Musculoskeletal Diseases and DisordersMusculoskeletal SystemBonesLong, short, flat, irregularCompact, spongyJointsBursaeMusclesTendonsLigamentsMusculoskeletal SystemTwo divisions:Axial skeletonAppendicular skeleton (inc. pelvic girdle)Muscle types:Skeletal muscle (voluntary, striated)Smooth muscle (involuntary, non-striated)Cardiac muscle (involuntary, striated)Disorders of BoneSpinal deformitiesHerniated intervertebral discsOsteoporosisOsteomyelitisPagets Disease (osteitis deformans)FracturesSpinal DeformitiesLordosisAbnormal inward or anterior curvatureAccentuation of normal curve of lumbar spineFrequently gradual onsetAffects lumbar spineAlso called swaybackSpinal DeformitiesKyphosisAbnormal outward curvature of the spineAccentuation of normal thoracic spine curvatureAlso called humpback or roundbackCommonly due to pathological fractures of spine in osteoporosisSpinal DeformitiesScoliosisLateral (sideways) curvature of the spineMay go to left or rightMay involve some rotation of spinal columnMay be caused by discrepancy in leg lengthsSurgery possible if interferes with breathing or mobilitySpinal DeformitiesEtiologiesPosture, leg length differences, congenital, epiphyseal growth disturbance, trauma, tumors, infection, arthritis, TB, endocrine abn, agingS/S: usually backache, fatigue, abnormal appearance or fitting of clothesTreatment: PT, exercise, braces, surgery, pain reliefHerniated Intervertebral DiscsDisc AnatomyAnnulus fibrosisNucleus pulposisHerniationNucleus pulposis pushes through annulus into spinal canalRupturePieces of the disc are free in the spinal canalHerniated DiscS/S: Back painParesthesiasSciatica: inflammation of sciatic nerve, leg pain Treatment:PT, exercise, pain relief meds, surgery (rarely), life correctlyOsteoporosisMetabolic disorder of bonesLess bone mineral (calcium) than normalOver 10 million in US affectedPost-menopausal females most commonlyBones are brittle, porous, easily brokenMore prone to pathological fractureOsteoporosisEtiology:Genetics, calcium intake & dietary, sedentary lifestyle, estrogen, vit D, or adrenal deficiency, steroid use, alcoholism, etcS/S: often asymptomatic until pathological fx.Treatment: calcium supplements, meds (antiresorptive, restorative of lost bone, etc)OsteomyelitisAcute or chronic bone infectionInflammation, edema, circulatory problemsMore common in childrenEtiology:Trauma most commonly with bacterial invasion from the skinInfection may also spread from adjacent tissues or blood supplyOsteomyelitisRisk factors:Diabetes, orthopedic hardware, splenectomy & SSA, hemodialysis, IV drug usersS/S: may be asymptomatic for yearsTreatment:Long-term antibiotics, sometimes surgical debridementPagets DiseaseOsteitis DeformansChronic metabolic bone diseaseHigh rate of bone turnover (reabsorption & deposition)Thicker but softer bone is the resultPatients typically over 40 YOAOne or many bonesUsually lower torse involvePagets DiseaseEtiology: UnknownS/S: graduation onset of swelling & painTreatment:PT, pain management, surgeryMedications (biphosphonates or calcitonin)Joint replacementsFracturesClosed/simpleOpen/compoundGreenstickDisplacedComminutedSegmentalSpiralPathologicalFracturesEtiology: trauma or diseaseS/S: usually pain and swellingTreatment: Rest, decreased useSplint, sling, castSurgery (ORIF, etc)Joint DiseasesOsteoarthritisRheumatoid ArthritisGout (gouty arthritis)OsteoarthritisMost common form of arthritisChronic inflammation causing degeneration and new bone formationWeight-bearing joints most commonKnees, hipsCommon in older patients (over 55 YOA)In over 70 YOA, females more frequently affectedOsteoarthritisEtiology:Mechanical, chemical, genetic, autoimmune, metabolicAging seems to be importantS/S:May be asymptomatic indefinitelyPain, swelling, sometimes erythema, limitation of motionTreatment:Anti-inflammatories, PT, exercise, surgicalRheumatoid ArthritisChronic, systemic, polyarticular inflammatioy diseaseDestruction (erosion) of bone & cartilageCauses ankylosis (fibrous fusion of joints, immobile)Exacerbations and remissions unpredictableAffects mostly femalesIncreasing risk with advancing ageRheumatoid Arthritis (RA)Etiology: autoimmune, geneticsS/S: symmetric pain, swelling of hands & fingers, also other LE joints, systemic (fever, fatigue, wt. Loss)Dx testing: Rheumatoid factor blood testTreatment:Antiinflammatories, PT, antimetabolites, antirheumatic drugsGoutGouty arthritisChronic uric acid metabolism disorder Uric acid crystals deposited in joints Tophi formation (urate compounds) around jointsAcute, severe episodes of arthritisMostly male patientsOther associated problems: Kidney stones, renal failure, hyperuricemiaGoutEtiology: Metabolic, renal, some geneticsS/S:Severe signs & symptoms of inflammationBig toe is classical siteTreatment:Pain relief, antiinflammatories, colchicine, diet low in purines, alopurinolMuscles & Connective Tissue DiseasesSprains & strainsBursitis & tendonitisCarpal Tunnel SyndromeMyasthenia Gravis (MG)PolymyositisSystemic Lupus Erythematosus (SLE)Duchennes Muscular DystrophySprains & StrainsSprainLigamentous tearing/stretching after a tortion injuryStrainTearing/stretching of tendon or muscleEtiology: trauma or overuseS/S: localized pain, swelling, limitation of motionTreatment: supportive, pain reliefBursitis & TendonitisBursitisInflammation of fluid-filled bursae near joints Shoulder, hip, elbow, kneeTendonitisInflammation of tendon or tendon-muscle attachementShoulder, wrist, Achilles, hamstringEtiology: trauma, excessive use, other diseasesS/S: pain, swelling, LOM, fluid accumulationBursitis & TendonitisTreatmentVaries with anatomic location & degree of disabilityAnti-inflammatories & pain relievers, splinting, exercise, orthotics, steroid injections, PTCarpal Tunnel SyndromeCompression of median nerve within the carpal tunnel of the wristCommon syndrome with repetitive use workInvolves pain, sensory & motor symptomsEtiology: edema within the carpal tunnel, causing inflammation of the nerve & other structures thereCompression of median nerve within the carpal tunnel of the wristCommon syndrome with repetitive use workInvolves pain, sensory & motor symptomsEtiology: edema within the carpal tunnel, causing inflammation of the nerve & other structures thereCompression of median nerve within the carpal tunnel of the wristCommon syndrome with repetitive use workInvolves pain, sensory & motor symptomsEtiology: edema within the carpal tunnel, causing inflammation of the nerve & other structures thereCompression of median nerve within the carpal tunnel of the wristCommon syndrome with repetitive use workInvolves pain, sensory & motor symptomsEtiology: edema within the carpal tunnel, causing inflammation of the nerve & other structures thereCarpal Tunnel SyndromeS/S:Wrist pain, burning or tingling paresthesias, numbnessWeakness of hand graspTinels signTreatment:Wrist immobilization, anti-inflammatoriesRarely surgeryMyasthenia GravisRare, autoimmune disorder of the neuromuscular junctionAntibodies against the acetylcholine receptors (post-synaptic)Chronic, progressive disease causing sporadic weakness of the skeletal musclesMost common in females, ages 20-40 YOAMyasthenia Gravis (MG)Reduced muscle strength & longer recovery time with repeated useSymptoms late in the dayBulbar (eye & facial) muscles involved firstFacial expression, drooping lids, etc.Thymomas in 15% MG patients75% have some thymic abnormality (hyperplasia)MGDiagnostic testing:Tensilon test (edrophonium challenge will increase muscle strength)Treatment: Oral anticholinergic meds (pyridostigmine, neostigmine), immune suppressives, cholinesterase inhibitors like edrophoniumPrognosis: normal life expectancy in modern timesPolymyositisChronic, idiopathic inflammatory disease of connective tissues and musclesExacerbations & remissionsMay have skin involvement (dermatomyositis)females more than malesBimodal peak of onset: 5-15 YOA & 50-70YOAPolymyositisS/S: sudden or slow weakness of muscle group over weeks to monthsOften have trouble arising from sitting or raising arms above head, also voice changesFever, fatigue, weight lossSkin: lilac-colored rash of eyelids, nose and face

Dx via EMG & muscle biopsyTreatment: immune suppressiveSystemic Lupus ErythematosusLupus or SLEMultisystem, autoimmune, inflammatory disease due to antibodies against cell nucleiFemales outnumber male patients ( 9 to 1)Genetics may also be involvedArthralgias are first complaint in most patientsSLEOrgan 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 testSLETreatment:Anti-inflammatories, pain relief, immune suppressivesDuchennes Muscular DystrophyInherited, x-linked, recessive disorderSeen only in malesOccasionally no family historyRapidly progressive wasting of skeletal musclesFirst in lower extremity & pelvis, then generalizesUsually appears by 6 YOACause of death: respiratory insufficiency usually by 25 YOADuchennes Muscular DystrophyAt first muscles appear largerDue to fat and CT infiltrationThen atrophy (wasting, decrease in size)Then scarring & contracturesCardiomyopathy present in almost all casesNeoplasmsOsteogenic sarcomaChondrosarcomaMalignant giant-cell tumorOsteogenic SarcomaMost common bone cancer3rd most common cancer in adolescenceSlightly more malesRisk factors: radiation therapy, geneticsTreatment: surgical, but mets later in 80%Most in long bonesFemur, tibia, humerus (in that order)Chondrosarcoma2nd most frequent primary bone cancer (25%)Malignant tumor of cartilageMostly over 40 YOA (mostly geriatric)Affects pelvis, femur, humerus, ribsGiant Cell TumorMultinucleated cells5-10% of all giant cell tumors are malignantRecurs locally about 50% of the timeOnly 4-5% of all bone tumorsMostly long bonesMostly 20-40YOARelatively good Px after tumor excision