TEXBOOK OF DISORDER AND INJURIES

OF THE MUSKULOSKELETAL SYSTEM

(SALTER)

2 NORMAL STRUCTURE AND FUCTION OF MUSCULOSKELETAL

TISSUES
• Bone as structure :
o Rigid framework for the trunk and extremities
o Levers
o Protection for viscera

• Bone as organ :
o Contain hemopoietic tissue of the myeloid type  erythrocytes, granular
leukocytes, platelets
o Reservoir for calcium, phosporus, magnesium and sodium
Embryonic development
Cartilage Model
• Initial Stage :
mesoderm  mesenchyme  connective tissue
• Fifth week :
limb bud covered by ectoderm appear  in central axis,
mesenchymal cell become condensed into a short cylinder 
mesenchymal model of the future long bone
• Sixth week :
mesenchymal cell differentiate by manufacturing cartilage
matrix and forming cartilaginous model.
Grows partly from interstitial growth & appositional growth
Primary Center Of Ossification
• Seventh Week :
• cartilage cell hypertrophy & matrix calcifies  cell death
• Vascular connective tissue bringing osteoblast that secrete collagen &
proteoglycan into the matrix
• Become immature bone on the calcified cartilage matrix, forming Primary
Center Of Ossification
• This process of replacement of cartilage by bone is called Endochondral
Osiification
Secondary Center of Ossification
• Birth
The largest epiphysis of the body have developed secondary center of
ossification by the process of endochondral ossification within it.
Bone growth and remodelling
Growth in Length
• By endochondral ossification
• 2 possible site :
• Articular cartilage
• In a long bone, the only growth plate for its epiphysis.
• In a short bone, the only growth plate for the whole bone.
• Epiphyseal plate cartilage
Wolff’s law

• Remodelling of bone in respone

to physical stress –or to the lack
of them

• Induced by electrical potentials

Anatomy of Bone
• 1. Long bones / Tubular
2. Short bones / Cuboidal
3. Flat bones
• 1. Cortical Bone / compacta
• Strong, dense bone, 80% of the skeleton
• Composed of multiple osteon / haversian system
2. Trabecular bone / spongiosa
- high bone turn over rate
- commonly found in metaphysis & epiphysis of long bone
Histological Structure
 Lamellar bone :
• Mature
• Concentric arrangement
of its lamellae
• Complex formation of
• Woven bone : haversian system.
• Immature • Compotition
• Irregularly woven collagen • Less cellular
fibers
• Cement >>
• Very cellular, less cement,
• Mineral >>
more proteoglycan 11
Bone Cells
Osteoblasts
From mesenchymal stem
cells
bone lining cells (the
inactive form of the
osteoblast)
For osteogenesis, produce
matrix
enz. alkaline phosphatase
 indicator of bone
formation
12
Bone Cells
Osteocytes

Osteocytes : osteoblast
surrounded by bone matrix
imprisioned in its own lacuna
Communicate via canaliculi

13
Bone Cells
Osteoclast

From : Haemopoietic stem cells

Motile, GIANT multi-nucleated cells, up to 100 microns

diameter, with a foamy cytoplasm.

Resorbing and removing bone

14
Calcium and Phospate Regulation
• 3 hormones: Vit D, Parathyroid hormone, Calcitonin
• 3 organs : bones, kidneys, intestine
Joints and Articular Cartilage
• Types of joints :
1. Syndesmosis : bound by fibrous tissue only (skull)
2. Synchondrosis: Bound by cartilage (epiphyseal plate)
3. Synostosis: at some stage, joint will obliterated by bony union.
4. Symphysis: two joint covered by hyaline cartilage and joined by
fibrocartilage and strong fibrous tissue. (intervetebral joint)
5. Synovial joint: two joint covered by hyaline articular cartilage and
joined peripherally by a fibrous tissue capsule, contain synovial
fluid. (limb)
 Skeletal muscle

• 2 main types of muscle fibers:

1. Type I : a slow-twitch  for
high-repetition, low-load
endurance activities
2. Type II : fast twitch  power
and speed activity, high
resistance training
 TEXBOOK OF DISORDER AND
INJURIES OF THE MUSKULOSKELETAL
(SALTER)

3 Reactions of Musculoskeletal Tissues to disorders and Injuries

 Reaction of living bone

Generalized reaction Localized reaction

Deposition > Deposition < Deposition > Deposition <

resorption resorption resorption resorption

Osteopetrosis Work hypertrophy Disuse atrophy

(marble bones) Osteoporosis
Degenerative OA Rheumatoid arthritis
Fractures, infection Infection
Rickets (children),
Acromegaly Osteosclerotic
Osteomalacia (adults) Osteolytic neoplasm
neoplasm
 Reaction of epiphyseal plates
Generalized reaction Localized reaction

Increased in Decreased in Decreased in

Increased in growh growth
growh growth

Arachnodactyly Chronic inflammation Disuse retardation

(marfan’s Achondroplasia
syndrome) Displaced fr of the Physical injury, thermal
shaft of long bone injury
Pituitary Gigantism Pituitary dwarfism
Congeital
arteriovenous Ischemia, infection
Rickets malformations
Reaction of articular cartilage
• Destruction : caused by RA, infections, ankylosing spondylitis, prolonged
immobilization, continous compression, Intra-articular inj of steroid
• Degeneration : a normal aging process
• Peripheral proliferation : osteophyte formation
Reaction of Synovial Membrane
• By producing excessive amount of fluid
• By becoming thicker (hypertophy)
• By forming adhesions
Reaction of Joint Capsule and Ligaments
• By becoming stretched and elongated (joint laxity)
o Injury
o infection
• By becoming tight and shortened (contracture)
o Congenital : clubfeet
o Infection : fibrous and scar
o Chronic arthritis
o Muscle contracture
Reaction of Skeletal Muscle
• Disuse atrophy
• Work hypertrophy
• Ischemic necrosis
• Contracture
• Regeneration
Musculoskeletal Deformities
• Bony deformity
• Joint deformity
Bony deformity
• Types :
o Loss of alignment
o Abnormal length
o Bony outgrowth
Bony deformity
• Causes :
o Congenital abnormalities of bony development
o Fractures
o Disturbances of epiphyseal plate growth
o Bending of abnormality soft bone : rickets and osteomalacia
o Overgrowth of adult bone : Paget’s disease , osteochondroma
Joint deformity
• Types :
o Displacement of the joint
o Excessive mobility of the joint
o Restricted mobility of the joint
Joint deformity
• Causes :
o Congenital : DDH, clubfoot, radioulnar synostosis
o Acquired : trauma, infection
o Mechanical blocks : degenerative disorder
o Joint adhesions : inflammatory joint disorder
Joint deformity
• Causes :
oMuscle contracture
oMuscle imbalance
oFibrous contracture of fascia and skin
oExternal pressures
oIdiopathic