Musculoskeletal Diseases and

Disorders
Chapter 15
 Musculoskeletal System
 Bones
 Long, short, flat, irregular
 Compact, spongy

 Joints
 Bursae
 Muscles
 Tendons
 Ligaments
 Musculoskeletal System
 Two divisions:
 Axialskeleton
 Appendicular skeleton (inc. pelvic girdle)

 Muscle types:
 Skeletalmuscle (voluntary, striated)
 Smooth muscle (involuntary, non-striated)
 Cardiac muscle (involuntary, striated)
 Disorders of Bone
 Spinal deformities
 Herniated intervertebral discs
 Osteoporosis
 Osteomyelitis
 Paget’s Disease (osteitis deformans)
 Fractures
 Spinal Deformities
 Lordosis
 Abnormal “inward” or anterior curvature
 Accentuation of normal curve of lumbar spine
 Frequently gradual onset
 Affects lumbar spine
 Also called “swayback”
 Spinal Deformities
 Kyphosis
 Abnormal “outward” curvature of the spine
 Accentuation of normal thoracic spine curvature
 Also called “humpback” or “roundback”
 Commonly due to pathological fractures of spine in
osteoporosis
 Spinal Deformities
 Scoliosis
 Lateral(sideways) curvature of the spine
 May go to left or right
 May involve some rotation of spinal column
 May be caused by discrepancy in leg lengths
 Surgery possible if interferes with breathing or mobility
 Spinal Deformities
 Etiologies
 Posture,leg length differences, congenital, epiphyseal
growth disturbance, trauma, tumors, infection, arthritis,
TB, endocrine abn, aging
 S/S: usually backache, fatigue, abnormal
appearance or fitting of clothes
 Treatment: PT, exercise, braces, surgery, pain
relief
 Herniated Intervertebral Discs
 Disc Anatomy
 Annulus fibrosis
 Nucleus pulposis
 Herniation
 Nucleus pulposis pushes through annulus into spinal
canal
 Rupture
 Pieces of the disc are free in the spinal canal
 Herniated Disc
 S/S:
 Back pain
 Paresthesias
 Sciatica: inflammation of sciatic nerve, leg pain

 Treatment:
 PT, exercise, pain relief meds, surgery (rarely), life
correctly
 Osteoporosis
 Metabolic disorder of bones
 Less bone mineral (calcium) than normal
 Over 10 million in US affected
 Post-menopausal females most commonly
 Bones are brittle, porous, easily broken
 More prone to pathological fracture
 Osteoporosis
 Etiology:
 Genetics, calcium intake & dietary, sedentary lifestyle,
estrogen, vit D, or adrenal deficiency, steroid use,
alcoholism, etc
 S/S: often asymptomatic until pathological fx.
 Treatment: calcium supplements, meds
(antiresorptive, restorative of lost bone, etc)
 Osteomyelitis
 Acute or chronic bone infection
 Inflammation, edema, circulatory problems
 More common in children
 Etiology:
 Trauma most commonly with bacterial invasion from
the skin
 Infection may also spread from adjacent tissues or
blood supply
 Osteomyelitis
 Risk factors:
 Diabetes,orthopedic hardware, splenectomy & SSA,
hemodialysis, IV drug users
 S/S:may be asymptomatic for years
 Treatment:
 Long-term antibiotics, sometimes surgical debridement
 Paget’s Disease
 Osteitis
Deformans
 Chronic metabolic bone disease
 High rate of bone turnover (reabsorption & deposition)
 Thicker but softer bone is the result
 Patients typically over 40 YOA
 One or many bones
 Usually lower torse involve
 Paget’s Disease
 Etiology: Unknown
 S/S: graduation onset of swelling & pain
 Treatment:
 PT, pain management, surgery
 Medications (biphosphonates or calcitonin)
 Joint replacements
 Fractures
 Closed/simple
 Open/compound
 Greenstick
 Displaced
 Comminuted
 Segmental
 Spiral
 Pathological
 Fractures
 Etiology: trauma or disease
 S/S: usually pain and swelling
 Treatment:
 Rest, decreased use
 Splint, sling, cast
 Surgery (ORIF, etc)
 Joint Diseases
 Osteoarthritis
 Rheumatoid Arthritis
 Gout (gouty arthritis)
 Osteoarthritis
 Most common form of arthritis
 Chronic inflammation causing degeneration and
new bone formation
 Weight-bearing joints most common
 Knees, hips
 Common in older patients (over 55 YOA)
 In over 70 YOA, females more frequently affected
 Osteoarthritis
 Etiology:
 Mechanical, chemical, genetic, autoimmune, metabolic
 Aging seems to be important

 S/S:
 May be asymptomatic indefinitely
 Pain, swelling, sometimes erythema, limitation of motion

 Treatment:
 Anti-inflammatories, PT, exercise, surgical
 Rheumatoid Arthritis
 Chronic, systemic, polyarticular inflammatioy
disease
 Destruction(erosion) of bone & cartilage
 Causes ankylosis (fibrous fusion of joints, immobile)

 Exacerbations and remissions unpredictable

 Affects mostly females
 Increasing risk with advancing age
 Rheumatoid Arthritis (RA)
 Etiology: autoimmune, genetics
 S/S: symmetric pain, swelling of hands & fingers,
also other LE joints, systemic (fever, fatigue, wt.
Loss)
 Dx testing: Rheumatoid factor blood test
 Treatment:
 Antiinflammatories, PT, antimetabolites, antirheumatic
drugs
 Gout
 Gouty arthritis
 Chronic uric acid metabolism disorder
 Uricacid crystals deposited in joints
 Tophi formation (urate compounds) around joints
 Acute, severe episodes of arthritis
 Mostly male patients
 Other associated problems:
 Kidney stones, renal failure, hyperuricemia
 Gout
 Etiology:
 Metabolic, renal, some genetics
 S/S:
 Severe signs & symptoms of inflammation
 Big toe is classical site
 Treatment:
 Pain relief, antiinflammatories, colchicine, diet low in
purines, alopurinol
 Muscles & Connective Tissue
Diseases
 Sprains & strains
 Bursitis & tendonitis
 Carpal Tunnel Syndrome
 Myasthenia Gravis (MG)
 Polymyositis
 Systemic Lupus Erythematosus (SLE)
 Duchenne’s Muscular Dystrophy
 Sprains & Strains
 Sprain
 Ligamentous tearing/stretching after a tortion injury
 Strain
 Tearing/stretching of tendon or muscle
 Etiology: trauma or overuse
 S/S: localized pain, swelling, limitation of motion
 Treatment: supportive, pain relief
 Bursitis & Tendonitis
 Bursitis
 Inflammation of fluid-filled bursae near joints
 Shoulder, hip, elbow, knee
 Tendonitis
 Inflammation of tendon or tendon-muscle attachement
 Shoulder, wrist, Achilles, hamstring
 Etiology:trauma, excessive use, other diseases
 S/S: pain, swelling, LOM, fluid accumulation
 Bursitis & Tendonitis
 Treatment
 Varies with anatomic location & degree of disability
 Anti-inflammatories & pain relievers, splinting,
exercise, orthotics, steroid injections, PT
 Carpal Tunnel Syndrome
 Compression of median nerve within the carpal
tunnel of the wrist
 Common syndrome with repetitive use work
 Involves pain, sensory & motor symptoms
 Etiology: edema within the carpal tunnel, causing
inflammation of the nerve & other structures there
 Carpal Tunnel Syndrome
 S/S:
 Wrist pain, burning or tingling paresthesias, numbness
 Weakness of hand grasp
 Tinel’s sign

 Treatment:
 Wrist immobilization, anti-inflammatories
 Rarely surgery
 Myasthenia Gravis
 Rare, autoimmune disorder of the neuromuscular
junction
 Antibodies against the acetylcholine receptors
(post-synaptic)
 Chronic, progressive disease causing sporadic
weakness of the skeletal muscles
 Most common in females, ages 20-40 YOA
 Myasthenia Gravis (MG)
 Reduced muscle strength & longer recovery time
with repeated use
 Symptoms late in the day
 Bulbar (eye & facial) muscles involved first
 Facial expression, drooping lids, etc.

 Thymomas in 15% MG patients

 75% have some thymic abnormality (hyperplasia)
 MG
 Diagnostic testing:
 Tensilon test (edrophonium challenge will increase
muscle strength)
 Treatment:
 Oral anticholinergic meds (pyridostigmine,
neostigmine), immune suppressives, cholinesterase
inhibitors like edrophonium
 Prognosis: normal life expectancy in modern times
 Polymyositis
 Chronic, idiopathic inflammatory disease of
connective tissues and muscles
 Exacerbations & remissions
 May have skin involvement (dermatomyositis)
 females more than males
 Bimodal peak of onset: 5-15 YOA & 50-70YOA
 Polymyositis
 S/S: sudden or slow weakness of muscle group over
weeks to months
 Often have trouble arising from sitting or raising arms above
head, also voice changes
 Fever, fatigue, weight loss
 Skin: lilac-colored rash of eyelids, nose and face

 Dx via EMG & muscle biopsy

 Treatment: immune suppressive
 Systemic Lupus Erythematosus
 Lupus or SLE
 Multisystem, autoimmune, inflammatory disease
due to antibodies against cell nuclei
 Females outnumber male patients ( 9 to 1)
 Genetics may also be involved
 Arthralgias are first complaint in most patients
 SLE
 Organ involvement:
 Skin,renal, CNS, GI, blood, musculoskeletal, CV,
pulmonary, vascular endothelium (Raynaud’s)
 Four criteria at any time:
 Malar rash or discoid rash, photosensitivity, arthritis,
renal disease, neuro, skin, hematologic, or immune
disorders, +ANA blood test
 SLE
 Treatment:
 Anti-inflammatories, pain relief, immune suppressives
 Duchenne’s Muscular Dystrophy
 Inherited, x-linked, recessive disorder
 Seenonly in males
 Occasionally no family history
 Rapidly progressive wasting of skeletal muscles
 First in lower extremity & pelvis, then generalizes
 Usuallyappears by 6 YOA
 Cause of death: respiratory insufficiency usually
by 25 YOA
 Duchenne’s Muscular Dystrophy
 At first muscles appear larger
 Due to fat and CT infiltration
 Then atrophy (wasting, decrease in size)
 Then scarring & contractures
 Cardiomyopathy present in almost all cases
 Neoplasms
 Osteogenic sarcoma
 Chondrosarcoma
 Malignant giant-cell tumor
 Osteogenic Sarcoma
 Most common bone cancer
 3rd most common cancer in adolescence
 Slightly more males
 Risk factors: radiation therapy, genetics
 Treatment: surgical, but mets later in 80%
 Most in long bones
 Femur, tibia, humerus (in that order)
 Chondrosarcoma
 2ndmost frequent primary bone cancer (25%)
 Malignant tumor of cartilage
 Mostly over 40 YOA (mostly geriatric)
 Affects pelvis, femur, humerus, ribs
 Giant Cell Tumor
 Multinucleated cells
 5-10% of all giant cell tumors are malignant
 Recurs locally about 50% of the time
 Only 4-5% of all bone tumors
 Mostly long bones
 Mostly 20-40YOA
 Relatively good Px after tumor excision