Skeletal Skeletal System System

Diseases & Diseases & DisordersDisorders

OsteoporosiOsteoporosiss

OsteoporosiOsteoporosiss

bone mass reduced; hormone-related; need calcium and Vitamin D when young; leads to spontaneous fractures; curvature of spine

OsteomalacOsteomalaciaia“soft bones”; bones are

inadequately mineralized; bone pain; aka Rickets in children; need for sunlight - Vit. D; calcium needs to be absorbed

Paget’s Paget’s DiseaseDisease

Paget’s Paget’s DiseaseDiseaseage >40

excessive bone formation and breakdownusually spine, pelvis, femur, skull virus?

OsteomyelitisOsteomyelitis

-bacterial infection-area is tender and swells-need for antibiotics

ScoliosisScoliosis“twisted disease”; abnormal lateral curvature in thoracic vertebrae; treat with surgery or body braces

ScoliosisScoliosis

KyphosisKyphosis“hunchback”; exaggerated curvature of thoracic vertebrae; common in osteoporosis, rickets, osteomalacia

LordosiLordosiss•“swayback”; accentuated curvature of lumbar vertebrae• common in spinal tuberculosis, osteomalacia, men with potbellies or pregnant women

Cleft PalateCleft Palate•congenital •right and left halves of palate fail to fuse•interferes with sucking & inhalation•surgery at 6 months & speech therapy

BursitisBursitis

BursitisBursitis•inflammation of a bursa•from blow or friction• “student’s elbow”•anti-inflammatory drugs or removal of fluid

OsteoarthritisOsteoarthritis•AKA degenerative joint disease (DJD)•MOST COMMON CHRONIC ARTHRITIS•articular cartilage deteriorates• leads to stiffness•no known cause•more common in women•joint replacement

OsteoarthritisOsteoarthritis

Rheumatoid Rheumatoid AthritisAthritis

Rheumatoid Rheumatoid AthritisAthritis

•chronic autoimmune disease•ages 40-50 onset•Effects joints of fingers, wrists, ankles, and feet•cartilage is eroded•Antibiotics, anti-inflammatory drugs, & immunosuppressants to treat it

DislocationDislocation

DislocationDislocation

•AKA subluxation•treatment is re-alignment or surgery•common for athletes

SprainSprain•damage to ligaments•synovial membrane•twisting of joint•treatment is to limit joint motion

SprainSprain

OsteosarcomaOsteosarcoma•bone cancer•10-25 years old•painfully erodes bone•spread to lungs

Time to see what you Time to see what you are made ofare made of

Case 1Case 1 PATIENT HISTORY:PATIENT HISTORY: This 19 This 19

year old man complained of year old man complained of unremitting, progressive low unremitting, progressive low back pain for several months. back pain for several months. Otherwise, he was in good Otherwise, he was in good general health without other general health without other medical problems. Physical medical problems. Physical examination revealed no examination revealed no sensory or motor deficits. sensory or motor deficits.

Radiology images including Radiology images including plain radiographs, computer plain radiographs, computer assisted tomography (CT) and assisted tomography (CT) and magnetic resonance imaging magnetic resonance imaging (MRI) were obtained. These (MRI) were obtained. These images demonstrated a large, images demonstrated a large, destructive mass involving destructive mass involving lumbar vertebra 3 with lumbar vertebra 3 with extension into the paraspinal extension into the paraspinal soft tissues. soft tissues.

FINAL DIAGNOSIS:FINAL DIAGNOSIS: EWING'S SARCOMA/PNET EWING'S SARCOMA/PNET Contributor's Note:Contributor's Note: Ewing's sarcoma (ES) is a Ewing's sarcoma (ES) is a

malignant neoplasm of bone and soft tissues with malignant neoplasm of bone and soft tissues with characteristic radiographic, morphologic, characteristic radiographic, morphologic, immunohistochemical and cytogenetic features. immunohistochemical and cytogenetic features. ES represents perhaps a more primitive, less ES represents perhaps a more primitive, less differentiated neoplasm in the spectrum of differentiated neoplasm in the spectrum of peripheral primitive neuroectodermal tumors. peripheral primitive neuroectodermal tumors. Primitive neuroectodermal tumor (PNET), Primitive neuroectodermal tumor (PNET), characterized by neuroectodermal differentiation characterized by neuroectodermal differentiation (rosette formation, presence of neuropil), may be (rosette formation, presence of neuropil), may be considered a more differentiated neoplasm in the considered a more differentiated neoplasm in the same family. Both share the same cytogenetic same family. Both share the same cytogenetic abnormality (11;22)(q24q12) or (21;22)(q22;q12) abnormality (11;22)(q24q12) or (21;22)(q22;q12) in about 90% of cases.in about 90% of cases.

Patient Patient HistoryHistory

female with left nipple discharge female with left nipple discharge and an inverted nipple. The and an inverted nipple. The patient stated that left nipple patient stated that left nipple retraction was chronic for many retraction was chronic for many years, and described crusting of years, and described crusting of the left nipple. the left nipple.

Digital diagnostic mammogram Digital diagnostic mammogram showed calcifications in the showed calcifications in the anterior left breast, some anterior left breast, some vascular, some coarse benign-vascular, some coarse benign-appearing and others punctate appearing and others punctate benign-appearing.benign-appearing.

There were also benign-There were also benign-appearing calcifications in the appearing calcifications in the anterior right breast. Ultrasound anterior right breast. Ultrasound of the left retroareolar area of the left retroareolar area revealed a focally dilated duct at revealed a focally dilated duct at 5 o'clock with abrupt termination 5 o'clock with abrupt termination of dilation approximately 2 cm of dilation approximately 2 cm from the nipple. No intraductal from the nipple. No intraductal mass was identified. mass was identified.

Paget’s DiseasePaget’s Disease Paget's disease (PD) of the Paget's disease (PD) of the

breast is rare, with a breast is rare, with a reported incidence of 0.5-reported incidence of 0.5-2% of all patients with 2% of all patients with breast cancer. However, breast cancer. However, this disorder should be this disorder should be considered in the considered in the differential diagnosis of all differential diagnosis of all the patients presenting with the patients presenting with lesions of the nipple. lesions of the nipple.

The characteristic erythema and The characteristic erythema and eczematous changes of the nipple eczematous changes of the nipple with this disease were first described with this disease were first described by Velpeau in 1856, but the by Velpeau in 1856, but the association of nipple-areolar changes association of nipple-areolar changes with underlying carcinoma of the with underlying carcinoma of the breast was not reported until 1874 by breast was not reported until 1874 by Paget (1). Ulceration, crusting and Paget (1). Ulceration, crusting and serous or bloody discharge serous or bloody discharge characterize more advanced cases.characterize more advanced cases.

Surgical biopsy is the Surgical biopsy is the diagnostic standard. diagnostic standard.

Case Study 3Case Study 3 A 66 year old woman with a 20 year history of A 66 year old woman with a 20 year history of

rheumatoid arthritis comes to your office for a new rheumatoid arthritis comes to your office for a new patient consultation complaining of swelling and pain in patient consultation complaining of swelling and pain in her left knee. her left knee.

She was diagnosed with rheumatoid arthritis when she She was diagnosed with rheumatoid arthritis when she was 45 years old, when she presented with swelling was 45 years old, when she presented with swelling and pain in multiple joints including her elbows, wrists, and pain in multiple joints including her elbows, wrists, hands, knees, ankles and feet. hands, knees, ankles and feet.

She recalls being treated with a variety of non-steroidal She recalls being treated with a variety of non-steroidal medications (NSAIDs) and low dose prednisone. She medications (NSAIDs) and low dose prednisone. She initially was started on hydroxychloroquine and then initially was started on hydroxychloroquine and then intramuscular gold therapy. She did well on gold, intramuscular gold therapy. She did well on gold, eventually stopping therapy after 8 years. eventually stopping therapy after 8 years.

Her rheumatologist told her she was "in remission" and Her rheumatologist told her she was "in remission" and stopped seeing her. She has been treated with NSAIDs stopped seeing her. She has been treated with NSAIDs alone for the past 7 years. alone for the past 7 years.

Her current knee problems began about 8 months Her current knee problems began about 8 months ago. Over the past several months she has had 4 to ago. Over the past several months she has had 4 to 5 episodes of severe swelling and pain in her left 5 episodes of severe swelling and pain in her left knee. She has morning stiffness lasting 15 minutes knee. She has morning stiffness lasting 15 minutes daily, mainly in her hands. She is currently only daily, mainly in her hands. She is currently only taking Ibuprofen 800 mg 4 times daily. On exam she taking Ibuprofen 800 mg 4 times daily. On exam she has chronic deformities at the wrists, MCP and PIP has chronic deformities at the wrists, MCP and PIP joints, with chronic synovial thickening. Her left knee joints, with chronic synovial thickening. Her left knee has good range of motion with crepitus but no has good range of motion with crepitus but no demonstrable swelling, warmth or tenderness. Her demonstrable swelling, warmth or tenderness. Her right knee exam is similar to her left. Her shoulders right knee exam is similar to her left. Her shoulders have good active range of motion. Her feet show have good active range of motion. Her feet show cock-up deformities at the MTP joints. cock-up deformities at the MTP joints.

She has x-rays of her hands, which show deformities She has x-rays of her hands, which show deformities of rheumatoid arthritis.of rheumatoid arthritis.

What to do next?

Your diagnostic impression is:a. gout b. osteoarthritis c. rheumatoid arthritis d. pseudogout