Clin Med: Musculoskelatal disorders

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  1. Osteogenesis imperfecta
    Congential hereditary disorders Problem in synthesis of Type 1 collagen Leads to defects in bone, ears, joints, teethSevere form --> May have fractures at birth Less severe --> fracture early in childhoodMy develop hearing loss --> fracture of middle ear
  2. Osteoporosis
    Decrease in bone mass Can't maintain sufficient mechanical supportMalnutritin (calcium) and endocrine disturbances (estrogen decline) may have an impact
  3. Osteomalasia/Rickets
    Vitamin D deficiencyInadequate mineralization of bone matrix Decrease in bone densityOsteomalasia- adult form; weight bearing bone deformitiesRickets- child form; "pigeon breast", lumbar lordosis, bowed legs
  4. Osteitis Fibrosa Cystica
    • Associated w/ advanced primary hyperparathyroidism
    • 1) early stage
    • 2) osteitis fibrosa
    • 3) osteitis fibrosa cystica
    • Lesion: osteoclastic resporption of bone w/ fibrous replacement
    • Formation of cysts
    • Mandible & maxilla initially affected
  5. Osteitis Deformans (Paget's disease)
    • Disordered bone remodeling --> mosaic pattern in bone
    • Mono or poly-ostotic
    • Unexplained pain & bone fractures & bone lysis
  6. Osteomyelitis
    • inflammation of bone from infection
    • Staphylococcus aureus
    • Suppurative inflammation, edema & bone necrosis
    • Either by: Hematogenous route: in children, bacteriemia in long bones
    • Direct bone penetration: wounds, fractures, surgery
  7. Assymetric cartilage growth
    • Part of epiphyseal plate grows faster than the other
    • Usually hereditary
    • Can also be due to trauma/forces near epiphyseal plate
  8. Scoliosis: List
    • lateral tilt of the spine from the T1 level
    • May result from herniated disk or painful spasm of muscles along spine
  9. Scoliosis: Gibbus
    • Angular deformity noted w/ a collapsed vertebra
    • Causes: metestatic malignancy of the spine, tuberculosis
  10. Scoliosis: Flattening of the lumbar curve
    Suggests: a herniated lumbar disk or ankylosing spondylitis
  11. Scoliosis: Kyphosis
    • may be 1st indication of osteoporosis in elderly
    • accompanied by pain in vertebral area & radiologic signs of osteoporosis
  12. Transverse Fracture
    Force perpendicular to long axis of the bone
  13. Compression fracture
    Force along the axis
  14. Spiral Fracture
    Torsional force
  15. 3 phases of fracture healing
    • Inflammatory: formation of granulation tissue; callus @ periphery of post-fracture; hemorrage clot
    • Reparative Phase: Pluripotent cells into fibroplasts & osteoblasts
    • Remodelling Phase: Reorganization & restoration; osteoblasts replaced w/ osteoclasts
  16. Osteoid osteoma
    • Type of Osteoblastic tumor
    • Benign
    • Painul
    • Occurs in diaphyses of long bones (femur, tibia)
    • Patients under 30
    • exacerbated by alcohol
  17. Osteosarcoma
    • Type of Osteblastic tumor
    • Most common primary bone tumor
    • Affects young ppl
    • Common sites: femur, tibia, humerus, 75% near the knee
    • Pain
    • Lung metastasis
  18. Enchondroma
    • Type of chondrogenic tumor
    • Benign
    • In small bones: hands & feet
    • In young adults
    • Pain, swelling, pathologic fractures
  19. Chondrosarcoma
    • Type of Chondogenic tumor
    • Malignant
    • Occurs ~ after age 35
    • Affects chondroblasts w/in the bone
    • Pelvic bones, ribs, vertebrae
    • Prognosis better than for osteosarcoma
  20. Giant cell tumor
    • Patients over 20 yr old
    • Ends of long bones
    • Pain in local joints
    • Locally agressive
    • Possibly malignant
    • Bone or cartilage formation
    • Multinucleated giant & fibroblast-like cells
  21. Ewing sarcoma
    • Rare
    • Extremely Malignant
    • Early metastasisPoor prognosis
    • Occurs in older children
  22. Pyogenic arthritis
    • Infective
    • Involves larger joints (hip, knee, ankle)
    • May become chronic & destructive if not treated
    • From a distant infection
    • In children: Hemophilus influenzae
    • In adults: streptococci, or staphilococci
  23. Osteoarthritis
    • Degeneration of articular cartilage
    • Most common joint diease
    • Associated with aging
    • May occur after trauma or infection of joint
    • Slowly progressive joint stiffness
    • Spur formation in distal interphalangeal joints
    • Nodular swelling
  24. Rheumatoid Arthritis
    • Idiopathic, possible autoimmune
    • Chronic & systemic
    • Symptoms: fatigue, low-grade fever, progrssively deforming
    • Affects multiple, bilateral, symmetric, small joints of feet and hands
    • Hands have claw-like appearance, also ulnar deviation
  25. Ankylosing Spondylitis
    • Spondyloarthropathy
    • Onset: in young men
    • Seronegativity for rheumatoid factor
    • Localized: Sacrum & vertebral column
    • Asymmetric joint involvement
    • Inflammation of pariarticular tendons
    • Carditis
    • Aortitis
  26. Gout Arthritis
    • Transient, recurrent attacks of acute arthritis
    • Monosodium urate crystals in synovial spaces, joint capsules, bursae, heart valves, kidney
    • Trophi- inflammatory foci
    • May develop due to elevated uric acid blood levels
  27. Duchenne's Muscular Dystrophy
    • X-linked recessive (males affected, females carriers)
    • Lack of dystropohin
    • Lack of sarcolemmal protein (strengthens muscle cells)
    • Progressive muscular weakness; apparent by age 3
    • Pts can't walk by age 10
    • Involved muscles APPEAR hypertrophied; from replacement by fibrofatty tissue --> pseudohypertrophy
    • Death by age 20
  28. Becker Muscular Dystrophy
    • X-linked recessive
    • Milder form of Duchenne's muscular dytrophy
    • Dystophin is mutated into less-effective form
    • Later onset
    • May not be noticed until after age 25
    • Most pts live normal life span
  29. Myotonic dystrophy
    • Autosomal Dominant
    • 2 forms:
    • a) extreme weakness from birth w/ death in neonatal period
    • b) adult form: muscular weakness, atrophy, myotonia (tonic spasm after stimulation), baldness, testicular atrophy, dementia
  30. Facio-scapulo-humeral dystrophy
    • Autosomal dominant
    • Not lethal
    • Varies
    • Usually appears during adolescence
    • Progressive weakness of face, shouldr & upper arms
  31. Limb girdle dystrophy
    • Autosomal recessive
    • Hips or shoulders involved
    • Weakness leads to progressive disability sometimes during adult life
  32. Mysthenia Gravis
    • Acquired autoimmune disease
    • Weakness & extreme muscular fatigue
    • Antibodies attack ACH receptor of postsynaptic membrane & neuromuscular junction
    • Receptors degraded
    • Common in females ~ age 20
    • Begins in eyes (ptosis, double vision)
  33. Rhabdomyolysis
    • Myoglobin leaks out of skelatal muscle
    • Acute or chronic
    • Sometimes after exercise (overdone)
    • Other causes: crush injury, electrical injury, heat stroke, seizure, virus
    • Myoglobin appears in urine
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Clin Med: Musculoskelatal disorders
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