Degenerative and Inflammatory Disorders of Musculoskeletal Tissue

Question 1

Incidence

Answer 1

The frequency with which a condition occurs over a period of time and in relation to the population in which it occurs

Question 2

Prevelence

Answer 2

The number of cases a disease present in a specified population at a given time

Question 3

Osteoarthritis

Answer 3

Slow, progressive degeneration of joint structures
Can lead to loss of mobility, chronic pain, deformity, and loss of function
Most common joint disease

Question 4

Primary OA

Answer 4

Disorder of unknown cause and degenerative effects are thought to be related to defects in the articular cartilage

Question 5

Secondary OA

Answer 5

Has known cause which may be trauma, infection, hemarthrosis, osteonecrosis

Question 6

OA Incidence and Risk

Answer 6

High % of population over 60 have damage; only 20% have symptoms
More frequent in males before 45, females after 55

Question 7

Etiology of OA

Answer 7

Primary etiology is unknown
“Wear and tear”
Imbalance between mechanical stresses and the ability of the joint structures to handle the loads

Question 8

Pathogenesis of OA

Answer 8

Once cartilage breaks down, mechanical stresses fall on other joints.
Fissuring and eburnation of cartilage occurs
Joint space narrows
New bone forms at joint margins

Question 9

Eburnation

Answer 9

Changes in bone causing it to become dense and hard like ivory

Question 10

Immobilization effect on OA

Answer 10

Articular cartilage needs repetitive loading and unloading; nutritional mechanism is interrupted with immobilization

Question 11

Clinical Manifestations of OA

Answer 11

Sudden or Insidious
Deep Ache
Stiffness after inactivity
Loss of flexibility

Question 12

OA Treatment and Prognosis

Answer 12

Depends on patient’s age, chronicity, and co-morbidities

Treatment involves physical agents, exercises, core stabilization, and unloading

Question 13

Tendinitis

Answer 13

Inflammation of the tendons

Question 14

Tenosynovitis

Answer 14

Inflammation of the lubricating fluid of the joint due to contractile tissue involvement

Question 15

Synovitis

Answer 15

Inflammation of the synovial membrane due to damaged cartilage or exposure to cold and dampness

Question 16

Bursitis

Answer 16

Inflammation of the padlike sac found in connective tissue

Question 17

Osteomyelitis Pathophysiology

Answer 17

Inflammation of bone caused by an infectious organism

Usually caused by direct innoculation into bone

Question 18

Osteomyelitis Incidence

Answer 18

Occurs more often in kids than adults
Acute hematogenous osteomyelitis is most common
Chronic osteomyelitis is more common in adults
Decreasing with use of antibiotics

Question 19

Osteomyelitis Etiology

Answer 19

Staphlococcus aureus is usual cause

Question 20

Osteomyelitis clinical picture

Answer 20

Pain may not be an initial factor
Can spread rapidly to outer surface of bone
Pain may be described as deep, continous worse with weight
Intermittent, throbbing back pain at rest

Question 21

Osteomyelitis Diagnosis

Answer 21

Increase in WBC and Erythrocyte sedimentation rate
Radionucleotide bone scans detect early stage
Identification of pathogen is critical
Treatment is oral or IV; surgery indicated if in joints

Question 22

Septic Arthritis Pathophysiology

Answer 22

Bacteria, viruses, and fungi infect a joint

History of alcohol, drug, prosthesis, diabetes, and trauma increases risk

Question 23

Septic Arthritis Incidence

Answer 23

Increasing as a result of a greater number of people with immunosupressed conditions

Question 24

Septic Arthritis Clinical Picture

Answer 24

May be of any age
Acute onset of joint pain, swelling, tenderness, and loss of motion
Accompanied by fever, chills, and systemic symptoms

Question 25

Septic Arthritis Managment

Answer 25

Diagnosed by analysis of joint fluid
Treatment w/ antibiotics
Surgical drainage may be required

Question 26

Adult Rheumatoid Arthritis

Answer 26

Chronic, systemic, inflammatory disease. Chronic polyarthritis can result in severe deformity and disability

Joints of the cervical spine often involved

Can include cardiovascular, pulmonary, and gastrointestinal systems

Question 27

Adult RA Incidence

Answer 27

~1-2% of adult pop

Less common, but still present in children

Question 28

Adult RA Etiology

Answer 28

Unknown cause, but may arise from autoimmune disease

Question 29

Autoimmune Disease

Answer 29

A disease produced when the body’s normal tolerance of its own antigenic markers on cells disappears

Question 30

Autoantibodies

Answer 30

Produced by B lymphocytes and attack normal cells whose surface contains a “self” antigen or autoantigen, causing destruction of tissue

Question 31

RA Pathogenesis

Answer 31

Interaction between rheumatoid factor and immunoglobin triggers inflammatory reaction

Attracted immune cells phagocytose immune complexes and lysosomal enzymes are released; leads to articular cartilage destruction and synovial hyperplasia

Question 32

Pannus

Answer 32

A destructive vascular granulation tissue;

Can proliferate and encroach the joint space; results in joint instability, joint deformity, or ankylosis

Question 33

Ankylosis

Answer 33

Ligaments turn to bone

Question 34

Adult RA Symptoms

Answer 34

Joint stiffness; Joint Pain; Fatigue; Weakness; Psychological depression

Question 35

Adult RA Signs

Answer 35

Swelling;Palmar erythema; cool moist skin; muscular atrophy; joint contracture; nodules; synovial hernias; weight loss

Question 36

RA Clinical Manifestations

Answer 36

Insidious; multiple joint usually; Periods of rest increase symptoms; ulnar deviation; Swan Neck; Boutonniere deformity

Question 37

Juvenile RA

Answer 37

Chronic Inflammatory disease; mild to severe, destructive arthropathy with extra-articular manifestations; anti-inflamatory meds used

Question 38

Still’s Disease

Answer 38

Form of Juvenile RA marked by fever and a rash on trunk or extremities

Question 39

Ankylosing Spondylitis

Answer 39

Inflammartory arthropathy of the axial skeleton, including the sacroiliac joints, apophysial joints, costovertebraljoints, and the discs;
can lead to fibrosis, calcification, and ossification

Question 40

Ankylosing Spondylitis Pathophysiology

Answer 40

Nongranulomatous inflammation; disrupts ligamentous-osseus junction
Progressive ossification

Question 41

Ankylosing Spondylitis Etiology

Answer 41

Unknown, but there is a genetic or environmental link

More prevelent in males between 20-40

Question 42

Ankylosing Spondylitis Clinical Manifestions

Answer 42

Insidious onset back pain
“Ache”
Tolerating recumbant positions is difficult with progression of disease

Question 43

Ankylosing Spondylitis Medical Management

Answer 43

Loss of spinal mobility in multiple plains is typical

Diagnosis by history, physical exam, laboratory, and radiography

Question 44

Gout and Gouty Arthritis Pathophysiology

Answer 44

Elevated level of serum uric acid and deposition of crystals in the joints, soft tissues, and kidneys.

Question 45

Primary Gout

Answer 45

Hyperuricemia without any other disease

Question 46

Secondary Gout

Answer 46

Hyperuricemia in the presence of an antecedent disease

Question 47

Gout and Gouty Arthritis Pathogenesis

Answer 47

Sodium urate crystals precipitate from supersaturated body fluids. Aggregate and result in local necrosis

Question 48

Tendinitis impairments

Answer 48

Active motion loss, Tenderness, pain w/ isometric resistance

Question 49

Bursitis Key impairments

Answer 49

End Feel, Local Pain

Mimics L5-S1 and C4/C5 myotomal problems