Flashcards in Topic 4 - Metabolic, rheumatic and degenerative bone disorders Deck (49):
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.
Rhaldomyolysis and Myoglobinurias
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.
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.
Defective synthesis of type 1 collagen.
Extreme skeletal fragility.
Thin poorly developed bones.
Short limbs and soft cranium with bifrontal prominences.
Defective connective tissue
Diseases of the joint where blood supply to a bone is disrupted, particularly the epiphysis.
Occurs in children and adolescents
Uneven vertebral growth -> wedging and Tx kyphosis.
Causes low/mis back pain.
Excessive Lx lordotic curve.
Often have tight hamstrings.
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.
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.
Failure of formation or segmentation
eg Cerebral palsy, Duchenne muscular dystrophy
No cause. Grouped by age
Deformity - High shoulder, prominent hip, projecting scapula.
Shortness of breathe.
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,
Loss of minerilsed bone mass - loss of trabeculae/thinning of cortex.
Vertebral compression, wedging, collapse, kyphosis.
Fractures with less force.
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.
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
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.
Heat/cold for muscle spasms.
Modifications of ADLs
Simple vs Compound.
Partial vs complete.
Comminuted # - 2+ pieces.
Location, pattern of # line.
Sudden injury - most common, direct injury or force.
Fatigue/Stress # - Repeated wear on bone.
Pathologic # - Already weakened by disease or tumour.
Deformity of long bones - Angulation, shortening, rotation.
Pain, tenderness, swelling, loss of function.
Blood loss and hypovolemic shock.
Nerve function loss - numbness.
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
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 #.
Healing with deformity, angulation, rotation.
Visible on X-ray.
Poor reduction or alignment.
Define delayed union
Failure of # to unite within normal period.