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Musculoskeletal Diseases and

Disorders
Arif Pandega,MD

Musculoskeletal System

Bones
Long, short, flat, irregular
Compact, spongy

Joints
Bursae
Muscles
Tendons
Ligaments

Disorders of Bone
Spinal

deformities
Herniated intervertebral discs
Osteoporosis
Osteomyelitis
Pagets Disease (osteitis deformans)
Fractures

Spinal Deformities
Lordosis
Abnormal

inward or anterior curvature


Accentuation of normal curve of lumbar spine
Frequently gradual onset
Affects lumbar spine
Also called swayback

Spinal Deformities
Kyphosis
Abnormal

outward curvature of the spine


Accentuation of normal thoracic spine curvature
Also called humpback or roundback
Commonly due to pathological fractures of spine in
osteoporosis

Spinal Deformities
Scoliosis
Lateral

(sideways) curvature of the spine


May go to left or right
May involve some rotation of spinal column
May be caused by discrepancy in leg lengths
Surgery possible if interferes with breathing or mobility

Figure 4.13 Abnormal spinal curvatures: kyphosis, lordosis, and scoliosis.

Medical Terminology: A Living Language, Fourth Edition


Bonnie F. Fremgen and Suzanne S. Frucht

Copyright 2009 by Pearson Education, Inc.


Upper Saddle River, New Jersey 07458
All rights reserved.

Spinal Deformities
Etiologies
Posture,

leg length differences, congenital, epiphyseal


growth disturbance, trauma, tumors, infection, arthritis,
TB, endocrine abn, aging

S/S:

usually backache, fatigue, abnormal


appearance or fitting of clothes
Treatment: PT, exercise, braces, surgery, pain
relief

Herniated Intervertebral Discs


Disc

Anatomy

Annulus

fibrosis
Nucleus pulposis
Herniation
Nucleus

pulposis pushes through annulus into spinal

canal
Rupture
Pieces

of the disc are free in the spinal canal

Herniated Disc
S/S:
Back

pain
Paresthesias
Sciatica: inflammation of sciatic nerve, leg pain
Treatment:
PT,

exercise, pain relief meds, surgery (rarely), life


correctly

Osteoporosis
Metabolic
Less

Over

disorder of bones

bone mineral (calcium) than normal

10 million in US affected

Post-menopausal

Bones

females most commonly

are brittle, porous, easily broken

More

prone to pathological fracture

Osteoporosis
Etiology:
Genetics,

calcium intake & dietary, sedentary lifestyle,


estrogen, vit D, or adrenal deficiency, steroid use,
alcoholism, etc

S/S:

often asymptomatic until pathological fx.


Treatment: calcium supplements, meds
(antiresorptive, restorative of lost bone, etc)

Osteomyelitis
Acute

or chronic bone infection


Inflammation, edema, circulatory problems
More common in children
Etiology:
Trauma

most commonly with bacterial invasion from

the skin
Infection may also spread from adjacent tissues or
blood supply

Osteomyelitis
Risk

factors:

Diabetes,

orthopedic hardware, splenectomy & SSA,


hemodialysis, IV drug users

S/S:

may be asymptomatic for years


Treatment:
Long-term

antibiotics, sometimes surgical debridement

Pagets Disease
Osteitis

Deformans
Chronic metabolic bone disease
High

rate of bone turnover (reabsorption & deposition)

Thicker

but softer bone is the result


Patients typically over 40 YOA
One or many bones
Usually

lower torse involve

Pagets Disease
Etiology:

Unknown
S/S: graduation onset of swelling & pain
Treatment:
PT,

pain management, surgery


Medications (biphosphonates or calcitonin)
Joint replacements

Fractures
Closed/simple
Open/compound
Greenstick
Displaced
Comminuted
Segmental
Spiral
Pathological

Types of fractures

Pathology Part 2

Complex

Incomplete

Comminuted

Greenstick

22

Simple (closed)

Compound (open)

Colles

Impacted

Fractures
Etiology:

trauma or disease
S/S: usually pain and swelling
Treatment:
Rest,

decreased use
Splint, sling, cast
Surgery (ORIF, etc)

Joint Diseases
Osteoarthritis
Rheumatoid

Arthritis
Gout (gouty arthritis)

Osteoarthritis
Most

common form of arthritis


Chronic inflammation causing degeneration and
new bone formation
Weight-bearing joints most common
Knees,

hips

Common
In

in older patients (over 55 YOA)

over 70 YOA, females more frequently affected

Osteoarthritis

Etiology:
Mechanical, chemical, genetic, autoimmune, metabolic
Aging seems to be important

S/S:
May be asymptomatic indefinitely
Pain, swelling, sometimes erythema, limitation of motion

Treatment:

Anti-inflammatories, PT, exercise, surgical

Rheumatoid Arthritis
Chronic,

systemic, polyarticular inflammatioy

disease
Destruction

(erosion) of bone & cartilage


Causes ankylosis (fibrous fusion of joints, immobile)
Exacerbations

and remissions unpredictable


Affects mostly females
Increasing

risk with advancing age

Rheumatoid Arthritis (RA)


Etiology:

autoimmune, genetics
S/S: symmetric pain, swelling of hands & fingers,
also other LE joints, systemic (fever, fatigue, wt.
Loss)
Dx testing: Rheumatoid factor blood test
Treatment:
Antiinflammatories,

drugs

PT, antimetabolites, antirheumatic

Gout
Gouty

arthritis
Chronic uric acid metabolism disorder
Uric

acid crystals deposited in joints


Tophi formation (urate compounds) around joints
Acute,

severe episodes of arthritis


Mostly male patients
Other associated problems:
Kidney

stones, renal failure, hyperuricemia

Gout
Etiology:
Metabolic,

renal, some genetics

S/S:
Severe

signs & symptoms of inflammation


Big toe is classical site
Treatment:
Pain

relief, antiinflammatories, colchicine, diet low in


purines, alopurinol

Muscles & Connective Tissue


Diseases
Sprains

& strains
Bursitis & tendonitis
Carpal Tunnel Syndrome
Myasthenia Gravis (MG)
Polymyositis
Systemic Lupus Erythematosus (SLE)
Duchennes Muscular Dystrophy

Sprains & Strains


Sprain
Ligamentous

tearing/stretching after a tortion injury

Strain
Tearing/stretching

Etiology:

of tendon or muscle

trauma or overuse
S/S: localized pain, swelling, limitation of motion
Treatment: supportive, pain relief

Bursitis & Tendonitis


Bursitis
Inflammation

of fluid-filled bursae near joints


Shoulder, hip, elbow, knee
Tendonitis
Inflammation

of tendon or tendon-muscle attachement


Shoulder, wrist, Achilles, hamstring
Etiology:

trauma, excessive use, other diseases


S/S: pain, swelling, LOM, fluid accumulation

Bursitis & Tendonitis


Treatment
Varies

with anatomic location & degree of disability


Anti-inflammatories & pain relievers, splinting,
exercise, orthotics, steroid injections, PT

Carpal Tunnel Syndrome


Compression

of median nerve within the carpal


tunnel of the wrist
Common syndrome with repetitive use work
Involves pain, sensory & motor symptoms
Etiology: edema within the carpal tunnel, causing
inflammation of the nerve & other structures there

Carpal Tunnel Syndrome


S/S:
Wrist

pain, burning or tingling paresthesias, numbness


Weakness of hand grasp
Tinels sign
Treatment:
Wrist

immobilization, anti-inflammatories
Rarely surgery

Myasthenia Gravis
Rare,

autoimmune disorder of the neuromuscular


junction
Antibodies against the acetylcholine receptors
(post-synaptic)
Chronic, progressive disease causing sporadic
weakness of the skeletal muscles
Most common in females, ages 20-40 YOA

Myasthenia Gravis (MG)


Reduced

muscle strength & longer recovery time


with repeated use
Symptoms

late in the day


Bulbar (eye & facial) muscles involved first
Facial expression, drooping lids, etc.
Thymomas
75%

in 15% MG patients

have some thymic abnormality (hyperplasia)

MG
Diagnostic

testing:

Tensilon

test (edrophonium challenge will increase


muscle strength)

Treatment:
Oral

anticholinergic meds (pyridostigmine,


neostigmine), immune suppressives, cholinesterase
inhibitors like edrophonium

Prognosis:

times

normal life expectancy in modern

Polymyositis
Chronic,

idiopathic inflammatory disease of


connective tissues and muscles
Exacerbations & remissions
May have skin involvement (dermatomyositis)
females more than males
Bimodal peak of onset: 5-15 YOA & 50-70YOA

Polymyositis

S/S: sudden or slow weakness of muscle group over


weeks to months
Often have trouble arising from sitting or raising arms above
head, also voice changes
Fever, fatigue, weight loss
Skin: lilac-colored rash of eyelids, nose and face

Dx via EMG & muscle biopsy


Treatment: immune suppressive

Systemic Lupus Erythematosus


Lupus

or SLE
Multisystem, autoimmune, inflammatory disease
due to antibodies against cell nuclei
Females outnumber male patients ( 9 to 1)
Genetics may also be involved
Arthralgias are first complaint in most patients

SLE
Organ

involvement:

Skin,

renal, CNS, GI, blood, musculoskeletal, CV,


pulmonary, vascular endothelium (Raynauds)

Four

criteria at any time:

Malar

rash or discoid rash, photosensitivity, arthritis,


renal disease, neuro, skin, hematologic, or immune
disorders, +ANA blood test

SLE
Treatment:
Anti-inflammatories,

pain relief, immune suppressives

Duchennes Muscular Dystrophy


Inherited,

x-linked, recessive disorder

Seen

only in males
Occasionally no family history
Rapidly
First

progressive wasting of skeletal muscles

in lower extremity & pelvis, then generalizes

Usually

appears by 6 YOA
Cause of death: respiratory insufficiency usually
by 25 YOA

Duchennes Muscular Dystrophy


At

first muscles appear larger

Due

Then

to fat and CT infiltration

atrophy (wasting, decrease in size)


Then scarring & contractures
Cardiomyopathy present in almost all cases

Neoplasms
Osteogenic

sarcoma
Chondrosarcoma
Malignant giant-cell tumor

Osteogenic Sarcoma
Most

common bone cancer


3rd most common cancer in adolescence
Slightly more males
Risk factors: radiation therapy, genetics
Treatment: surgical, but mets later in 80%
Most in long bones
Femur,

tibia, humerus (in that order)

Chondrosarcoma
2nd

most frequent primary bone cancer (25%)


Malignant tumor of cartilage
Mostly over 40 YOA (mostly geriatric)
Affects pelvis, femur, humerus, ribs

Giant Cell Tumor


Multinucleated

cells
5-10% of all giant cell tumors are malignant
Recurs locally about 50% of the time
Only 4-5% of all bone tumors
Mostly long bones
Mostly 20-40YOA
Relatively good Px after tumor excision