Pathology 2 : Musculoskeletal System

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  1. Biomechanical dysfunction is triggered by a variety of mechanisms (3)
    Neuromuscular: the connection between the neruon & the muscle

    Myofascial: disorders at the interface between muscle and fascial layers

    Joint related: problems associated with the joint & its associated tissues
  2. Common manifestations of bone disease
    Bone pain: is often the only symptom of bone disease. Constant, worse @ night or when weight bearing

    Localized tenderness & swelling

  3. Achondroplasia
    • most common inherited form of dwarfism
    • a decrease in the proliferation of chondrocytes in the growth plate
  4. Asymmetric Cartilage Growth
    one sided of the epiphyseal growth plate grows faster than the other

    • Genu valgum (knock knees)
    • Genu varum (bowed legs)
  5. Genu valgrum (knock knees)
    cartilage thinner lateral
  6. Genu varum (bowed legs)
    cartilage thinner medial
  7. Club Foot (talipes equinovarus)
    • congenital
    • heel pointing downward
    • forefront turning inward
    • the Achilles tendon is tight drawing the heel up toward the leg
    • more common in boys
    • 1 in 1000 live births
    • massage can help a ton
  8. Flat foot (pes planus)
    • the hind foot is in valgus
    • the forefoot in inversion
  9. Bunions (hallux valgus)
    hallux valgus deformity of the great toe
  10. Osteopetrosis
    • abnormally dense bone
    • complications include no bone marrow & nerve entrapment (nerve pinch)
    • deficient osteoclastic activty
    • bones are brittle & break like chalk
    • with no bone marrow, there is a decrease in cell production
    • bones grows much thicker
  11. Paget's Disease of bone
    • thickening & disorganization of bone architecture
    • most common metabolic disease
    • "Matrix of Madness"
  12. Osteogenesis Imperfecta
    • inherited disorders of connective tissue that affect joints, ligaments, teeth, sclera and skin
    • a problem with the synthesis of collagen
    • aka "brittle bone disease"

    massage could be too much, energy work better
  13. Osteomalacia and Rickets
    • structural abnormality of bone caused by defective mineralization, you get too much collagen, not enough minerals
    • Vitamin D deficiency
    • reversible when vitamin D is replaced
    • Rickets is a vitamin D deficiency
    • soft bones
  14. Scurvy
    • Vitamin D defiency
    • loss of teeth
    • sunken eyes
  15. Osteoporosis
    a reduction in bone mass per unit volume while displaying a normal ratio of mineral to matrix
  16. Osteoporosis Epidemiology
    • frequency & distribution
    • 8x common in women
  17. Osteoporosis Risk Factors
    • Age-related changes: osteoblasts slow down while osteoclasts continue their normal activity
    • Physical activity: decreased physical activity leads to a decrease in bone mass
    • Genetic Factors: the type of vitamin D, receptor the individual has inherited accounts for 75% of maximal peak bone mass achieved
    • Nutritional state: reduced calcium intake during adolescence increases the risk of osteoporosis in females
    • Hormonal influences: in the decade following menopause there is a loss of up to 2% of compact bone & 79% of spongy bone per year
    • Environmental factors: cigarettes
  18. Osteoporosis Pathology
    Loss of spongy bone and a thin covering of compact bone lead to collapse/fracture
  19. Osteoporosis Functional Significance
    pathologic bone fractures
  20. Osteomyelitis
    • inflammation of the bone
    • pus forms under pressure in the bone and there is a loss of the bone's vascular supply
  21. Transverse Fracture
    a powerful direct or angular force
  22. Comminuted Fracture
    A powerful direct impact can shatter a bone into several fragments
  23. Spiral Fracture
    A sharp sudden twist may break a bone diagonally across the shaft
  24. Greenstick Fracture
    Strong force may cause long bones to bend and crack obliquely on only one side
  25. Fractures : Collateral Damage
    • Extensive muscle necrosis (muscle death)
    • Hemorrhage
    • Tearing of tendinous insertions and ligaments
    • Nerve damange
  26. Classification of Fractures
    • Open: the fracture site communicates with the integument
    • Closed: overlying tissue intact
    • Displacement: fracture in which bone is displaced greater than the thickness of the bone
    • Pathologic: result of the disease process that weakens the bone to the point of fracture
  27. Factors that Delay Healing (fractures)
    • repeating injuries
    • movement
    • age
    • nutrition
  28. Stress Fractures
    Accumulation of stress induced micro-fratures which eventually result in a true fracture through the cortex
  29. Stress Fractures Pathogenesis
    Occurs in bones in which the cortex has few osteons and forms only when stress is applied
  30. Stress Fractures Clinical manifestations
    • pain and swelling over affected bone
    • a callus forms at the site of the stress fracture before the fracture occurs
  31. Myositis Ossificans
    • Inflamed muscle torn to bone
    • usually develops in athletic adolescents and young adults following a traumatic injury
    • painful
    • do not massage - will do more damage
  32. Arthrology
    Common Manifestations of Joint Disease
    • Pain: joint pain without inflammation
    • Swelling: joint swelling is the result of an increase in synovial fluid volume
    • Joint mass lesions: a joint may increase in size due to a lesion that feels boggy
    • Crepitus: is an abnormal sound and/or sensation of grafting that accompanies joint movement
    • Abnormal joint mobility: most joint diseases result in restricted range of motion
  33. Strains
    effect muscle or tendon
  34. First degree strain (mild)
    • inflammation
    • localized pain
    • worse with movement
    • moderate spasm
    • swelling
    • ecchymosis
  35. Second degree strain (moderate)
    • hemmorrhage
    • tearing
    • localized pain aggravated by movement, moderate spasms, ecchymosis, redness, swelling and impaired muscle function
  36. Third degree strain (severe)
    • ruptured muscle or tendon with separation of muscle from muscle or tendon, or tendon from bone
    • sever pain
    • disability
    • spasm
    • swelling
    • ecchymosis
  37. What you can do for strains as a massage therapist
    • Ice 1st 24-48 hrs
    • massage distal to injury, unaffected areas
    • use cross-fiber friction for healing
  38. Sprains
    ligament injury
  39. First degree sprain
    • minor tearing
    • little or no swelling
    • hemorrhaging
    • loss of function
  40. Second degree sprain
    • partial tearing
    • moderate tenderness
    • swelling with abnormal motion
    • local hemorrhaging
    • recurrence, persistent instability and traumatic arthritis are common outcomes
  41. Third degree sprain
    • complete tear
    • loss of function
    • abnormal motion
    • tenderness
    • swelling
    • hemorrhaging
    • possibility of deformity
  42. Dislocations or Luxation
    A dislocation or displacement of bone (FULL)
  43. Subluxation
    an incomplete or partial dislocation
  44. Osteoarthritis aka osteoarthrosis
    • most common cause of joint disability
    • NON-INFLAMMATORY degeneration of articular cartilage
  45. Chondromalacia
    subcategory (of Osteoarthritis/osteoarthrosis) that affects the patellar cartiliage in young people causing pain & stiffness
  46. Osteoarthritis/osteoarthrosis Clinical Manifestations
    • Affects the PIP and DIP joints of the upper lime, the hip, cervical and lumbar vertebrae
    • pain stiffness and swelling of affected joints with no evidence of inflammation
    • Creptius is a characteristic feature
    • deep aching joint pain after activity that is relieved by rest is the hallmark of osteoarthritis/osteoarthrosis
  47. Massage for Osteoarthritis/Osteoarthrosis
    • moist heat
    • passive ROM
    • friction around joints - when pain is minimal or after rest
  48. Rheumatoid Arthritis
    slow, chronic, and progressive inflammatory disease
  49. Rhematoid Arthritis Etiology (cause)
    • unknown
    • although genetic predisposition is suggested
    • considered an autoimmune disease
  50. Rhematoid Arthritis Clinical Manifestations
    • Symmetric polyarticular arthritis usually affecting the small joints of the hands and feet (PIP).
    • The affected joins are swollen, painful, and stiff.
    • Stiffness is worst in the morning after the joints have been inactive during the night.
    • Severe flexion and extension deformities often result
  51. Massage for Rhematoid Arthritis
    • Stress Reduction helpful
    • heat decrease pain (no heat in acute stage)
    • no aggressive massage
    • passive ROM
    • cross-fiber friction
  52. Gout
    • increased serum uric acid level leading to deposition of urate crystals in joints and kidneys
    • 10:1 ratio men to women
  53. Tendinitis
    • Inflammation of the tendon
    • hurts during active vs. passive
    • massage muscle
  54. Tenosynovitis
    Inflammation of the tendon sheath
  55. Bursitis
    • Inflammation of the bursa
    • usually from trauma
  56. Osgood Schlatter Disease
    • Typically seen in rapidly growing athletic adolescents
    • The tibial tuberosity becomes tender and swollen
    • bones growing faster than muscle
    • massage: work quads & all muscle of thigh
  57. Plantar fasciitis
    • micro tears in the plantar fascia
    • areas of the medial calcaneous or mid foot
    • (plantar fascia is the thick band of tissue that covers the bones on the bottom of the foot)
    • massage great! Stripping strokes, cross-fiber, ice: acute, heat: chronic, self-massage before getting out of bed
  58. Baker's Cyst
    synovial cyst associated with fluid escaping posterior to the knee
  59. Ganglion Cysts
    Subchondral cyst within the fused epiphysis
  60. Common manifestations of muscle disease
    • Myalgia: muscle pain
    • Inflammation: extra blood
    • Atrophy: decreases
    • Hypertrophy: enlarges
    • Spasm: contracting - involuntary
    • Weakness
  61. Muscular dystrophy
    • muscle being destroyed
    • a chronic, active, non-inflammatory myopathic process leading to spontaneous, progressive degeneration of skeletal muscle fibers
    • sensation there
    • muscle protein missing
    • a lot of weakness
  62. Duchenne Muscular Dystrophy
    severe progressive, X-linked, inherited condition affecting 1 out of 3500 males
  63. Duchenne Muscular Dystrophy Pathology
    relentless degeneration of muscle
  64. Myotonic dystrophy
    common form of adult muscular dystrophy
  65. Myasthenia Gravis
    • an aquired autoimmune disease characterized by abnormal fatigability
    • more common in women typically beginning in young adults
    • muscle fatigues easily
  66. Manifestations of Back Disease
    • Pain
    • Spinal deformity
  67. Scoliosis
    A lateral curvature of the spine
  68. Kyphosis
    Excessive posterior curve of the thoracic spine
  69. Lordosis
    An exaggerated cervical or lumbar curve
  70. Gibbous
    • A humpback
    • Collection of tissue @ C7 - extra stress in body (head forward causes collection of tissue)
  71. Vascular Back Pain
    (1 of 5 possible list & discuss essay questions for quiz & final *just need 4 of 5)
    Aneurysms or peripheral vascular disease may give rise to symptoms similar to sciatica
  72. Neurogenic Back Pain
    (2 of 5 possible list & discuss essay questions for quiz & final *just need 4 of 5)
    Tension, irritation, and/or compression of lumbar nerves may cause pain radiating down both legs
  73. Viscerogenic Back Pain
    (3 of 5 possible list & discuss essay questions for quiz & final - *just need 4 of 5)
    Disorders of the retroperitoneal organs may affect the spine
  74. Psychogenic Back Pain
    (4 of 5 possible list & discuss essay questions for quiz & final *just need 4 of 5)
    • Emotional overtones may cloud the clinical picture
    • Stress / emotional issues
  75. Spondylogenic Back Pain (5 of 5 possible list & discuss essay questions for quiz & final *just need 4 of 5)
    • Disc degeneration may occur anywhere along the spine producing pain.
    • Disc degeneration may lead to nerve root irritation or compression.
    • 90% of back pain
  76. Spondylolisthesis
    The forward displacement of one vertebra over another, usually L5 over S1
  77. Anklylosing spondylitis
    • degenerative joint disease
    • predominantly affects young men (3:1) with the peak incidence between 15 and 30 years
    • the sacrioiliac joint is the most commonly affected joint
    • low back pain and stiffness are often the presenting symtoms
    • massage can be beneficial @ relieving px
Card Set:
Pathology 2 : Musculoskeletal System
2013-07-11 15:32:56
musculoskeletal system massage therapy

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