Musculoskeletal Disorders (MODULE 9) Flashcards

Question

Synovial cells proliferate in response to chronic inflammation • Leads to the development of a pannus Pannus Formation will?

Answer 1

• Damage cartilage • Erode bone • Cause secretion of MMPs which further destroys cartilage • Causes irreversible damage, leading to joint deformities and functional impairment *Synovial fibroblasts proliferate in response to chronic inflammation; this proliferation leads to the formation of pannus, an abnormal, thickened, and inflamed tissue, mass; pannus invades cartilage and bone, causing cartilage destruction, bone erosion, and joint deformations; pannus is a hallmark of RA and contributes significantly to the progressive joint damage and disability characteristics of the disease.

Answer 2

The control of pannus formation and its associated inflammation is a key goal in the treatment of rheumatoid arthritis. As the disease progresses- joint space is replaced with fibrous connective tissue that eventually leads to bone fusion • Fibrous ankylosis ——> Bony ankylosis

Answer 3

Brain, skin, lungs, heart, vessels, liver

Answer 4

FALSE Always bilateral Small joints of phalanges in the hands, wrist, and feet affected first

Answer 5

• Ulnar Deviation • Boutonniere Deformity —>Extensor tendon ruptures • Swan Neck Deformity —>Flexor tendon ruptures

Answer 6

Diagnosis - Physical examination; imaging; Blood work (Rheumatoid factor (RF) antibodies; Anti-cyclic citrullinated peptide (CCP) antibodies; Erythrocyte sedimentation rate; C-reactive protein (CRP)) Treatment - No cure; medications (NSAIDs, Corticosteroids, Biological agents, Disease-modifying anti-rheumatic drugs); Physical and occupational therapy; surgery.

Answer 7

• AKA Juvenile Rheumatoid Arthritis • Basically, RA in juveniles • JIA affects one or more joints for at least 6 weeks in a child age 16 or younger —> Affects bone development • Children grow out of it (not chronic) • Nearly half of children fully recover from joint damage • Multiple types of JIA

Answer 8

F No cure Can medicate with NSAIDs, corticosteroids, biological agents, disease-modifying antirheumatic drugs, physical and occupational therapy

Answer 9

Similar to OA and RA Slow Growth

Answer 10

Imaging, blood work (Rheumatoid factor antibodies (RF factor); Anti-cyclic citrullinated peptide antibodies (CCP); Erythrocyte sedimentation rate (ESR or sed rate); C-reactive protein (CRP))

Answer 11

Lyme disease is the most common vector-borne disease in the US —>Caused by the bacterium Borrelia burgdorferi • Transferred by deer tick bite • Commonly unilateral • Commonly larger joints- knee • Causes severe joint pain and swelling • Headaches and Fevers!!! • Body aches • Extreme fatigue • Skin Rash If not treated, damage could become permanent

Answer 12

Diagnosis • Checking for antibodies • ELISA (enzyme-linked immunosorbent assay) test • Western blot test Treatment • Antibiotics: ~1 month • Sometimes repeated doses

Answer 13

Arthritis of a joint caused by urate crystals being deposited into a joint • Commonly only affects 1 joint at time • First metatarsal joint of big toe

Answer 14

• Can have flare-ups (gout flares) that last days to weeks • When no symptoms- remission • Repeated and chronic episodes of flare ups can lead to gouty arthritis • Sudden, intense, burning/fire feeling joint pain • Even a bed sheet on it is painful • Redness and swelling of joint

Answer 15

Hyperuricemia • High levels of uric acid in the blood • Uric acid is not very soluble in fluid • Forms sharp monosodium urate crystals Hyperuricemia Causes: 1. Increased Dietary Intake of Purines a. Red meat, organ meats, seafood, HFCS 2. Decreased Uric Acid Excretion a. Dehydration: Decreased water and increased alcohol Gouty arthritis

Answer 16

Uric acid is a by product of purine degradation within the kidneys • Attracts WBCs and cytokines to induce inflammation and is then able to be excreted from the body via urine • These urate crystals get deposited in joints and within the kidneys Associated with gout toe

Answer 17

Diagnosis • Joint fluid extraction • Blood test of uric acid • Ultrasound Treatment • NSAIDs, corticosteroids • Medications that block uric acid production and improve excretion • Dietary changes

Answer 18

Psoriasis is an autoimmune skin disorder that causes proliferation of skin in random areas on the body • Red/purple/white, itchy, patchy scales on the skin • Due to autoimmune condition- psoriatic arthritis can occur

Answer 19

Joint pain and inflammation (bilateral or unilateral) • Swollen fingers and toes • Foot pain at Achilles tendon

Answer 20

F Commonly a seronegtive arthritis BUT has NO cure

Answer 21

Used to be called: Reiter's syndrome (NBCE loves this) • Joint pain and swelling triggered by an infection in another part of the body • Usually targets the knees, ankles and feet • Can also affect the eyes and urinary system • Mainly bacterial infection (foodborne and sexually) • Campylobacter, Chlamydia, Clostridioides difficile, Escherichia coli, Salmonella, Shigella, Yersinia • Most often the intestines, genitals or urinary tract

Answer 22

• Nucleus Pulposus Gel like structure; 75% water Accounts for much strength and flexibility of spine • Annulus Fibrosis Concentric rings of collagen fibers Effective resistance of multidirectional movements • Vertebral Endplate Located superior and inferior portions of IVD Allows diffusion and is main source of nutrition • Disc degeneration, mechanical compression, poor posture abnormal rotational stress, spinal stenosis, spondylolisthesis, pregnancy

Answer 23

• Is not necessarily a disease but a condition where the intervertebral discs undergo degenerative changes and causes pain • Anatomical changes • Loss of function • As you age, your discs are going to ”wear out” -Some faster than others -But not everyone has pain associated with it • Common Causes -Disc injury - Disc becoming dehydrated -Disc tears from daily activities and physical activities

Answer 24

Symptoms - pain increases with bending, twisting, lifting Numbness/tingling in extremities Transient pain Treatment- Chirpractic care, NSAIDs/Corticosteriods, icing, lifestyle changes Poor outcomes - Damage that is done is done, must correct postural imbalances

Answer 25

Common hip condition in adolescents • Growth plate present • Growth plate fractures and causes a slippage of the neck of femur from the epiphysis (capital) • Technically the femoral neck is displaced anterolaterally and superiorly slippage is severe- can tear the epiphyseal blood vessels • Causes avascular necrosis of femoral head • Causes of slippage is unknown but risk factors: • Obesity • Trauma • Family history

Answer 26

Mild case - pain increases the groin; worsen with activities and may lead to limp Severe case - walking is greatly affected; leg length inequality; externally rotated leg Diagnosis - x-ray; MRI Treatment - Surgery

Answer 27

Osteochondrosis is a group of disorders that affect the growth plates of bones in children and adolescents, leading to disturbances in bone growth and development • Caused by the loss of blood supply to bone tissue, leading to necrosis and potential collapse of the affected bone structures • Results in severe joint pain and dysfunction Pathophysiology: • Loss of blood flow to the epiphysis • Causes bone necrosis • Re-establishment of blood flow • Leads to removal of necrotic bone tissue and little recalcification Cause is unknown but believed to involve: • Rapid Growth Phases • Physical Activity • Nutritional and Hormonal Factors

Answer 28

1. Spinal (Physeal) • Affects the growth plates (physes) specifically • Scheuermann’s Kyphosis 2. Articular Osteochondrosis • Affects the joints • Legg-Calvé-Perthes disease, Köhler's disease, Freiberg's infraction 3. Non-Articular Osteochondrosis • Affects sites other than the joint spaces- typically where tendons and ligaments attach to bones • Osgood-Schlatter's disease, Sever’s disease

Answer 29

Scheuermann’s Disease • Juvenile osteochondrosis of the spine affecting the thoracic vertebrae — Leads to increased kyphosis of the thoracic spine • Caused by osteochondrosis of growth plates within the thoracic spine — Causes disruption of normal growth and ossification at the vertebral growth plates — Wedge shaped vertebrae — Anterior portion grows slower than posterior *Results in an increase kyphotic curve of thoracic spine • Stooped posture • Patients cannot consciously correct their posture • About 25% will develop scoliosis

Answer 30

S/S - Pain in the neck/back; postural imbalances; hyperhypoosis (hunchback); hyperlordosis; Schmorl’s nodes; muscle spasms; decreased lung capacity; tight hamstrings Treatment - monitoring/exercise; chiropractic; PT; bracing; surgery if severe

Answer 31

Spondyl/o vertebrae; spine Spondylitis -itis: inflammation Spondylosis destruction -osis: condition of Spondylolisthesis -listhesis: slipping or falling Spondylopathy -pathy: condition of Spondylolysis -lysis: separation, breakdown,

Answer 32

Condition where there is a break in the pars interarticularis of the vertebral arch • Spondylolysis —Fracture can be unilateral or bilateral • Spondylolysis • Commonly occurs at L5 — Can also occur at L4 and rarely in the cervical spine • Etiology — Unknown but associated with activities (sports) that have forceful blows to the spine or repetitive force/stress and hyperextension • Stress factures in this region are common for adolescents • Affects 3-7% of population

Answer 33

Signs/Symptoms • Asymptomatic • Low back pain that increases on activity Diagnosis • X-ray (oblique view) • Scotty dog • Scotty dog • Scotty dog • MRI Treatment • Monitor • Bracing • Strengthening exercises • Activity restrictions • Surgery • Do you adjust a spondylolysis? No Concerns • Can lead to a spondylolisthesis

Answer 34

The cousin to spondylolysis * Displacement or slippage of one vertebrae compared to another • Commonly it is L5 slipping off the sacral base • Slippage can technically occur in any direction but is most commonly anterior (forward) displacement —Will focus on anterolisthesis * Important to note- you can have a spondylolisthesis WITHOUT a spondylolysis

Answer 35

• 1. Congenital spondylolisthesis • 2. Isthmic spondylolisthesis • Due to spondylolysis • 3. Degenerative spondylolisthesis • Most common type • Due to aging • 4. Traumatic spondylolisthesis • 5. Pathological spondylolisthesis • 6. Post-surgical spondylolisthesis

Answer 36

• Asymptomatic • Tenderness/pain over the area • Pain on hyperextension of lower back • Intermittent sciatica symptoms • Increased intrathecal pressure may cause momentary increase of pain • Possible gait changes due to pain and muscle changes • Tight hamstrings • 4-6% of population has this condition • If diagnosed 50+ yoa; then degenerative spondylolisthesis • If diagnosed <40 yoa; then isthmic spondylolisthesis

Answer 37

Diffuse Idiopathic Skeletal Hyperostosis (DISH) • Skeletal condition characterized by the calcification and ossification of ligaments, tendons, and soft tissues —Hyperostosis: excessive growth or thickening of bone —Primarily affects the spine (thoracic) • DISH occurs when there is calcification of the ligaments, tendons, and soft tissue surrounding the thoracic spine —Leads to the formation of *syndesmophytes* that can bridge adjacent vertebrae giving the spine a distinctive "flowing" appearance on X-ray images —Posterior and anterior longitudinal ligament can be affected —Primarily the anterior longitudinal ligament

Answer 38

• Marginal Syndesmophytes — Ligament ossification that develop along the edges of the vertebrae • Non-Marginal Syndesmophytes — Ligament ossification that develops beyond the edges of the vertebral margin

Answer 39

Clinical Manifestations • Flowing candle wax appearance on X- ray • Non-marginal syndesmophytes ** Four contiguous vertebrae • Disc height preserved • No SI joint involvement • No presence of osteopenia

Answer 40

Etiology Diagnosis • There is no known cause to the pathophysiology of DISH • High majority of causes develop after the age of 50 years of age Signs/Symptoms Treatment impingement • Commonly are asymptomatic • Back pain • Decreased ROM • Stiffness with flexion/extension • Dysphagia • Imaging • Ossification along the anterolateral aspect of at least 4 contiguous vertebrae • Disc height preserved 124 • No cure or treatment to stop calcification • Manage the symptoms • Stretching/Strengthening • Heat • Analgesics • Surgery if there is nerve/structure

Answer 41

Ankyl/o = Bent, crooked, stiff, fused, fixed, closed • Chronic inflammation due to an autoimmune response —Classified as a seronegative spondyloarthropathy —No autoantibody has been found • Chronic inflammation of the intervertebral joints, facet joints, and SI joints • More commonly diagnosed in individuals under 40 • Males primarily

Answer 42

Most individuals have gene HLA-B27 that impacts the self-tolerance of self antigens • About 5% of population with HLA-B27 gene will develop ankylosing spondylitis • About 90% of individuals who have ankylosis spondylitis have HLA-B27 gene • Immune system ”attacks” intervertebral discs, facet joints, and SI joints • Causes massive inflammation and joint damage • Joint damage is then replaced with fibrous fibers (fibrin) by fibroblasts 126 • Limits ROM • Eventually, this fibrous fiber undergoes ossification • Syndesmophyte formation • Drastic loss of ROM

Answer 43

CM - Bamboo spine; squaring of vertebrae; marginal syndesmophytes; Romani’s lesions; bilateral SI joint erosion/sacrolilitis; osteopenia S/S - Relasping and remitting pain and stiffness in the back and hips; decrease ROM; hyperkyphosis Complications - Eye • Develop eye inflammation and lead to vision problems • Compression fractures • Can have osteopenia develop • Heart valve • Aortic valve complications

Answer 44

Treatment • Goal is to relieve pain and impede/delay complications and deformities • Medications for pain and trying to reduce autoimmune function • Stretching and strengthening exercises

Answer 45

• Dysregulated bone tissue homeostasis and remodeling • Excessive bone reabsorption followed up excessive and disorganized bone formation — Leads to abnormal structural changes, deformities, and weakened bone structure • Commonly affects the skull, lumbar spine, pelvis, femur • Etiology • Exact cause is unknown • Can be triggered by a viral infection • Genetic influence

Answer 46

• 1. Lytic (osteoclast) Phase • Osteoclasts demineralize bone (bone reabsorption) • 20x more than usual • 2. Mixed (lytic and blastic) Phase • Due to increased and continued osteoclast activity, osteoblasts are recruited to the area • 3. Sclerotic (osteoblastic) Phase • Bone formation exceeds bone resorption • Bone is structurally disorganized and weakened

Answer 47

AKA: Brittle Bone Disease • Group of genetic disorders that affect primarily affect the bones causing osteoporosis and fragile bones • Affects bone density and quality of bone tissue • Genetic mutation that leads to improper collagen fiber formation • Type I collagen fiber • Many different types that can affect other areas of the body • Eyes, nervous system, gastrointestinal

Answer 48

• Closed/Simple Fracture —Overlying skin is intact • Open/Compound Fracture —Bone breaks through the surface of the skin surface • Displaced Fracture —Bone breaks into two or more pieces and moves out of alignment • Non-Displaced Fracture —Bone breaks but does not move out of alignment

Answer 49

• Avulsion Fracture —When a fragment of bone is separated from the main mass • Buckled Fracture —Also referred to as impacted fracture —Ends are driven into each other; commonly seen in arm fractures in children • Comminuted Fracture —The bone breaks into several piecesr • Compression or Wedge Fracture —Usually involves the bones in the back (vertebrae) • Greenstick Fracture —An incomplete fracture in which the bone is bent; occurs most often in children • Linear Fracture —The break is parallel to the bone’s long axis • Oblique Fracture — The break has a curved or sloped pattern • Pathologic Fracture —Caused by a disease that weakens the bones • Spiral Fracture — One part of the bone has been twisted at the break point • Stress Fracture — Hairline crack • Transverse Fracture —The broken piece of bone is at a right angle to the bone’s axis

Answer 50

Bone infection - Infection of bone tissue (bone/bone marrow) from a bacteria or fungus Develops from different routes to get into the blood: • Bloodstream (Hematogenous spread) —Lung infection, urinary tract infection • Direct invasion —Open fracture, surgery • Contiguous Spread —Foot ulcer or cellulitis spreading to bone

Answer 51

Fever • Inflammation in bone that is infected • Pain, swelling, redness, heat • Fatigue • Weight loss • Pathology • Most common pathogen: Staphylococcus aureus (NBCE loves this)

Answer 52

• Bacteria reach the bone and initiates the immune response • Bone marrow can swell and can compress blood vessels • Avascular regions can develop causing necrosis of bone • Commonly, immune system resolves the issue fully with assistance of antibiotics • Osteoblasts/clasts repair the damage over a few weeks

Answer 53

Can last months to years • Affected bone can become necrotic within healthy bone tissue —Abscess formation —Sequestrum: dead bone tissue; completely separated from surrounding bone —Involucrum: new bone tissue produced around the infection (NBCE loves these) —Cloaca: gap in the cortex of a bone affected by chronic osteomyelitis that allows the drainage of pus or other material from the bone into the adjacent tissues • Can lead to infections of soft tissue over bone —Causing possible drainage externally Abscess can spread superficial and cause separation of periosteum from bone —Subperiosteal abscess • Vertebral osteomyelitis is a rare form of osteomyelitis —Persistent back pain and tenderness when touched

Answer 54

Can be a result from osteomyelitis Osteonecrosis, Aseptic Necrosis • Localized necrosis (death) of bone tissue due to decreased or loss of blood flow Can Be Categorized As: 1. Traumatic — Most common cause — From a displaced fracture or dislocation (hip fracture/dislocation) 2. Nontraumatic —Disease/condition that blocks vessels —Corticosteroids —Chronic, excessive alcohol use • Spontaneous osteonecrosis of the knee

Answer 55

• Softening and weakening of bones mainly due to a long-term deficiency of vitamin D • Commonly called rickets in children and osteomalacia in adults Etiology • Lack of vitamin D due to decreased production (sunlight) and/or decreased intake • Certain medications Signs/Symptoms • Dull, ache, pain in bones • Bowing of the bones • Diagnosis • Examination and imaging • Blood test- Vitamin D • Treatment • Vitamin D supplementation

Answer 56

• Vitamin D2 (Ergocalciferol) • Derived from plant sources • Cheaper to produce- commonly found in supplements • Physiologically inactive form of Vitamin D • Vitamin D3 (Cholecalciferol) • Derived animal sources • Derived from sun exposure and skin • Physiologically inactive form of Vitamin D • Vitamin D2 (Ergocalciferol) and Vitamin D 3 (Cholecalciferol) must ultimately be converted into active form of Vitamin D: Calcitriol • Undergo two hydroxylation reactions in the body for activation

Answer 57

• Literally means condition of porous bones • Bone tissue is very dynamic- Bone Remodeling —Spongy bone is replaced every 3-4 years —Compact bone is replaced every ~10 years • Bone remodeling dependent upon serum calcium levels —PTH, Calcitonin, and Vitamin D

Answer 58

• Amount of bony tissue present at the end of the skeletal maturation • Important indicator of osteoporosis risk later in life • Genetics, diet, exercise, and lifestyle factors will influence peak bone mass • After achieving peak, bone mass plateaus for about 10 years —Bone formation approximately equals bone resorption • Then bone loss occurs at a rate of about 0.3 to 0.5% per year • Menopause accelerates bone lose in women to 3 to 5% per year for about 5 to 7 years and then the rate of loss decelerates • Peak Bone Mass • Males: ~ 25- 30 years of age • Females: ~18-30 years of age (about 95% of a young woman's peak bone mass is present by age 20)

Answer 59

DEXA: Dual-energy x-ray absorptiometry —Uses small amounts of ionizing radiation to measure bone mineral density —Commonly examines the lumbar spine and pelvis —Specialized X-ray • Results are given in the form of a T score: • T score of -1.0 or higher —Considered normal bone density • T score between -1.0 and -2.5 —Low bone density (osteopenia) and may be at risk for developing osteoporosis • T score of -2.5 or less —Osteoporosis

Answer 60

Both relate to loss of bone mineral density, but osteoporosis is more severe Pathology is associated with not achieving a high peak bone mass density and then not maintaining activities/lifestyles to keep lower activity of osteoclasts afterwards • Both pertain to the same factors that increase risk for bone mass loss

Answer 61

Decrease physical activity (stress) - sedentary lifestyle Decreased calcium intake -Foods high in calcium - Low levels of vitamin D - Imbalance with calcium homeostatsis Smoking -Alcohol intake Medications (glucocorticoids, proton pump inhibitors) Disease Low estrogen levels - menopause and post menopause Low testosterone levels

Answer 62

Primary Osteoporosis - 95% in women and 80% in men - No exact identifiable cause Secondary Osteoporosis - Due to a specific medial condition or situation (parathyroid, kidney dysfunction)

Answer 63

Severity: Osteoporosis is more severe than osteopenia. Fracture Risk: Osteoporosis presents a higher risk of fractures compared to osteopenia. Bone Density: Osteopenia is a precursor to osteoporosis but doesn’t yet indicate fragile bones, whereas osteoporosis results in fragile, easily fractured bones.

Answer 64

Rare cancer that forms in skeletal muscle or even smooth muscle • Epidemiology • About 400 to 500 new cases of rhabdomyosarcoma (RMS) occur each year —Most often diagnosed in children and teens, with more than half of them in children younger than 10 years old —About 3% of all childhood cancers are RMS • Etiology —Cause is unknown and few risk factors are known in the United States

Answer 65

Commonly called: Rhabdo Rhabd/o = rod shape • Breakdown of damaged muscle (skeletal) • Causes release of muscle fiber components into blood • Damages the kidneys • Characterized by muscle necrosis and the release of intracellular muscle constituents into the circulation • Myoglobin and creatine kinase (CK) released into the blood • Myoglobin that is released into the blood is metabolized into components that are harmful to the kidneys • Can occur anytime muscle is damaged or killed • Can be fetal

Answer 66

• Painful condition resulting from a build-up of pressure in a group of muscles —Commonly happens in lower legs • Leading theory: Swelling of the muscles during exercise affecting the blood supply to a whole group of muscles • Can Occur From: • Muscle damage (rhabdo) • Regular repetitive exercise Clinical Manifestations (5 P’s) • Pain • Pallor • Paresthesia (numbness and pins/needles feeling) • Pulselessness • Paralysis Treatment • Acute- medical emergency • Chronic- limit aggravating activities • Both may need surgery

Answer 67

chondroctes start making less of the proeoglycans and switch to making type I collagen fibers = OA mechanism Type I collagen fibers and the proteoglycans don’t mix as well as type II collagen fibers • Cartilage LOSES ELASTICITY and becomes further damaged!

Musculoskeletal Disorders (MODULE 9) Flashcards

(136 cards)