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Musculoskeletal for MTs

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  1. 1. Musculoskeletal System <ul><li>Consist of Bones/joints/Muscles </li></ul><ul><li>Types of Joints: </li></ul><ul><li>Synarthrosis:immovable, e.g skull, tooth in socket </li></ul><ul><li>Amphiarthrosis(intercartilage):slightly movable, e.g intervertebral joint </li></ul><ul><li>Diaarthrosis:freely movable, all Synovial joint, following are the types </li></ul><ul><li>Hinge joint: elbow, ankle joint </li></ul><ul><li>Pivot joint: radioulnar </li></ul><ul><li>Condylar joint: knee, Temporomandibular joint </li></ul><ul><li>Ellipsoid joint: wrist, metaphalayngeal joint </li></ul><ul><li>Saddle joint: sternoclavicular jt., carpophalyngeal jt. </li></ul><ul><li>Ball & socket joint: shoulder jt, hip jt </li></ul><ul><li>Plane:intercarpal joint </li></ul><ul><li>Bursa is a small sac which contains </li></ul><ul><li>small amount </li></ul><ul><li>Of fluid </li></ul>
  2. 2. Pathological conditions of joints(rheumatic diseases) <ul><li>Classification </li></ul><ul><li>Inflammatory joint diseases: Infectious diseases Crystal deposition </li></ul><ul><li>Rheumatoid arithritis Bacterial/fungal/viral gout/osteoarthrosis </li></ul><ul><li>Ankylosing spondylitis </li></ul><ul><li>Reiter’s disease </li></ul><ul><li>Behcet’s disease </li></ul><ul><li>Connective tissue :Systemic lupus eryhtromatosus/polymyositis/polyarteritis </li></ul><ul><li>Arthritis:It is a inflammation of the joint , Rx is steroids, painkillers,analgesics </li></ul><ul><li>Ankylosing spondylitis:chronic progressive arithritis with stiffning of joint primarily of spines.There is bilateral sclerosis of the joints.Rx corticosteroids & anti-inflammatory drugs </li></ul><ul><li>Gouty arthritis:swelling over small joints because of excessive uric acid in body, because of hyperuricemia.The uric acid crystal destroy the articular cartilage & damage the synovial membrane(podagra).Rx consist of allopurinol & colchine </li></ul><ul><li>Osteoarithritis:progressive degenerative joint disease characterized by loss of srticular cartilage & hypertrophy of the bones at articular surface,Rx anlgesics, cartilage regenerators, physiotherapy, diet management </li></ul>
  3. 3. <ul><li>Rheumatoid arthritis: A chronic disease in which joint becomes inflammed & painful, because of immune reaction against joint tissue.The small joints of hand & feet are more commonly effected in the men.sometimes there is formation of fibrous tissue & calcification leading to ankylosis & preventing any movement at all.Rx consist of analgesics, corticosteroids,heat therapy </li></ul><ul><li>Carpal tunnel syndrome:the medial nerve gets tender because of getting fixed inside the carpel tunnel, leading to burning sensation in fingers.Rx consist of splinting the wrist to immobilize& surgical resection of carpal ligaments </li></ul><ul><li>Dislocation: of the bone from the joints, Rx consist of reduction to normal position, which helps in healing.subluxation is partial dislocation </li></ul><ul><li>Ganglion: cystic mass arising from the tendon in wrist, causing restriction of movement, Rx surgical removal </li></ul><ul><li>Herniation of disc or disc prolapse: abnormal protusion of cartilagenous intervertebral disc into neural canal or spinal nerve, also called as slip disc, pt has sciatica, cervical pain.Rx bedrest, physiotheraphy, analgesics, chronic case laminectomy, chemonucleosis </li></ul>
  4. 4. <ul><li>Lyme disease: a recurrent disease marked by arthritis, malaise, nerologic & cardaic symptoms, due to spirochete bacteria. </li></ul><ul><li>Sprain:trauma to the joint with pain, swelling & injury to ligaments, also involve danage to b.v, muscles, tendons, nerves.Rx application of ice, analgesics, elevation of joint </li></ul><ul><li>Systemic lupus erythematosus.A chronic inflammatory disease involving the joints, skin, kidneys, nervous system.It effects the connective tissue such as tendon, bone, cartilage all over the body.Typically there is Butterfly rash over face, pt has polyarthralgia, pyrexia & malaise.It is a autoimmune disease, diagnosed by antibodies in the blood stream.Rx corticosteroids, antiinflammatory, drugs, analgesics </li></ul><ul><li>Disease-modifying antirheumatic drugs ( DMARDs ) </li></ul><ul><li>adalimumab </li></ul><ul><li>azathioprine </li></ul><ul><li>gold salts ( sodium aurothiomalate , auranofin </li></ul><ul><li>methotrexate (MTX) </li></ul><ul><li>sulfasalazine (SSZ) </li></ul><ul><li>cyclosporine (Cyclosporin A) </li></ul><ul><li>chloroquine and hydroxychloroquine (antimalarials) </li></ul>
  5. 5. Muscles:They are the contractile tissue of the body.Types:skeletal/cardaic & smooth. Muscle has a origin, insertion and a belly. <ul><li>Muscle of facial expression & lower jaw </li></ul>
  6. 6. <ul><li>Direction of movement </li></ul><ul><li>Directions of movement:    </li></ul><ul><li>Flexion - brings a body part forward. </li></ul><ul><li>Extension - moves a body part to the rear. </li></ul><ul><li>Abduction - moves an appendage laterally from the midline. </li></ul><ul><li>Adduction - moves an appendage toward the midline. </li></ul><ul><li>Circumduction - movement of an appendage in a circle around a joint. </li></ul><ul><li>Pronation - rotating the palm of the hand downward. </li></ul><ul><li>Supination - rotating the palm of the hand upward. </li></ul><ul><li>Inversion - turning the toes of the foot inward. </li></ul><ul><li>Eversion - turning the toes of the foot outward </li></ul>
  7. 7. <ul><li>Anterior </li></ul><ul><li>view </li></ul>
  8. 8. <ul><li>Posterior </li></ul><ul><li>view </li></ul>
  9. 9. Pathological conditions <ul><li>Muscular Dystrophy: a group of inherited disease characterized by progressive weakness & degeneration of muscle fibre without involvement of nervous system.Duchenne s muscular dystrophy as fat replaces functional muscle cells especially in cardiac muscle. </li></ul><ul><li>Polymyositis:chronic inflammatory disease, symmetrical muscle weakness & pain often accompanied by rash around eyes, face, limbs.It is a autoimmune disorder. </li></ul><ul><li>Fibromyalgia </li></ul><ul><li>Rhabdomyosarcoma:tumor of muscle </li></ul><ul><li>Muscular atrophy:loss of muscle mass because of loss of function </li></ul><ul><li>Viral myositis:viral infection of muscle </li></ul>
  10. 10. Abbreviations <ul><li>ANA:anti-nuclear antibody(plasma tested for antibodies in pt with SLE) </li></ul><ul><li>C1-C7 cervical vertebra </li></ul><ul><li>Ca: calcium </li></ul><ul><li>CPK: creatinine phosphokinase </li></ul><ul><li>CTS: carpal tunnel syndrome </li></ul><ul><li>DTR: deep tendon reflex </li></ul><ul><li>EMG: electromyography </li></ul><ul><li>ESR: erthythrocyte sedimentation rate </li></ul><ul><li>IM: intramuscular(given over the deltoid, buttock & lateral part of thigh) </li></ul><ul><li>L1-L5: lumbar vertebra </li></ul><ul><li>LE cell: lupus erytheromatosus cell </li></ul><ul><li>Ortho: orthopedics </li></ul><ul><li>P: phosphorus </li></ul><ul><li>RA: Rheumatoid arthritis </li></ul><ul><li>RF: rheumatoid factor(blood tested for antibody in pt of rheumatoid arthritis </li></ul><ul><li>ROM: range of motion </li></ul><ul><li>SLE: Systemic lupus erthromatosus </li></ul><ul><li>TMJ: temporal joint arthritis </li></ul>
  11. 11. Clinical procedure <ul><li>Arthrocentesis: surgical puncture of joint space with a needle, synovial fluid is removed for analysis. </li></ul><ul><li>Arthrography: process of taking x ray pictures of joint after injection of opaque contrast material </li></ul><ul><li>Arthroplasty : surgical repair of joint </li></ul><ul><li>Arthroscopy: visual examination thru endoscope </li></ul><ul><li>Bone scan: scanning of bone after injection of dye </li></ul><ul><li>Electromyography: process of recording the strength of muscle contraction as a result of electrical stimulation </li></ul><ul><li>Muscle biopsy: piece of muscle tissue removed for microscopic ex. </li></ul><ul><li>Marrow biopsy </li></ul>
  12. 12. Skeletal System Post. view Ant. view
  13. 13. <ul><li>Bone: It is a hardest connective tissue impregnated with salts. </li></ul><ul><li>Types of bones: Bones are classified as </li></ul><ul><ul><li>Soft </li></ul></ul><ul><ul><li>Hard </li></ul></ul><ul><li>Regional Classification </li></ul><ul><ul><li>Appendicular skeleton: clavicle & scapula </li></ul></ul><ul><ul><li>Axial skeleton : These include upper limbs, lower limbs, skull, hyoid, auditory ossicles, vertebral column, sternum & ribs. </li></ul></ul><ul><ul><li>According to structure of bone: </li></ul></ul><ul><ul><li>Compact bone: Are arranged very densely and are ivory in colour. It contains yellow bone marrow. It is a layer of dense connective tissue that lies under the periosteum in all bone chiefly around the diaphysis . long routes within the compact bone is a system of small canals containing blood vessels that brings oxygen and nutrients to the bone and remove waste products such as CO2. these canals are called as haversion canals. </li></ul></ul><ul><ul><li>Cancellous bone: it is also known as spongy bone or trabeculae bone. It is found largely in epiphysis of the long bones and in the middle portion of the most other bones of the body as well. Spaces in cancellous bone contains red bone marrow which is richly supplied with blood and consists of immature and mature blood cells in various stages of development. The minerals is laid down in series of fibers known as trabeculae. </li></ul></ul>
  14. 14. <ul><li>According to shape of the bone </li></ul><ul><li>Long bone- femur, humerus, tibia, fibula, radius, ulna </li></ul><ul><li>Short bone: carpal & tarsal bone </li></ul><ul><li>Flat bone: ribs, scapula, sternum, bones of skull </li></ul><ul><li>Irregular bone: vertebra, hip bone </li></ul><ul><li>Pneumatic bone: bones which contain air e.g maxilla, spenoid, ethmoid </li></ul><ul><li>Seasamoid bone:patella, pisiform & fabella developed in the tendons </li></ul><ul><li>Acessory bones: skull </li></ul>
  15. 15. <ul><li>Formation of bones: bones are complete organs chiefly composed of osseous tissue + a rich blood supply and nerves. The osseous tissue consists of osteocytes surrounded by calcium salts.During foetal development bones are composed of cartilage tissue which is more flexible and lacks calcium. The gradual replacement of cartilage and its deposition by calcium salts is known as ossification. </li></ul><ul><li>Osteoblasts are the immature osteocytes that produce bony tissue that replaces cartilage during ossification. Osteoclasts are large cells that function to reabsorb or digest the bony tissue. They digest dead bone tissue from inner side of the bone. The formation of bone is dependent on supply of calcium and phosphorus to the bony tissue. These minerals must be taken into the body along with sufficient amount of Vit. D. Vit. D helps in passage of calcium through lining of small intestine and into the blood stream. The necessary level of calcium in the blood is maintained by parathyroid glands which secrete hormones to release calcium from bone storage. </li></ul>
  16. 16. <ul><li>Processes & depressions in the Bone </li></ul><ul><li>Bone head:rounded end of bone seperated from body by neck. </li></ul><ul><li>Tubercle:small rounded process on many bones for attachment of tendons & muscles </li></ul><ul><li>Trochanter:large process on femur for attachment of muscle </li></ul><ul><li>Tuberosity: large rounded process on many bone for attachment of muscles & tendons </li></ul><ul><li>Fossa shallow cavity in bone </li></ul><ul><li>Foramen opening for blood vessels nerves </li></ul><ul><li>Fissure: a narrow deep slit like opening </li></ul><ul><li>Sulcus: a groove or furrow </li></ul><ul><li>Sinus: a hallow cavity within bone </li></ul>
  17. 21. Diseases of bone <ul><li>Ewing’s sarcoma:malignant tumor, pain & swelling are common , occurs in young people, Rx radiation, chemotheraphy </li></ul><ul><li>Exostosis: bony growth arising from the bone. It occurs over the diaphysis of long bones.A bunion is a swelling of metatarsophalangeal joint at the base of big toe. </li></ul><ul><li>Osteochondroma tumor of cartilage & bone.Rx is surgical removal </li></ul><ul><li>Osteogenic sarcoma: malignant tumor arising from the bone, osteoblast multiply without control & form large tumor, especially at the ends of long bone.Metastasis is thru’ blood stream & often occurs in lungs.RX is surgical resection with chemotheraphy </li></ul><ul><li>Osteoporosis: Decrease in bone density thinning and weakening of bone: This condition is also known as osteopenia. It occurs in older women as a consequence of oestrogen deficiency following menopause. Weakened bone is subject to fractures, loss of weight, kyphosis, (hunchback) in vertebra. Estrogen replacement therapy and intake of calcium helps in treating the condition. It can also occur in paraplegia or bedridden patients. </li></ul><ul><li>Osteomalacia: softening of the bone with inadequate amount of minerals in the bone. It is a disease of infancy and childhood and is known as rickets. It occurs due to inadequate amount of calcium and phosphorus in the body because of deficiency of Vit. D. </li></ul>
  18. 22. <ul><li>Osteomyelitis: inflammation of bone & bone marrow due to bacterial inflammation. Occurs in the long bones of legs & arms. Rx consist of antibiotics , curettage </li></ul><ul><li>Pott’s disease: tuberculosis of backbone </li></ul><ul><li>Club foot: congenital deformity of the bones of the foot. </li></ul><ul><li>Black Eye: secondary blood collection in upper eyelids </li></ul><ul><li>Mastoidits: it is the inflammation of the mastoid bone present behind the ear </li></ul><ul><li>Cleft palate: non fusion of the lower horizontal palatine bones. </li></ul><ul><li>Cleft lip: split in the upper lip </li></ul><ul><li>Sinusitis: inflammation of the sinuses in the skull bone </li></ul><ul><li>Dislocation of jaw: displacement of condylar process from the mandibular fossa. </li></ul><ul><li>Whiplash injury: severe torsion of neck over the shoulder </li></ul><ul><li>Scoliosis: lateral bending of the vertebra especially the thoracic </li></ul><ul><li>Kyphosis(hunchback) is the exaggeration of the thoracic curve of the vertebral column. </li></ul><ul><li>Lordosis(swayback) is an exaggeration of lumbar curve of the vertebral column. </li></ul>
  19. 23. <ul><li>Fracture: is the sudden breakdown of bone, types are </li></ul><ul><li>Simple fracture(closed fracture): bone is broken without an open wound in the skin. </li></ul><ul><li>Compound fracture(open): broken bone with open skin </li></ul><ul><li>Pathological fractures: due to disease of bone due to change in tissue surrounding the bone making it weak </li></ul><ul><li>Colles’ fracture: it occurs at the wrist at the lower end of radius. </li></ul><ul><li>Comminuted fracture: crushed bone </li></ul><ul><li>Compression fracture: compression of the bone, especially in vertebra. </li></ul><ul><li>Greenstick fracture: bone is partially broken & bent on opposite side as when greenstick breaks. </li></ul><ul><li>Impacted fracture: fracture segment is driven into other segment of bone.Rx consist of reduction followed by cast application. </li></ul><ul><li>Spiral fracture:bones are twisted apart </li></ul><ul><li>Transverse: fracture at right angle to long axis of bone </li></ul><ul><li>Partial fracture: incomplete break across the bone </li></ul><ul><li>Pott’s fracture: fracture of distal end of tibia </li></ul><ul><li>Fracture are diagnosed by plane simple X-ray </li></ul><ul><li>Fracture is treated by close reduction or by open reduction followed by application of the cast to make the bone immobile </li></ul>