msk system related to physiotherapy

1. Pathology of
Musculoskeletal System

2. Introduction
• Function of musculoskeletal system
– movement/ support
– protection of vital organs
– site of hematopoiesis
– reservoir for calcium/ phosphate

3. Biological response to Trauma
• Generalized Inflammatory reaction by vascular,
chemical and cellular events
• Vasoconstriction
• Margination
• Pavementing

4. Developmental and genetic diseases
• Achondroplasia
– autosomal dominant defect
of bone formation
resulting in dwarfism.
– defective formation of long bones which do not
lengthen
– normal trunk, short limbs, relatively large heads
– 80 % have normal parents (ie. new mutation)

5. Osteogenesis imperfecta
– group of inherited diseases resulting from
defective collagen type I
– results in production of osteopenic bone which
is weak
– severe forms present with multiple fractures in
fetus, usually fatal
– mild forms present with stunted growth, prone
to fractures

6. Osteopetrosis
– Group of inherited diseases resulting from
defective osteoclast function
– Bones grow but not re-modelled resulting in
thick but brittle bones

7. Infection & circulatory disturbances
Osteomyelitis
– inflammation of bones, most commonly due to
bacterial infection
– bacteria reach bone via hematogenous or direct
spread
• most common is Staphylococcus aureus
• Mycobacterium tuberculosis infection in 1-3% of
those with lung infection
• Treponema pallidum

8. – treatment consists of antibiotics, surgical
drainage if necessary
– chronic osteomyelitis results from incompletely
healed or persistent suppurative acute
osteomyelitis
– complications include bone deformities,
fractures, squamous carcinoma

9. Aseptic necrosis (avascular necrosis,
osteonecrosis)
– death of part of a bone secondary to infarct
– infarct occurs as a consequence of ischemia
– idiopathic ischemia
• In children/adolescents, idiopathic infarcts of
bone often have names
– Legge-Calve-Perthe disease, osteonecrosis of head
of femur.
• osteonecrosis of head of femur occurs in chronic
alcoholics

10. important identifiable causes of Osteonecrosis
include
• trauma
• corticosteroids
• radiation therapy
• systemic diseases (e.g. sickle cell anemia, SLE)
• emboli

11. Biotechnology impacts on research,
preclinical and clinical components
of musculoskeletal repair

12. Biotechnology target Expectations
Improved in vivo models for preclinical
Evaluations
Genetically altered small and large
experimental animal models that more
accurately
reproduce aspects of human physiology,
disease, and healing
New bioreactor-based ex vivo/in vitro
living
tissue equivalents and tissue phantoms
Reduced cost, more accessible living and
non-living biomimetic models for testing
therapeutic manipulations of tissue and
avoid animal use
Advanced patient diagnostics and rapid
genetic analysis
Rapid, molecular level diagnosis and
biomarker profiling of bone and
connective tissue
disease states and risks, prediction of
optimal drug therapies
(pharmacogenomics)
and outcomes

13. Biotechnology target Expectations
Treatment of osteoporosis and fragility
fractures
Advanced molecular imaging tools,
improved diagnostic and screening reagents
and methods, new interventional therapies
from innovative biopharmaceutical drugs
and
new devices, improved patient identification
and prophylaxis
Improved cell and molecular biology
tools, methods and probes to advance
musculoskeletal research
Improved understanding of the biological
basis of healing, identification of markers of
disease, genetically programmed cell types
for therapies, exploitation of pluripotent
cells to program wound healing and bone
neogenesis, cells as advanced imaging tools
Solutions to large bone defects, nonunions,
enhanced bone healing
Therapeutic gene and bioengineered growth
factor delivery, tissue-engineered bone
regeneration, cell-based healing, reliable
therapeutic vasculogenesis and new small
molecule bone regenerative drugs

14. Biotechnology target Expectations
Mitigating infection Elucidation of pathogenesis mechanisms
associated with implant-centered
infection,
new anti-microbials addressing virulence
and resistance mechanisms, new methods
to better deliver antimicrobials to implant
sites, novel combination device and
biomaterials-based approaches to limit
device and wound-site colonization
Reduce health care costs Depends upon regulatory and
reimbursement strategies that provide
economic
incentives, drive competition, and
increase treatment options

15. Aging and Musculoskeletal system

16. DISORDER: OSTEOPOROSIS
• Condition of porous bone
• Due to depletion of calcium from diet
• Cause fracture, shrinkage of vertebra, height
loss, hunched back and bone pain
• Effect middle age and elderly people, 80% are
women

17. Older women suffer osteoporosis
more often than men
• Due to women’s bone are less massive than men’s
bone
• Production of estrogen in women decline
dramatically at menopause but production of
androgen, testosterone, waves gradually and only
slightly in elder men
• Estrogen and testosterone stimulate osteoblast
activity (bone production) and synthesis of bone
extracellular matrix

18. Comparison of spongy bone tissue
from a normal young adult and a
person with osteoporosis

19. AGING AND JOINTS
• Decrease production of synovial fluid in joints.
• Articular cartilage become thinner and ligament
shorten and loss of some of their flexibility.
• The effect of aging on joints influenced by genetic
factors and by wear and tear and vary considerably
from one person to another.
• Degenerative changes in joints may begin as early as
age 20, most changes do not occur. By age 80, almost
everyone develops some type of degeneration in the
knees, elbows, hips and shoulders.

20. DISORDER: OSTEOARTHRITIS (OA)
• Osteoarthritis is a progressive disorder of the
joints cause by gradual loss of cartilage and
resulting in the development of bony spurs
forward at the margin of the joints associated by
aging.

21. Musculoskeletal System and
Exercise

22. The short
term effects
on
MUSCLES/
JOINTS and
BONES
Musculoskeletal response:
increased blood supply; increase
in muscle pliability; increased
range of movement; muscle
fibre micro tears

23. Short term effects of & responses to
exercise – Bones & Joints.
• Produce more synovial fluid
– Movement stimulates the secretion of
synovial fluid.
• The joints become warmer
– Exercise increases the bodies
temperature
– The synovial fluid becomes thinner,
making movement more efficient.
• The range of movement increases
– Due to the fact that the synovial fluid
is thinner and warmer
• All of this is because exercise makes
our joints move quickly, so there needs
to be more synovial fluid in the joints to
allow and assist this movement

24. When we start to warm up:
• The muscles need energy in the
form of glycogen to make the
sarcomeres contract.
– So the heart (cardiac muscle) beats
faster to provide the glycogen to the
muscles via the blood.
• The conversion of chemical energy (from the
Glycogen) to movement (contraction of the
sarcomeres) causes a waste product – HEAT.
– The muscle become warmer.
• This also allows them to operate more
efficiently, up to a point.
• Once this point is reached, we need to get
rid of heat, hence why we go red and get
hot. – Our body is trying to remove the
heat

25. In a warm up…
• We are working quite lightly
(aerobically)
– This means that the muscles are
demanding Oxygen to continue
contracting at that low intensity.
– The nervous system detects this an
makes the heart pump faster
• Because our muscles are
demanding more Oxygen we also
begin to take up more Oxygen from
the blood as it passes through the
muscles
– The capillaries become more
dilated allowing this to happen

26. Within the Muscles
• More fibres are involved in
contraction
– This means that the
contractions are stronger
• Because more muscle
fibres are contracting, they
have less opportunity to
rest, so there is more
muscular contraction.

27. Damage to the muscles
• In the short term, muscles
are damaged by exercise
(microtears)
– This is why we feel sore
after exercise
– Only with appropriate rest
and food, can we recover
• In fact we should recover
stronger than before the
exercise.

28. Different types of muscles
• Each of the muscles reacts
differently to exercise
• Skeletal
– Demands Oxygen and
Glycogen
• At rest 20% of our blood
goes to our muscles.
• In a warm up 50% of our
blood goes to our working
muscles
• In intense exercise 80% of
our blood goes to our
working muscles
– Works harder
– Warms up
• Cardiac
– Works harder (beats more often and
with larger amount of blood in each
beat) to provide the Oxygen and
Nutrients to the skeletal muscle via the
blood, and get rid of the Waste
products of exercise (Carbon Dioxide,
Water and Heat).

29. • Involuntary
Blood is shunted away from the parts of the body that don’t
need it
Eg the stomach gets 25% of our blood during rest. This can
reduce to 1% during exercise