Musculoskeletal Diseases and Disorders

8/10/2019 Musculoskeletal Diseases and Disorders

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Musculoskeletal Diseases and

Disorders

Arif Pandega,MD


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Musculoskeletal System Bones

Long, short, flat, irregular

Compact, spongy

Joints

Bursae

Muscles Tendons

Ligaments


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Disorders of Bone Spinal deformities

Herniated intervertebral discsOsteoporosis

Osteomyelitis

Pagets Disease (osteitis deformans) Fractures


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Spinal DeformitiesLordosis

Abnormal inward or anterior curvature

Accentuation of normal curve of lumbar spine

Frequently gradual onset

Affects lumbar spine

Also called swayback


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Spinal DeformitiesEtiologies

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


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Herniated Intervertebral DiscsDisc Anatomy

Annulus fibrosis

Nucleus pulposis

Herniation

Nucleus pulposis pushes through annulus into spinal

canalRupture

Pieces of the disc are free in the spinal canal


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OsteoporosisMetabolic disorder of bones

Less bone mineral (calcium) than normal

Over 10 million in US affected

Post-menopausal females most commonly

Bones are brittle, porous, easily brokenMore prone to pathological fracture


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OsteoporosisEtiology:

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)


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OsteomyelitisAcute 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


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OsteomyelitisRisk factors:

Diabetes, orthopedic hardware, splenectomy & SSA,

hemodialysis, IV drug users

S/S: may be asymptomatic for years

Treatment:

Long-term antibiotics, sometimes surgical debridement


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Pagets DiseaseOsteitis Deformans

Chronic metabolic bone disease

High rate of bone turnover (reabsorption & deposition)

Thicker but softer bone is the result

Patients typically over 40 YOAOne or many bones

Usually lower torse involve


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Pagets DiseaseEtiology: Unknown

S/S: graduation onset of swelling & pain

Treatment:

PT, pain management, surgery

Medications (biphosphonates or calcitonin)

Joint replacements


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Fractures Closed/simple

Open/compound

Greenstick

Displaced

Comminuted

Segmental

Spiral

Pathological


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Pathology Part 2

Types of fractures

Complex Incomplete Comminuted Greenstick

Simple (closed) Compound (open) Colles Impacted


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OsteoarthritisMost common form of arthritis

Chronic inflammation causing degeneration and

new bone formation

Weight-bearing joints most common

Knees, hips

Common in older patients (over 55 YOA)

In over 70 YOA, females more frequently affected


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Rheumatoid ArthritisChronic, 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


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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, PT, antimetabolites, antirheumatic

drugs


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GoutGouty 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 patientsOther associated problems:

Kidney stones, renal failure, hyperuricemia


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GoutEtiology:

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


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Muscles & Connective Tissue

Diseases Sprains & strains

Bursitis & tendonitis

Carpal Tunnel Syndrome

Myasthenia Gravis (MG)

Polymyositis Systemic Lupus Erythematosus (SLE)

Duchennes Muscular Dystrophy


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Sprains & Strains Sprain

Ligamentous tearing/stretching after a tortion injury

Strain

Tearing/stretching of tendon or muscle

Etiology: trauma or overuse

S/S: localized pain, swelling, limitation of motion

Treatment: supportive, pain relief


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Bursitis & TendonitisBursitis

Inflammation of fluid-filled bursae near joints

Shoulder, hip, elbow, knee

Tendonitis

Inflammation of tendon or tendon-muscle attachement

Shoulder, wrist, Achilles, hamstringEtiology: trauma, excessive use, other diseases

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


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Bursitis & TendonitisTreatment

Varies with anatomic location & degree of disability

Anti-inflammatories & pain relievers, splinting,

exercise, orthotics, steroid injections, PT


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Carpal Tunnel SyndromeCompression 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


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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


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Myasthenia GravisRare, 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


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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 in 15% MG patients

75% have some thymic abnormality (hyperplasia)


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MGDiagnostic testing:

Tensilon test (edrophonium challenge will increase

muscle strength)Treatment:

Oral anticholinergic meds (pyridostigmine,neostigmine), immune suppressives, cholinesteraseinhibitors like edrophonium

Prognosis: normal life expectancy in moderntimes


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PolymyositisChronic, 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


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

weeks to months

Often have trouble arising from sitting or raising arms abovehead, also voice changes

Fever, fatigue, weight loss

Skin: lilac-colored rash of eyelids, nose and face

Dx via EMG & muscle biopsy

Treatment: immune suppressive


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Systemic Lupus ErythematosusLupus 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


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SLEOrgan 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 immunedisorders, +ANA blood test


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SLETreatment:

Anti-inflammatories, pain relief, immune suppressives


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Duchennes Muscular Dystrophy Inherited, x-linked, recessive disorder

Seen only in males

Occasionally no family history

Rapidly progressive wasting of skeletal muscles

First in lower extremity & pelvis, then generalizes

Usually appears by 6 YOACause of death: respiratory insufficiency usually

by 25 YOA


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Duchennes Muscular DystrophyAt first muscles appear larger

Due to fat and CT infiltration

Then atrophy (wasting, decrease in size)

Then scarring & contractures

Cardiomyopathy present in almost all cases


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NeoplasmsOsteogenic sarcoma

Chondrosarcoma

Malignant giant-cell tumor


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Osteogenic SarcomaMost common bone cancer

3rdmost 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)


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Chondrosarcoma 2ndmost frequent primary bone cancer (25%)

Malignant tumor of cartilage

Mostly over 40 YOA (mostly geriatric)

Affects pelvis, femur, humerus, ribs


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Musculoskeletal Diseases and Disorders

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