Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1
Alterations of Musculoskeletal
Function
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2
Musculoskeletal Injuries
• Complete or inc...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3
Fractures
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4
Bone Fractures
 A broken bone can cause d...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 5
Callus Formation
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 6
Callus Formation (cont’d)
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 7
Bone Fractures
 Manifestations:
 Often n...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 8
Bone Fractures (cont’d)
 Improper reducti...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 9
Bone Fractures (cont’d)
 Dislocation and ...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 10
Support Structure Injuries
 Strain
 Tea...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 11
Tendinopathy and Bursitis
 Tendinitis
 ...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 12
Tendinopathy and Bursitis (cont’d)
 Epic...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 13
Tendinopathy and Bursitis (cont’d)
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 14
Tendinitis and Epicondylitis
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 15
Muscle Strain
 Sudden, forced motion cau...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 16
Myositis Ossificans
 Complication of loc...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 17
Rhabdomyolysis
 Rhabdomyolysis (myoglobi...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 18
Osteoporosis
 Porous bone
 Poorly miner...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 19
Osteoporosis (cont’d)
 Potential causes:...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 20
Osteoporosis (cont’d)
 Demonstrated by r...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 21
Osteoporosis (cont’d)
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 22
Osteoporosis (cont’d)
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 23
Osteoporosis (cont’d)
 Iatrogenic osteop...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 24
Osteoporosis (cont’d)
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 25
Osteoporosis (cont’d)
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 26
Osteoporosis (cont’d)
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 27
Osteomalacia
 Deficiency of vitamin D lo...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 28
Paget Disease
 Also called osteitis defo...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 29
Paget Disease (cont’d)
 Thickened bones ...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 30
Osteomyelitis
 Osteomyelitis is most oft...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 31
Osteomyelitis (cont’d)
 Manifestations:
...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 32
Osteomyelitis (cont’d)
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 33
Osteomyelitis (cont’d)
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 34
Inflammatory vs. Noninflammatory
Joint Di...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 35
Osteoarthritis
 Degeneration and loss of...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 36
Osteoarthritis (cont’d)
 Risk factors:
...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 37
Osteoarthritis (cont’d)
 Characteristics...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 38
Osteoarthritis (cont’d)
 Manifestations:...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 39
Osteoarthritis (cont’d)
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 40
Osteoarthritis (cont’d)
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 41
Osteoarthritis (cont’d)
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 42
Osteoarthritis (cont’d)
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 43
Rheumatoid Arthritis
 Inflammatory autoi...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 44
Rheumatoid Arthritis (cont’d)
 Presence ...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 45
Rheumatoid Arthritis (cont’d)
 Pathogene...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 46
Osteoarthritis
 Manifestations:
 Insidi...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 47
Rheumatoid Arthritis
 Evaluation
 Four ...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 48
Rheumatoid Arthritis (cont’d)
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 49
Rheumatoid Arthritis (cont’d)
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 50
Rheumatoid Arthritis (cont’d)
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 51
Ankylosing Spondylitis
 Inflammatory joi...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 52
Ankylosing Spondylitis (cont’d)
 Cause u...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 53
Ankylosing Spondylitis (cont’d)
 Manifes...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 54
Ankylosing Spondylitis (cont’d)
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 55
Gout
 Metabolic disorder that disrupts t...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 56
Gout (cont’d)
 Crystals deposit in conne...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 57
Gout (cont’d)
 Gout is related to purine...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 58
Gout (cont’d)
 Mechanisms for crystal de...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 59
Gout (cont’d)
 Clinical stages:
 Asympt...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 60
Gout (cont’d)
 Manifestations:
 An incr...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 61
Gout (cont’d)
 Manifestations of acute g...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 62
Gout (cont’d)
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 63
Disorders of Skeletal Muscle
 Contractur...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 64
Disuse Atrophy
 Reduction in the normal ...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 65
Fibromyalgia
 Chronic widespread diffuse...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 66
Fibromyalgia (cont’d)
 80% to 90% of ind...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 67
Fibromyalgia (cont’d)
 Viewed as the res...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 68
Fibromyalgia (cont’d)
 Manifestations:
...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 69
Fibromyalgia (cont’d)
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 70
Muscle Membrane Abnormalities
 Myotonia
...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 71
Diseases of Muscle Metabolism
 Endocrine...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 72
Polymyositis and Dermatomyositis
 Collec...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 73
Polymyositis and Dermatomyositis
(cont’d)
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 74
Toxic Myopathies/”Muscle
Damage”
 The mo...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 75
Toxic Myopathies/”Muscle
Damage” (cont’d)...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 76
Bone Tumors
 May originate from bone cel...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 77
Bone Tumors (cont’d)
 Malignant bone tum...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 78
Bone Tumors (cont’d)
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 79
Bone Tumors (cont’d)
 Patterns of bone d...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 80
Bone Tumors (cont’d)
 Osteosarcoma
 38%...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 81
Osteosarcoma
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 82
Bone Tumors
 Chondrosarcoma
 Tumor of m...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 83
Bone Tumors (cont’d)
 Fibrosarcoma
 Fir...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 84
Bone Tumors (cont’d)
 Myelogenic tumors:...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 85
Muscle Tumors (cont’d)
 Rhabdomyosarcoma...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 86
Muscular Dystrophy
 Group of inherited d...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 87
Duchenne Muscular Dystrophy
 Most common...
Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 88
Duchenne Muscular
Dystrophy(Cont)
 Manif...
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Week three muscles

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Week three muscles

  1. 1. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1 Alterations of Musculoskeletal Function
  2. 2. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2 Musculoskeletal Injuries • Complete or incomplete  Closed or open • Comminuted • Linear • Oblique • Spiral • Transverse • Greenstick • Torus • Bowing • Pathologic • Stress  Fatigue and insufficiency  Transchondral  Fractures  A fracture is a break in the continuity of a bone  Classifications:
  3. 3. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3 Fractures
  4. 4. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4 Bone Fractures  A broken bone can cause damage to the surrounding tissue, the periosteum, and the blood vessels in the cortex and marrow  Hematoma formation  Bone tissue destruction triggers an inflammatory response  Procallus formation
  5. 5. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 5 Callus Formation
  6. 6. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 6 Callus Formation (cont’d)
  7. 7. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 7 Bone Fractures  Manifestations:  Often numbness up to 20 minutes following injury  Unnatural alignment, swelling, muscle spasm, tenderness, pain, impaired sensation, and possible muscle spasms  Treatment:  Closed manipulation, traction, and open reduction  Internal and external fixation
  8. 8. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 8 Bone Fractures (cont’d)  Improper reduction or immobilization  Nonunion, delayed union, and malunion  Dislocation  Temporary displacement of two bones  Loss of contact between articular cartilage  Subluxation  Contact between articular surfaces is only partially lost
  9. 9. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 9 Bone Fractures (cont’d)  Dislocation and subluxation are associated with fractures, muscle imbalance, rheumatoid arthritis, or other forms of joint instability
  10. 10. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 10 Support Structure Injuries  Strain  Tear or injury to a tendon  Sprain  Tear or injury to a ligament  Avulsion  Complete separation of a tendon or ligament from its bony attachment site
  11. 11. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 11 Tendinopathy and Bursitis  Tendinitis  Inflammation of a tendon  Tendinosis  Painful degradation of collagen fibers  Bursitis  Inflammation of a bursa • Skin over bone, skin over muscle, and muscle and tendon over bone  Caused by repeated trauma  Septic bursitis is caused by a wound infection
  12. 12. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 12 Tendinopathy and Bursitis (cont’d)  Epicondylitis  Inflammation of a tendon where it attaches to a bone • Tennis elbow (lateral epicondylitis) • Golfer’s elbow (medial epicondylitis)
  13. 13. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 13 Tendinopathy and Bursitis (cont’d)
  14. 14. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 14 Tendinitis and Epicondylitis
  15. 15. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 15 Muscle Strain  Sudden, forced motion causing the muscle to become stretched beyond its normal capacity  Local muscle damage  Muscle strains can also involve the tendons
  16. 16. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 16 Myositis Ossificans  Complication of local muscle injury  Inflammation of muscular tissue with subsequent calcification and ossification of the muscle  Rider’s bone in equestrians  Drill bone in infantry soldiers  Thigh muscles in football players
  17. 17. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 17 Rhabdomyolysis  Rhabdomyolysis (myoglobinuria) is a life- threatening complication of severe muscle trauma with muscle cell loss  Crush syndrome  Compartment syndromes • Volkmann ischemic contracture  Malignant hyperthermia
  18. 18. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 18 Osteoporosis  Porous bone  Poorly mineralized bone  Bone density:  Normal bone • 833 mg/cm2  Osteopenic bone • 833 to 648 mg/cm2  Osteoporosis • <648 mg/cm2
  19. 19. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 19 Osteoporosis (cont’d)  Potential causes:  Decreased levels of estrogen and testosterone  Decreased activity level  Excess intake of caffeine, phosphorus, alcohol, nicotine  Inadequate levels of vitamins D and C, or Mg++
  20. 20. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 20 Osteoporosis (cont’d)  Demonstrated by reduced bone mass/density and an imbalance of bone resorption and formation  Bone histology is usually normal but it lacks structural integrity
  21. 21. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 21 Osteoporosis (cont’d)
  22. 22. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 22 Osteoporosis (cont’d)
  23. 23. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 23 Osteoporosis (cont’d)  Iatrogenic osteoporosis  Regional osteoporosis  Postmenopausal osteoporosis  Glucocorticoid-induced osteoporosis  Age-related bone loss
  24. 24. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 24 Osteoporosis (cont’d)
  25. 25. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 25 Osteoporosis (cont’d)
  26. 26. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 26 Osteoporosis (cont’d)
  27. 27. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 27 Osteomalacia  Deficiency of vitamin D lowers the absorption of calcium from the intestines  Inadequate or delayed mineralization  Bone formation progresses to osteoid formation but calcification does not occur; the result is soft bones  Pain, bone fractures, vertebral collapse, bone malformation
  28. 28. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 28 Paget Disease  Also called osteitis deformans  Excessive resorption of spongy bone and accelerated formation of softened bone  Disorganized, thickened, but soft bones  Most often affects the axial skeleton
  29. 29. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 29 Paget Disease (cont’d)  Thickened bones can cause abnormal bone curvatures, brain compression, impaired motor function, deafness, atrophy of the optic nerve, etc.
  30. 30. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 30 Osteomyelitis  Osteomyelitis is most often caused by a staphylococcal infection  Most common cause is open wound (exogenous); also can be from a blood- borne (endogenous) infection
  31. 31. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 31 Osteomyelitis (cont’d)  Manifestations:  Acute and chronic inflammation  Fever  Pain  Necrotic bone  Treatment:  Very difficult to treat  Antibiotics, debridement, surgery, hyperbaric oxygen therapy
  32. 32. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 32 Osteomyelitis (cont’d)
  33. 33. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 33 Osteomyelitis (cont’d)
  34. 34. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 34 Inflammatory vs. Noninflammatory Joint Disease  Differentiated by:  Absence of synovial membrane inflammation  Lack of systemic signs and symptoms  Normal synovial fluid analysis
  35. 35. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 35 Osteoarthritis  Degeneration and loss of articular cartilage, sclerosis of bone underneath cartilage, and formation of bone spurs (osteophytes)  Also referred to as degenerative joint disease  Incidence increases with age  Primary disease is idiopathic
  36. 36. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 36 Osteoarthritis (cont’d)  Risk factors:  Increased age  Joint trauma, long-term mechanical stress  Endocrine disorders (hyperparathyroidism)  Drugs  Obesity
  37. 37. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 37 Osteoarthritis (cont’d)  Characteristics:  Local areas of damage and loss of articular cartilage  New bone formation of joint margins  Subchondral bone changes  Variable degrees of mild synovitis and thickening of the joint capsule
  38. 38. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 38 Osteoarthritis (cont’d)  Manifestations:  Pain (worsens with activity)  Stiffness (diminishes with activity)  Enlargement of the joint  Tenderness  Limited motion  Deformity
  39. 39. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 39 Osteoarthritis (cont’d)
  40. 40. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 40 Osteoarthritis (cont’d)
  41. 41. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 41 Osteoarthritis (cont’d)
  42. 42. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 42 Osteoarthritis (cont’d)
  43. 43. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 43 Rheumatoid Arthritis  Inflammatory autoimmune joint disease  Systemic autoimmune damage to connective tissue, primarily in the joints (synovial membrane)  Similar symptoms to osteoarthritis  Cause unknown; multifactorial with strong genetic predisposition
  44. 44. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 44 Rheumatoid Arthritis (cont’d)  Presence of rheumatoid factors (RA or RF test)  Antibodies (IgG and IgM) against antibodies  Joint fluid presents with inflammatory exudate
  45. 45. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 45 Rheumatoid Arthritis (cont’d)  Pathogenesis  Three Processes: • Neutrophils and other cells in the synovial fluid become activated • Inflammatory cytokines (tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), interleukin-6 (IL- 6), interleukin-7 (IL-7), interleukin-21 (IL-21), induce enzymatic breakdown of cartilage and bone • T cells also interact with synovial fibroblasts through TNF-α, converting synovium into a thick, abnormal layer of granulation tissue (pannus)
  46. 46. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 46 Osteoarthritis  Manifestations:  Insidious onset  Begins with general systemic manifestations of inflammation, including fever, fatigue, weakness, anorexia, weight loss, and generalized aching and stiffness  Over a period of weeks or months, the joints become painful, tender, stiff, swollen, warm, boggy, and lose range of motion  Joint deformities
  47. 47. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 47 Rheumatoid Arthritis  Evaluation  Four or more of the following: • Morning joint stiffness lasting at least 1 hour • Arthritis of three or more joint areas • Arthritis of the hand joints • Symmetric arthritis • Rheumatoid nodules • Abnormal amounts of serum rheumatoid factor • Radiographic changes
  48. 48. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 48 Rheumatoid Arthritis (cont’d)
  49. 49. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 49 Rheumatoid Arthritis (cont’d)
  50. 50. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 50 Rheumatoid Arthritis (cont’d)
  51. 51. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 51 Ankylosing Spondylitis  Inflammatory joint disease of the spine or sacroiliac joints causing stiffening and fusion of the joints  Systemic, immune inflammatory disease  Primary proposed site is the enthesis  Site where ligaments, tendons, and the joint capsule are inserted into bone
  52. 52. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 52 Ankylosing Spondylitis (cont’d)  Cause unknown, but there is a strong association with HLA-B27 antigen  Begins with the inflammation of fibrocartilage, particularly in the vertebrae and sacroiliac joint  Inflammatory cells infiltrate and erode fibrocartilage  As repair begins, the scar tissue ossifies and calcifies; the joint eventually fuses
  53. 53. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 53 Ankylosing Spondylitis (cont’d)  Manifestations:  Early symptoms: • Low back pain that begins in early 20s and progresses over time • Stiffness • Pain • Restricted motion  Loss of normal lumbar curvature (lordosis)  Increased concavity of upper spine (kyphosis)
  54. 54. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 54 Ankylosing Spondylitis (cont’d)
  55. 55. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 55 Gout  Metabolic disorder that disrupts the body’s control of uric acid production or excretion  Gout manifests high levels of uric acid in the blood and other body fluids  Occurs when the uric acid concentration increases to high enough levels to crystallize
  56. 56. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 56 Gout (cont’d)  Crystals deposit in connective tissues throughout the body  Sites: • 50% of the initial attacks occur in the metatarsophalangeal joint of the great toe • Heel, ankle, instep of the foot, knee, wrist, or elbow  When these crystals occur in the synovial fluid, the inflammation is known as gouty arthritis
  57. 57. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 57 Gout (cont’d)  Gout is related to purine (adenine and guanine) metabolism  Affected patients can have accelerated purine synthesis, breakdown, or poor uric acid secretion in the kidneys
  58. 58. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 58 Gout (cont’d)  Mechanisms for crystal deposition:”  Lower body temperatures  Decreased albumin or glycosaminoglycan levels  Changes in ion concentration and pH  Trauma  Risk factors:  Male sex  Increasing age  High intake of alcohol, red meat, and fructose  Drugs
  59. 59. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 59 Gout (cont’d)  Clinical stages:  Asymptomatic hyperuricemia  Acute gouty arthritis  Tophaceous gout
  60. 60. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 60 Gout (cont’d)  Manifestations:  An increase in serum urate concentration (hyperuricemia)  Recurrent attacks of monoarticular arthritis (inflammation of a single joint)  Deposits of monosodium urate monohydrate (tophi) in and around the joints  Renal disease involving glomerular, tubular, and interstitial tissues and blood vessels  Formation of renal stones
  61. 61. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 61 Gout (cont’d)  Manifestations of acute gouty attack:  Severe pain especially at night  Hot, red, tender joint  Signs of systemic inflammation: • Increased sedimentation rate • Fever • Leukocytosis)
  62. 62. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 62 Gout (cont’d)
  63. 63. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 63 Disorders of Skeletal Muscle  Contracture  Muscle fiber shortening without an action potential  Caused by failure of the sarcoplasmic reticulum (calcium pump) even with available ATP  Stress-induced muscle tension  Neck stiffness, back pain, clenching teeth, hand grip, and headache  Associated with chronic anxiety
  64. 64. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 64 Disuse Atrophy  Reduction in the normal size of muscle cells as a result of prolonged inactivity  Bed rest  Trauma  Casting  Nerve damage  Treatment  Isometric movements  Passive lengthening exercises
  65. 65. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 65 Fibromyalgia  Chronic widespread diffuse joint pain, fatigue, and tender points  Vague symptoms:  Increased sensitivity to touch  Absence of inflammation  Fatigue  Sleep disturbances/non-restorative sleep
  66. 66. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 66 Fibromyalgia (cont’d)  80% to 90% of individuals affected are women, and the peak age is 30 to 50 years  New research indicates a genetic predisposition and environmental factors play a role in development of symptoms
  67. 67. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 67 Fibromyalgia (cont’d)  Viewed as the result of central nervous system dysfunction, where pain transmission and interpretation are amplified (central sensitization)  Autoimmune disorders often coexist  Studies of genetic factors have implicated alterations in genes affecting serotonin, catecholamines, and dopamine
  68. 68. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 68 Fibromyalgia (cont’d)  Manifestations:  Prominent symptom of fibromyalgia is diffuse, chronic (defined as being present more than 3 months) pain that is burning or gnawing in nature  Only reliable finding on examination is the presence of multiple tender points; the pain often begins in one location, especially the neck and shoulders, but then becomes more generalized  Profound fatigue  Diagnosis  Tenderness in eleven pairs of tender points along with a history of diffuse pain
  69. 69. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 69 Fibromyalgia (cont’d)
  70. 70. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 70 Muscle Membrane Abnormalities  Myotonia  Periodic paralysis:  Hypokalemic  Hyperkalemic
  71. 71. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 71 Diseases of Muscle Metabolism  Endocrine disorders  Hyperthyroidism  Diseases of energy metabolism:  McArdle disease • Myophosphorylase deficiency  Acid maltase deficiency • Pompe disease  Myoadenylate deaminase deficiency (MDD)  Lipid deficiencies
  72. 72. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 72 Polymyositis and Dermatomyositis  Collectively described by the term myositis  Viral, bacterial, and parasitic myositis  Staphylococcus aureus infections  Trichinosis • Trichinella infection  Toxoplasmosis  Polymyositis and dermatomyositis
  73. 73. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 73 Polymyositis and Dermatomyositis (cont’d)
  74. 74. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 74 Toxic Myopathies/”Muscle Damage”  The most common cause of toxic myopathy is alcohol abuse  Acute attack of muscle weakness, pain, and swelling  Chronic weakness in a drinker of long duration  Necrosis of individual muscle fibers • Disturbance of energy turnover, gene dysregulation, and initiation of apoptosis  Other causes include lipid-lowering agents (fibrates and statins), antimalarial drugs, steroids, thiol derivatives, and narcotics
  75. 75. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 75 Toxic Myopathies/”Muscle Damage” (cont’d)  Manifestations:  Acute muscle weakness  Painless or severe pain if necrosis  Most severe complication is rhabdomyolysis (acute muscle fiber necrosis with leakage of muscle protein into the bloodstream) that leads to myoglobinuria and acute renal failure
  76. 76. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 76 Bone Tumors  May originate from bone cells, cartilage, fibrous tissue, marrow, or vascular tissue  Osteogenic  Chondrogenic  Collagenic  Myelogenic
  77. 77. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 77 Bone Tumors (cont’d)  Malignant bone tumors  Increased nuclear/cytoplasmic ratio  Irregular borders  Excess chromatin  A prominent nucleolus  An increase in the mitotic rate
  78. 78. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 78 Bone Tumors (cont’d)
  79. 79. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 79 Bone Tumors (cont’d)  Patterns of bone destruction:  Geographic pattern  Moth-eaten pattern  Permeative pattern
  80. 80. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 80 Bone Tumors (cont’d)  Osteosarcoma  38% of bone tumors  Predominant in adolescents and young adults; occurs in seniors if they have a history of radiation therapy  Contain masses of osteoid • Streamers: noncalcified bone matrix and callus  Located in the metaphyses of long bones • 50% occur around the knees
  81. 81. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 81 Osteosarcoma
  82. 82. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 82 Bone Tumors  Chondrosarcoma  Tumor of middle-aged and older adults  Infiltrates trabeculae in spongy bone; frequent in the metaphyses or diaphysis of long bones  The tumor contains lobules of hyaline cartilage that expand and enlarge the bone  Causes erosion of the cortex and can expand into the neighboring soft tissues
  83. 83. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 83 Bone Tumors (cont’d)  Fibrosarcoma  Firm, fibrous mass of collagen, malignant fibroblasts, and osteoclast-like cells  Usually affects metaphyses of the femur or tibia  Metastasis to the lungs is common
  84. 84. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 84 Bone Tumors (cont’d)  Myelogenic tumors:  Giant cell tumor • Causes extensive bone resorption because of the osteoclastic origin of the giant cells • Located in the epiphyses of the femur, tibia, radius, or humerus • The tumor has a slow, relentless growth rate  Myeloma
  85. 85. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 85 Muscle Tumors (cont’d)  Rhabdomyosarcoma  Malignant tumor of striated muscle  Usually muscles of the tongue, neck, larynx, nasal cavity, axilla, vulva, and heart  Highly malignant with rapid metastasis  Types: • Pleomorphic • Embryonal • Alveolar
  86. 86. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 86 Muscular Dystrophy  Group of inherited disorders that cause degeneration of skeletal muscle fibers  The muscular dystrophies cause progressive, symmetric weakness and wasting of skeletal muscle groups
  87. 87. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 87 Duchenne Muscular Dystrophy  Most common of the muscular dystrophies  X-linked recessive inheritance  Deletion of a segment of DNA or a single gene defect on the short arm of the X-chromosome  Generally affects boys  Duchenne muscular dystrophy gene  Encodes for the dystrophin protein  Dystrophin maintains the structural integrity of the cytoskeleton
  88. 88. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 88 Duchenne Muscular Dystrophy(Cont)  Manifestations of the disorder begin to appear by approximately 3 years of age:  Slow motor development  Progressive weakness  Muscle wasting  Sitting and standing are delayed  The child is clumsy, falls frequently, and has difficulty climbing stairs

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