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2010-11-22 20:04:28

Muskuloskeletal disorders
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  1. muscular dystrophy
    • disease of the muscle, genetically determined
    • progressive degeneration of skeletal muscles
    • Duchenne Muscular Dystrophy: most common, x linked recessive, rarely live past young adulthood, absence of a cytoskeletal muscle protein called dystrophin
  2. Myasthenia Gravis
    • Auto-immune disease: peripheral nervous system disorder
    • Defect in nerve impulse signaling: post synaptic acetylcholine receptors are no longer recognized as self, antibodies are produced to the receptor and bind to it, they block the ability of acetylcholine to bind at the sit and therefore it does not activate muscle receptor
    • symptoms: muscle weakness fatigue
    • Treatment: Thymectomy:take out thymus gland to stop tcell production (helps in 40%)
    • Medication: neostigmine (ans agent): prolongs action of acetylcholine, has direct stimulant action on voluntary muscle fibers
  3. muscle and tendon strain evaluation
    • strong and pain free on motion= not injured
    • strong but painful= injured but partially intact
    • weak and painful=severe injury around joint
    • weak and pain free= rupture of muscle or nerve
  4. Osteoarthritis
    • non inflammatory arthritis: a degenerative joint disease, erosion of articular cartilage, hardening and thickening of bone beneath cartilage, bone spurs
    • 50s to 60s maybe earlier "morning stiffness", joints become swolen, heberden(d)/bouchard nodes
    • Treatment: pain meds, neutraceiuticals, surgery
  5. Rheumatoid Arthritis
    • Inflammatory Arthritis: autoimmune chronic inflammation of connective tissue, 1st synovial membrane, then cartilage joint capsule ligaments tendons
    • 30s maybe earlier 1-2% female/male 3:1: inflammation rxns, swelling pain in joints (earlier in RA pressure from swelling, later in RA scarring of bone and new bone formation), morning stiffness >1 hr, joint deformity and loss of function, rheumatoid nodules invade skin and central organs
  6. RA diagnostics and treatments
    • diagnostics: elevated serum rheumatoid factor (80%), synovial fluid aspiration of WBCs in sterile culture, xray changes of joints, 4+ criteria for 6+ weeks (morning stiffness for 1+ hr, arthritis in 3+ joints, arthritis of hand joints, symmetric arthritis, rhematoid nodules over extensor surfaces/bony prominences, serum rheumatoid factor, radiographic changes
    • Treatment: rest inflamed joints during exacerbation and whole body rest daily, alternating hot/cold packs, high calorie and vit diet, disease-modifying anti-rheumatic drugs (DMARDs), Biologic response modifiers (BRMs), steroids, NSAIDs, surgery
  7. Systemic Lupus
    SLE, Autoimmune disease: joint pains, malar rash, discoid lupus (raised patches scaling), mostly attacks dna, photosensitivity, oral or nasopharyngeal ulcers, nonerosive arthritis of peripheral joints, serositis (pleurisy, pericarditis)
  8. scleroderma
    autoimmune disease: inflammatory disease of connective tissue, fibrosis thickening of skin, polyarthritis, may occur systemically and involve kidneys lungs and gut, massive deposits of collagen under skin or in internal organs resulting in inflammation and fibrosis, more women than men
  9. Gout
    • inflammatory response due to inability to metabolize uric acid to a soluble compound (either excessive uric acid production or underexcretion of uric acid, crystallizes and deposits in joints causing inflammation)
    • mostly males 40-50, females later
    • trauma most common aggravating factor, renal stones 1000 times more prevalent
    • 3 stages: asymptomatic hyperurecemia, acute gouty arthritis, tophaceous gout
  10. fibromyalgia
    • a chronic musculoskeletal syndrome: diffuse pain fatigue and tender points (lower back, neck, shoulder, arms, hands, knees, hips, thighs, legs, and feet) diagnosis 11/18 points burning/gnawing, pain begins in one location and becomes generalized/increased sensitivity to touch/ sleep disturbance
    • often misdiagnosed as chronic fatigue syndrome
    • 80-90% are women age 30-50
  11. Osteoblasts
    Synthesize collagen, secrete cytokin (growth factor) that activates osteoclasts
  12. Osteocytes
    transformed osteoblasts. maintain hardened bone matrix
  13. Osteoclasts
    giant multinuclear cell formed in bone marrow of growing bones. found in depressions on the surface of the bone. involved in absorption and removal of unwanted tissue, asist with mineral homeostasis
  14. bone (osseous) tissues
    • Major difference is organization of same structural elements
    • cortical compact bone: 85% of skeleton, highly organized solid strong
    • cancellous spongy bone: greater turnover, remodeling (trabeculae), less complex, irregular meshwork
  15. Parathyroid hormone
    • release stimulated by decreased serum Ca2+
    • increases ca2+ absorption by kidneys
  16. Vitamin D
    works with pth to increase ca2+ absorbtion in gut
  17. calcitonin
    • hormone from the thyroid
    • reduces ca2+ absorption and opposes pth effects
  18. hypocalcemia
    • +chvosteks sign: facial twitching when tapped at masseter muscle
    • +trousseaus sign (spasm of hand forearm when BP cuff inflates) could also be low magnesium
  19. fracture types
    • transverse, spiral, oblique, impacted, greenstick, stress, occult, open, pathologic, segmented 1029
    • displaced, complete, open (compound), closed (simple), comminuted
  20. fracture healing
    • hematoma because of broken blood vessels
    • callus formation: osseous material woven between ends of fractured bone that is ultimately replaced by true bone
    • remodeling: activation by stimulus (hormone drug vitamin physical stressor), resorption (osteoclasts at work), formation (laying down of new bone; osteoblasts at work
  21. osteomyelitis
    • infection of bone (bacteria)
    • provokes intense inflammatory response, clo formation and sealing off canaliculi occurs, exudate forms and pushes on periosteum (cut off of blood supply), necrosis of bone occurs; new bone formation also occurs around area of infection
    • very difficult to treat 4- weeks of iv antibiotics
    • may require surgical removal of an implanted device; necrotic tissue debridement also necessary
    • usually pain swelling fever malaise anorexia
  22. osteoporosis
    • estrogen has complex effect on bone cells: decrease osteoblast, increase osteoclast
    • menopause, cyclosporine, glucocorticoids, anticonvulsants, lithium, etoh abuse, smoking, exercise, low ca2+ intake, etoh intake, elderly, caucasion, asian, female
    • avoid: ca2+ wen young, resistance exercise, meds
  23. bone tumors
    • —These are NOT primary bone tumors
    • —Primary bone tumors have 4 types and depend on cell type origin
    • 1.Osteogenic – bone cells
    • 2.Chondrogenic – cartilage
    • 3.Collagenic – fibrous tissue
    • 4.Myelogenic – marrow
    • —Osteosarcoma: a malignant boneforming tumor
    • —38% of bone tumors
    • —Occurs mostly in adolescents – most frequently in knee
    • —Male/female ratio is 3:2