Topic 4 - Metabolic, rheumatic and degenerative bone disorders Flashcards Preview

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Flashcards in Topic 4 - Metabolic, rheumatic and degenerative bone disorders Deck (49):

Define myopathy

Muscle disease


Myopathy common symptoms

Weakness, pain, muscle enlargement or atrophy


List and describe inherited myopathies

Dystrophies - degeneration and regeneration.
Congenital myo. - microscopic muscle changes.
Mitochondrial myo. - defects in mitochondria.
Inflammatory myo. - autoimmune disease.
Metabolic myo. - defects in biochemical metabolism


List and describe acquired myopathies

Drug-induced/alcoholic - includes other toxic agents.
Dermatomyositis - muscle weakness and skin changes.
Polymyositis - inflammation of many muscles.
Inclusion body myositis - slow progressive weakness hand grip and knee extension.
Myositis ossificans.
Rhaldomyolysis and Myoglobinurias


Describe Fibromyalgia

Muscle and connective tissue pain.
Fatigue, sleep disturbances, joint stiffness.
Frequent co-morbidity with psychiatric conditions.


Describe Muscular dystrophy

Group of hereditary progressive, multisystem diseases.
Progressive muscle weakness, defects in muscle proteins, muscel cell/tissue death.
No cure


Describe Myasthenia Gravis

Autoimmune neuromuscular disease.
Fluctuating muscle weakness/fatigue.
ACH receptors blocked.
Progressive weakness during activity.
Facial, postural, swallowing/chewing, breathing muscles all susceptible.


Osteogensis imperfecta

Defective synthesis of type 1 collagen.
Extreme skeletal fragility.
Thin poorly developed bones.
Short limbs and soft cranium with bifrontal prominences.
Defective connective tissue


Define osteochondroses

Diseases of the joint where blood supply to a bone is disrupted, particularly the epiphysis.
Occurs in children and adolescents


Scheurermann's Disease

Uneven vertebral growth -> wedging and Tx kyphosis.
Causes low/mis back pain.
Excessive Lx lordotic curve.
Often have tight hamstrings.


Legg-Calve-Perthes disease

Idiopathic osteonecrotic disease of proximal femoral epiphysis.
Unknown cause, associated with acute trauma.
Mani: short stature, hip knee groin pain, decreased hip ROM, thigh atrophy.


Osgood-Schlatter disease

Microfractures at pattella tendon insertion to tibial tubercle.
From growth spurts - bone longer than muscle length.
Mani: Front knee pain, swelling/tenderness, prominence on tibial tubercle.


Congenital Scoliosis

Failure of formation or segmentation


Neuromuscular Scoliosis

eg Cerebral palsy, Duchenne muscular dystrophy


Idiopathic Scoliosis

No cause. Grouped by age


Scoliosis Manifestations

Deformity - High shoulder, prominent hip, projecting scapula.
Usually painless.
Shortness of breathe.
GIT disturbances.


Define osteopenia

Reduction in bone mass greater than expected for age, race, gender.
Common to all metabolic bone diseases.


Osteoporosis risk factors

Personal - age, race, gender, family Hx, post menopausal.
Lifestyle - sedentary, smoker, nutrition.
Drugs/Diseases - RA, diabetes, corticosteriods
Hormones - Oestrogen, Growth factors,


Osteoporosis manifestations

Loss of minerilsed bone mass - loss of trabeculae/thinning of cortex.
Vertebral compression, wedging, collapse, kyphosis.
Fractures with less force.


Osteoporosis diagnosis

Bone mineral density scan - DEXA
Esp spine and hip joints.


Osteomalacia vs Rickets Causes

Osteomalacia: Inadequate Ca absorption/intake, kidney issues, Coeliac.
Rickets: Lack of Vitamin D, inadequate Ca.


Osteomalacia vs Rickets Manifestations

Osteomalacia: Weak bones, bone pain, muscle weakness, hypocalcemia, compressed Vx, bone softening, bendy bones.
Rickets: Dental problems, bone pain, skeletal deformities, growth disturbances, tetany, soft skull, hypocalcemia.


Define Systemic autoimmune rheumatic disease

Group of 100+ chronic disorders.
Diffuse inflammatory lesions.
Degenerative changes in connective tissue.


Rheumatoid arthritis - Features

Development of excessive blood vessel network in synovial membrane.
Destructive granulation tissue b/w cartilage and subchrondral bone.
Destroys cartilage and bone.
Decreased joint ROM - structural and pain


Rheumatoid arthritis - Joint Manifestations

Pain/stiffness for more than 30mins.
Swollen, warm, tender joints.
Decreased ROM initially from pain, then fibrosis.
Joint deformity.
Progressive joint destruction that may lead to subluxation/instability.
Tendon tethering erosion and destruction of joint surface


Rheumatoid arthritis - Organ manifestations

Lungs - fibrosis, Pleural effusions & rheumatoid lung disease.
Kidneys - Renal amyloidosis.
Heart/vessels - More prone to atherosclerosis, increase myocardinal infarction/stroke risk, Pericarditis, Endocarditis, L ventricular failure, Valvulitis and Fibrosis.


Rheumatoid arthritis - Other manifestations

Haematological - Anaemia.
Neurological - peripheral neuropathy, carpel tunnel syndrome, atlanto-axial subluxation.
Constitutional - Fatigue, low grade fever, malaise, loss of appetite and weight.


Rheumatoid arthritis - Treatment

No cure - symptomatic Rx.
Education, Rest (physical splints), Positioning posture body mechanics and shoes.
Therapeutic exercise, Heat/Cold.
Pharmacology: NSAIDs, corticosteriods.
Surgery - synovectomy, arthrodesis, arthroplasty.


Define Seronegative spondyloarthropathies

Group of multi-system inflammation disorders.
Primary affect axial skeleton
Absence of rheumatoid factor (seronegative).


Ankylosing spondylitis - Features

Pain and progressive stiffening of spine.
Inflammatory erosion of tendon/ligament attachment.
Ultimately destruction of bone or posterior fusion of the spine.
Usually in adolescence/early adult.


Ankylosing spondylitis - Manifestations

Persistent or intermittent low back pain, worse with rest.
Prolonged stiffness after rest.
Progressive stiffening of spine.
Weight loss, fever, fatigue, interrupted sleep.
Decreased lung volume, ROM.
Loss of Lx lordosis -> increased Kyphosis and neck ext.


Ankylosing spondylitis - Treatment

Symptomatic - control pain and mobility.
Positioning, Posture, extensor muscle strengthening, heat, hydro, NSAIDs.


Osteoarthritis - Pathology

Change in cartilage architecture.
Progressive disruption of smooth surface.
Erosion articular cartilage, develop surface cracks.
Exposure of subchrondrial bone - dislodgement of fragments/free bodies.
Develop bone cysts, abnormal bony spurs at joint margins


Osteoarthritis - Manifestations

Sudden/insidious onset.
Pain - aching, difficult to localise, worse with use, relieved by rest.
Limited ROM, joint instability and enlargement.


Osteoarthritis - Common sites

Hips, knees, Lx, Cx, PIP, DIP, 1st MTP, 1st MCP


Osteoarthritis - Risk factors

Age, gender, race, obesity.


Osteoarthritis - Treatment, non physio

No cure, symptom relief.
Pharmacological - NSAIDs, corticosteriod injection.
Surgical - Lavage and debridement, joint replacement, arthodesis.


Osteoarthritis - Physio Management

Supporting joint - strengthen muscle groups.
Balance rest/activity.
Splints/orthoses/walking aids.
Heat/cold for muscle spasms.
Weight reduction.
Modifications of ADLs


Fracture classifications

Simple vs Compound.
Partial vs complete.
Compression/impacted #.
Comminuted # - 2+ pieces.
Location, pattern of # line.


Fracture causes

Sudden injury - most common, direct injury or force.
Fatigue/Stress # - Repeated wear on bone.
Pathologic # - Already weakened by disease or tumour.


Fracture manifestations

Deformity of long bones - Angulation, shortening, rotation.
Pain, tenderness, swelling, loss of function.
Blood loss and hypovolemic shock.
Nerve function loss - numbness.


Fracture treatment

Determined by nature of #.
Reduction - restoring bone to normal position.
Immobilisation - prevent movement. eg splints, casts.
Preservation - Rehab to restore function and ROM.


Bone healing stage 1

Haematoma formation.
Fibrin network seals off # site.
Framework for inflammatory cells.
Develops capillary bed.


Bone healing stage 2

Fibrocartilaginous callus formation.
Capillaries continue to develop.
Tissue -> granulation tissue.
Outside cells invade.
Fibroblasts produce fibrocartilaginous soft callus bridge.
Not strong enough for weight bearing.


Bone healing stage 3

Bony callus formation.
Ossification = bridge -> boney callus.
Trabeculae produced, slowly reach # site until bony sheath covers it.
Replaced by mature bone, 3-4 weeks post injury.


Bone healing stage 4

Dead portions replaced/removed by osteoclasts.
Compact replaces spongy bone.
Minerised bone reorganised along mechanical stress.
May heal thicker than before #.


Define malunion

Healing with deformity, angulation, rotation.
Visible on X-ray.
Poor reduction or alignment.


Define delayed union

Failure of # to unite within normal period.


Define nonunion

Failure to produce union, mobility at # site, pain on weight bearing.