose and treat scoliosis?
diagnose - history, physical exam and xray
treatment - if mild (less than 20 degrees (common)) than no treatment, more severe = braces or surgery (fuses vertebrae and itnernal fixation with rods, wires or plates and pedicle screws) (if neuromuscular scoliosis than usually related to other diseases like muscular dystrophy, spina bifida, or cerebral palsy), exercise to strengthen weak muscles, milwauee brace, boston brace, moded pastic clamshell kacket or WIlmington brace
What is kyphosis?
- exaggerated posterior curve of thoracic spine, first occurring in adulthood and more noticable in older adults
- most often caused by collapse of vertebrae affected by osteoporosis or by degerative changes associated with arthritis of vertebra
- if in adolescent kyphosis is usually related to Scheurmann disease (degenerative defromity of thoracic vertebrae)
- additional disease processes that contribute to occurence of kyphosis include tumors or tbueroculosis of ertebral bodiesand ankylosing spondylitits
- atnerior wedging (wearing away f anterior portion of bertebrae in wedge shape) or deterioraton of vertebrae = excesive curvature with kyphosis
s/s of kyphosis?
- insidious onset and is asymptomatic until hump becomes obvious
- mild back pain
- back fatigue
- tenderness
- difficulty breathing bc compression of throacic cage
how to diagnose and treat kyphosis?
diagnose - physical exam and x-rays, test for loss of bone density
treatment - few and no cure (if osteoporosis is underlying than treat like that, if underlying is arthritis than relieve pain and immobility to limited degree), exdrcises to streghten muscle and ligaments, back braces, spinal fusion, tomparory immoilization, vertebroplasty (bone cement is inserted with vertebra to maintain the reestablished vetebral height and reduce pain)
What is lordosis?
- aka swayback or saddleback deformity
- inward curvature of lumbar vertebrae
- some degree of curvature is normal and most cases r benign
- can be caused by added adominal girth from pregnancy, obesity, large abd tumor, no cause, s/s could be non or low back pain bc strains on muscle and ligaments
- often notes in prepubescent girls (one possible cause is rapid skeletal growththat occurs without necessary natural strechign of posterior soft tissue) or osteoporosis
- treat with wt loss, strengthened abd muscles, use of brace, spinal fusion and displacement osteostomy (surgical division of vertebrae)
- if untreated can lead to degenerative lumbar disk disease or ruptured lumbar disks
What is bone cancer?
- malignant bone tumors
- priamry is uncommon (1% of malignancies)
- primary is mostly in males, esp children and adolescents
- chondrogenic (from cartilage), osteogenic (from bone) and fibrogenic (fibrous tissue)
- main s/s is pain, esp at night or with exercise, limping, painful soft tissue swelling
- if metastasized it’s from breast, lung, prostate, thyroid and kidney cancer
- bones most affected are pelvis, vertebrrae, ribs, hip, femur and humerus
- diagnose with radiographym radionuclide bone scanning, PET, CT, MRI (for ewing sarcoma bone marrow aspiration), elevated serum alkaline phospatase level for ostesarcomas and elevated lactate dehydrogenase in Ewing sarcoma
What is osteogenic sarcoma?
- in bony tissue
- frequeitnyl affects ends of long bones, esp knee and distal femur, follwoed by proximal tibua and humerus
- cause is unknown
- s/s: dull localized pain that intensifies at night, bone masses and fractures near sarcona
- metastasize to lungs
- diagnose: biopsy, x-ray and CT (appears to have sunburst appearance on radiograph)
treatment - chemo, surgical removal
What r s/s of fracture?
- Visibly out-of-place limb or joint
- Swelling, bruising, or bleeding
- Intense pain
- Numbness and tingling
- Broken skin with bone protruding
- Limited mobility or inability to move a limb
- edema
- tenderness
how to diagnose and treat fracutres?
diagnose - based on s/s, MRI, bone scanning, physical exam, bone biopsy
treat - closed: immobilization with splint or cast or open: others need surgery, pins and plates, external or interal fixation (surgically implanted pins, wires, rods, plates, screws, etc.)
Types of fractures?
closed - bone breaks clean but no penetration (simple fracture)
open - broken bits protrude through skin (make = oesteomyelitis) (compound fracture)
communicated - bone fragments into many pieces (common in conditions causign brittle bones)
compression - bone is crushed (common in osteoporosis))
impacted = broken ends r forced into each other (common frm fall and hip fracture)
depressed - broken bone presses inward (skull fracure)
spiral - jagged break due to twisting force applied to bone (common in sport injuries)
greenstick - bone breaks incompletely (common in children whose bones r more flexible)
What is arthritis?
- inflammation of hoin
- ss r persistent joint pain and stiffness
- hoints may swell, lose mobility, and become deformed and noonfunctional
- commonly in lower vertebrae, hips, figners and knees
What is rheumatoid arthritis?
- chronic, debitiliating, autoimmune, systemic, inflammatory disease that affects several hoints, surrounding muscles, tnedons and ligaments
- affects mrore than 1 M americans
- one of the most sever e forms of arthritis, commonly causing deformity and disability
risk factors for rheumatoid arthritis?-
- family history
- gender (3x more in women)
- age (30-60)
- smoking
What is pathogenesis of RA
- rheumatoid factors that form antibody complexes in synovial fluid which attracts neutrophils to joints = inflammation and destruction of synovial joint tissue
s/s of RA
- as RA progresses joint tissue is repalced iwth thichkend granulatio called pannus
- joint pain and stiffness (particularly on waking)
- joints r swollen, red and worm
- joints r affected on both sides of body
- fatigue
- weakness
- wt loss
- further destruction = joint eriosion, scarring and fusion (called ankylosis)
- inflammation and edema of synovial membranes surrounding a joint
How to diagnose and treat RA?
diagnose - physical exam, xray for joint changes, rheuamtoid factor test, synovial fluid analysis, radiographic studies, blood tests that show elevated levels of rheumatoid factor, CBC, serum protein electrophoresis, ESR, citrulline antidoy and antinuclear antibody titer
treatment - as early as possible, disease-modifying anti-rheumatic drugs (DMARDS), anti-inflammatory (aspririn or NSAIDs) and immune-suppressants, new DMARD drug approved in 2018 for treatment of RA (baricitinib), special splints, surgery to correct deformity, relieve e pain and improve ROM
What is osteoarthritis?
- most common form of arthritis
- aka degenerative joint disease or degenerative arthritis
- breakdown and eventual loss of cartilage of one or more joints
- 27 M americans (men and women equally)
- primary occurs with normal aging
- secondary assoicated with joint injury, trauma, diabetes, or obesity
s/s of osteoarthritis?
- pain
- stiffness in joints
- muscle tension and fatigue
- lose of ROM
- edema
- pain in morning
- stiffness
- crepitation with joint movement
- assoicated muscles weaken
- mainly in large weight-bearing joints (esp knees and hips)
- tendenct for smallest joints at ends of fingers to be affeced by spur formation which leads to Heberden node
- lesser degree = involvement of joints of fingers at proximal interphalangsal (PIP) joints (Bouchard nodes), wrists, elbows, and ankles
