CLINICAL ASPECTS OF THE MUSCULAR SYSTEM
Muscle function may be affected by disorders
elsewhere, particularly in the nervous system and
connective tissue. The conditions described below
affect the muscular system directly or involve the
muscles and have not been described in other chapters.
Any disorder of muscles is described as a myopathy.
Techniques for diagnosing muscle disorders include
electrical studies of muscle in action, electromyography
(EMG), and serum assay of enzymes released in
increased amounts from damaged muscles, mainly
creatine kinase (CK)
A. MUSCULAR DYSTROPHY
Muscular dystrophy refers to a group of hereditary
diseases involving progressive, noninflammatory de
generation of muscles. There is weakness and wasting
of muscle tissue with gradual replacement by
connective tissue and fat. There also may be
cardiomyopathy (disease of cardiac muscle) and mental
impairment The most common form is Duchenne
muscular dystrophy, a sex-linked disease passed from
mother to son.
MULTIPLE SYSTEMDIS ORDERS INVOLVING MUSCLES
1. Polymyositis is the inflammation of skeletal muscle
lea ding to weakness, frequently associated with
dysphagia (dificulty in swallowing) or cardiac problems.
The cause is unknown and may be related to viral
infection or autoimmunity. Often the disorder is
associated with some other systemic disease such as
rheumatoid arthritis or lupus erythematosus.
When the skin is involved. The condition is termed
dermatomyositis. In this case, there is erythema
(redness of the skin), dermatitis (inflammation of the
skin), and a typical lilac colored rash, predominantly on
the face. In addition to enzyme studies and EMG,
muscle biopsy is used in diagnosis.
2. FMS or Fibromyalgia Syndrome is a difficult to
diagnose condition involving the muscles. It is
associated with widespread muscle aches, tenderness,
and stiffness along with fatigue and sleep disorders in
the absence of neurologic abnormalities or any other
known cause. The disorder may coexist with other
chronic diseases, may follow infection, and may involve
immune system dysfunction.
TREATMENTS FOR FMS
May include a carefully planned exercise program and
medication with pain relievers, muscle relaxants, or
antidepressants.
3. CFS or Chronic Fatigue Syndrome involves persistent
fatigue of no known cause that may be associated with
impaired memory, sore throat, painful lymph nodes,
muscle and joint pain, headaches, sleep problems, an
immune disorders. The condition often occurs
traditional or alternative therapies have been
consistently successful in treating CFS
4. Miyasthenia gravis is an acquired autoimmune
disease in which antibodies interfere with muscle
stimulation at the neuromuscular junction. There is a
progressive loss of muscle power, especially in the
external eye muscles and other muscles of the face.
SKELETON
CLINICAL ASPECTS OF THE SKELEION
Disorders of the skeleton often involve surrounding
tissues-ligaments, tendons, and muscle and may be
studied together as disease of the musculoskeletal
system. The medical specialty that concentrates on
diseases of the skeletal and muscular systems is
orthopedics. Physical therapists and occupational
therapists must also understand these systems.
Most abnormalities of the bones and joints appear on
simple radiographs. Radioactive bone scans, computed
tomography (CT), and magnetic resonance imaging
(MRI) scans are used as well. Also indicative of disorders
are changes in blood levels of calcium and alkaline
phosphatase, an enzyme needed for calcification of
bone.
INFECTION
Osteomyelitis is an inflammation of bone caused by
pus-forming bacteria that enter through a wound or are
carried by the blood. Often the blood-rich ends of the
long bones are invaded and the infection then spreads
to other regions, such as the bone marrow and even the
joints. The use of antibiotics has greatly reduced the
threat of osteomyelitis.
Tuberculosis may spread to bone, especially the long
bones of the arms and legs and the bones of the wrist
and ankle. Tuberculosis of the spine is Pott disease.
Infected vertebrae are weakened and may collapse,
causing pain, deformity, and pressure on the spinal
cord. Antibiotics can be used to control tuberculosis as
long as the strains are not resistant to these drugs and
the host is not weaken by other disease.
FRACTURES
A fracture is a break in a bone, usually caused by
trauma. The effects of a fracture depend on the
location and severity of the break; the amount of
associated injury;, possible complications, such as
infections; and success of healing, which may take
months. In a closed or simple fracture, the skin is not
broken. If the fracture is accompanied by a wound in
the skin, it is described as an open fracture
Reduction of a fracture refers to realignment of the
broken bone. If no surgery is required, the reduction is
described as closed; an open reduction is one that
requires surgery to place the bone in proper position.
Rods, plates, or screws might be needed to ensure
proper healing. A splint or cast is often needed during
the healing phase to immobilize the bone. Traction
refers to using pulleys and weights to maintain
alignment of a fractured bone during healing. A traction
device may be attached to the skin or attached to the
bone itself by means of a pin or wire.
METABOLICBONE DISEASES
Osteoporosis is a loss of bone mass that resulting
weakening of the bones (Fig. 19-8). A decrease in
estrogens after menopause makes women over age 50
most susceptible to the effects of this disorder. Efforts
to prevent osteoporosis include adequate intake of
calcium and engaging in weight-bearing exercise.
Because of safety concerns, hormone replacement
therapy (HRT) is currently being re-evaluated for use in
prevention of osteoporosis. Some drugs are available
for reducing bone resorption and increasing bone
density.
Osteoporosis can be diagnosed and monitored using a
DEXA (dual-energy»-ray
Absorptiometry) scan, an imaging technique that
measures bone mineral density (BMD).
Other conditions that cam lead to osteoporosis include
nutritional deficiencies; disuse, as in paralysis or
immobilization in a cast; and excess steroids from the
adrenal cortex. Over activity of the parathyrcid glands al
so leads to osteoporosis because paratiryroid hormone
releases calcium from bones to raise blood calcium
levels. Certain drugs, smoking, lack of exercise and high
intake of alcohol, caffeine, and proteins may also
contribute to the development of osteoporosis.
Osteomalacia there is a softening of bone tissue
because of lack of formation of calcium salts. Possible
causes include deficiency of vitamin D, needed to
absorb calcium and phosphorus from the intestine;
renal disorders; liver disease; and certain intestinal
disorders. When osteomalacia occurs in children, the
disease is called rickets. Rickets is usually caused by a
deficiency of vitamin D.
Paget disease (osteitis deformans) is a disorder of aging
in which bones become overgrown and thicker, but
deformed. The disease results in bosing of the long
bones and distortion of the at bones, of the skull. Paget
disease usually involves the bones of the axial skeleton,
causing pain, fractures, and hearing loss. With time,
there may be neurologic signs, heart failure, and
predisposition to cancer of the bones.
NEOPLASMS
Osteogenic sarcoma (osteosarcoma) most commonly
occurs in the growing region of a bone, especially
around the knee. This is a highly malignant tumor that
often requires amputation. It most commonly
metastasizes to the lungs.
Chondrosarcoma usually appears in midlife. As the
name implies, this tum or arises in cartilage. It may
require amputation and most frequently metastasizes
to the lungs. In cases of malignant bone tumors, early
surgical removal is important for prevention of
metastasis. Signs of bone tumors are pain, easy
fracture, and increases in serum calcium and alkaline
phosphatase levels. Aside from primary tumors,
neoplasms at other sites often metastasize to bone,
most commonly to the spine.
\
ARTHRITIS Changes begin low in the spine and progress upward,
limiting mobility. In cases of a herniated disk, the
In general, arthritis means inflammation of a joint. The
central mass (nucleus pulposus) of an intervertebral
most common form is osteoarthritis or degenerative
disk protrudes through the weakened outer ring
joint disease (DJD). This is a gradual de generation of
(anulus? brosus) of the disk into the spinal canal. This
articular (joint) cartilage caused by wear and tear. It
commonly occurs in the lumbosacral or cervical regions
usually appears at midlife and beyond and involves the
of the spine as a result of injury or heavy lifting. The
weight-bearing joints and joints of the ?ngers
herniated or "slipped" disk puts pressure on the spinal
Radiographs show a narrowing of the joint cavity and cord or spinal nerves, often causing pain along the
thickening of the bone. The cartilage may crack and sciatic nerve ( sciatica).There may be spasms or the
break loose, causing inflammation in the joint and back muscles, lea ding to disability.
exposing the underlying bone. Osteoarthritis is treated
A herniated disk is diagnosed by myelography; CT scan,
with analgesics to relieve pain, anti inflammatory
MRI, and neuromuscular tests. Treatment is bed rest;
agents, such as corticosteroids and nonster ci dal anti.
drugs to reduce pain, muscle spasms and inflammation:
inflammatory drugs (NSAIDs), and physical therapy.
followed by an exercise program to strengthen muscles.
Predisposing factors are age, heredity, injury, In severe cases, it may be necessary to remove the disk
congenital skeletal abnormalities, and endocrine surgically in a discectomy, sometimes followed by
disorders. fusion of the vertebrae with a bone graft to stabilize the
spine. Using techniques of microsurgery; surgery done
Rheumatoid arthritis is a systemic inflammatory through a small incision under magnification, it is now
disease of the joints that commonly appears in young possible to remove an exact amount of extruded disk
adult women. Its exact causes are unknown, but it may tissue instead of the entire disk.
involve immunologic reactions. A group of antibodies
called rheumatoid factor often appears in the blood, but
is not always specific for rheumatoid arthritis because it
may occur in other systemic diseases as well. There is
an overgrowth of the synovial membrane that lines the
eventually causing fusion of the bones, or ankylosis.
Treatment includes rest, physical therapy, analgesics,
and anti-inflammatory drugs

Gout is caused by an increased level of uric acid in the

blood, salts of which are deposited in the joints. It
mostly occurs in middle-aged men and almost always
involves pain at the base of the great toe. Gout may
result from a primary metabolic disturbance or may be
a secondary effect of another disease, as of the kidneys.
Gout is treated with drugs to suppress formation of uric
acid or to increase elimination of uric acid (uricosuric
agent)

DISORDERS OF THE SPINE

Ankylosing spondylitis is a disease of the spine that

appears mainly in males. Joint cartilage is destroyed;
eventually the disks between the vertebrae calcify and
there is fusion of the bones (ankylosis).