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Denver School of Nursing – BSN ProgramLecture: Monday & Thursday 8:00 am – 10:45 amNo Laboratory component for this class
BIO 308 – CH 37 Alterations of Musculoskeletal Function
Fractures A fracture is a break in the continuity of a bone
Classifications▪ Complete or incomplete
▪ Closed or open
▪ Comminuted ▪ Linear▪ Oblique▪ Spiral▪ Transverse
Greenstick Torus Bowing
Pathologic
Stress Fatigue and insufficiency Transchondral
A broken bone can cause damage to the surrounding tissue, the periosteum, and the blood vessels in the cortex and marrow Hematoma formation
Bone tissue destruction triggers an inflammatory response
Procallus formation
Manifestations Unnatural alignment, swelling, muscle
spasm, tenderness, pain, impaired sensation, and possible muscle spasms
Treatment Closed manipulation, traction, and open
reduction Internal and external fixation
Improper reduction or immobilization Nonunion, delayed union, and malunion
Dislocation Temporary displacement of two bones Loss of contact between articular cartilage
Subluxation Contact between articular surfaces is only
partially lost
Dislocation and subluxation are associated with fractures, muscle imbalance, rheumatoid arthritis, or other forms of joint instability
Strain Tear or injury to a tendon or muscle
Sprain Tear or injury to a ligament
Avulsion Complete separation of a tendon or
ligament from its bony attachment site
Tendinitis Inflammation of a tendon
Tendinosis Painful degradation of collagen fibers
Bursitis Inflammation of a bursa
▪ Skin over bone, skin over muscle, and muscle and tendon over bone
Caused by repeated trauma
Septic bursitis is caused by a wound infection
Epicondylitis Inflammation of a tendon where it attaches
to a bone ▪ Tennis elbow (lateral epicondylitis) ▪ Golfer’s elbow (medial epicondylitis)
Sudden, forced motion causing the muscle to become stretched beyond its normal capacity
Local muscle damage
Muscle strains can also involve the tendons
Rhabdomyolysis (myoglobinuria) is a life-threatening complication of severe muscle trauma with muscle cell loss
Crush syndrome
Compartment syndromes▪ Volkmann ischemic contracture
Porous bone
Poorly mineralized bone
Bone densityNormal bone
▪ 833 mg/cm2
Osteopenic bone▪ 833 to 648 mg/cm2
Osteoporosis▪ <648 mg/cm2
Potential causes Decreased levels of estrogen and testosterone
Decreased activity level
Inadequate levels of vitamins D and C, or Mg++
Demonstrated by reduced bone mass/density and an imbalance of bone resorption and formation
Bone histology is usually normal but it lacks structural integrity
Iatrogenic osteoporosis
Regional osteoporosis
Postmenopausal osteoporosis
Glucocorticoid-induced osteoporosis
Age-related bone loss
Deficiency of vitamin D lowers the absorption of calcium from the intestines
Inadequate or delayed mineralization
Bone formation progresses to osteoid formation but calcification does not occur; the result is soft bones Pain, bone fractures, vertebral collapse,
bone malformation
Also called osteitis deformans
Excessive resorption of spongy bone and accelerated formation of softened bone
Disorganized, thickened, but soft bones
Most often affects the axial skeleton
Thickened bones can cause abnormal bone curvatures, brain compression, impaired motor function, deafness, atrophy of the optic nerve, etc.
Osteomyelitis is most often caused by a staphylococcal infection
Most common cause is open wound (exogenous); also can be from a blood-borne (endogenous) infection
Manifestations Acute and chronic inflammation, fever,
pain, necrotic bone
Treatment Antibiotics, débridement, surgery,
hyperbaric oxygen therapy
Synovial cavity separates articulating bones
Freely moveable (diarthroses)
Articular cartilage reduces friction absorbs shock
Articular capsule surrounds joint thickenings in fibrous
capsule called ligaments Synovial membrane
inner lining of capsule
Differentiated by:
Absence of synovial membrane inflammation
Lack of systemic signs and symptoms
Normal synovial fluid analysis
Commonly called rheumatoid arthritis
Characterized by inflammatory damage or destruction in the synovial membrane or articular cartilage and by systemic signs of inflammation Fever, leukocytosis, malaise, anorexia, and
hyperfibrinogenemia
Infectious or noninfectious
Degeneration and loss of articular cartilage, sclerosis of bone underneath cartilage, and formation of bone spurs (osteophytes)
Also referred to as degenerative joint disease
Incidence increases with age
Primary disease is idiopathic
Osteoarthritis is characterized by local areas of damage and loss of articular cartilage, new bone formation of joint margins, subchondral bone changes, and variable degrees of mild synovitis and thickening of the joint capsule
Manifestations Pain, stiffness, enlargement of the joint,
tenderness, limited motion, and deformity
Inflammatory joint disease
Systemic autoimmune damage to connective tissue, primarily in the joints (synovial membrane)
Similar symptoms to osteoarthritis
Presence of rheumatoid factors (RA or RF test) Antibodies (IgG and IgM) against
antibodies
Joint fluid presents with inflammatory exudate
Pathogenesis CD4 T helper cells and other cells in the
synovial fluid become activated and release cytokines
Recruitment and retention of inflammatory cells in the joint sublining region
Cycle of altered cytokine and signal transduction pathways
Evaluation Four or more of the following:
▪ Morning joint stiffness lasting at least 1 hour▪ Arthritis of three or more joint areas▪ Arthritis of the hand joints▪ Symmetric arthritis▪ Rheumatoid nodules ▪ Abnormal amounts of serum rheumatoid factor▪ Radiographic changes
Inflammatory joint disease of the spine or sacroiliac joints causing stiffening and fusion of the joints
Systemic, immune inflammatory disease
Primary proposed site is the enthesis Site where ligaments, tendons, and the
joint capsule are inserted into bone
Cause unknown, but there is a strong association with HLA-B27 antigen
Begins with the inflammation of fibrocartilage, particularly in the vertebrae and sacroiliac joint
Inflammatory cells infiltrate and erode fibrocartilage
As repair begins, the scar tissue ossifies and calcifies; the joint eventually fuses
Early symptoms Low back pain, stiffness, pain, and
restricted motion
Patient demonstrates loss of normal lumbar curvature
Metabolic disorder that disrupts the body’s control of uric acid production or excretion
Gout manifests high levels of uric acid in the blood and other body fluids
Occurs when the uric acid concentration increases to high enough levels to crystallize
Crystals deposit in connective tissues throughout the body
When these crystals occur in the synovial fluid, the inflammation is known as “gouty arthritis”
Gout is related to purine (adenine and guanine) metabolism
Affected patients can have accelerated
purine synthesis, breakdown, or poor uric acid secretion in the kidneys
Mechanisms for crystal deposition:
Lower body temperatures, decreased albumin or glycosaminoglycan levels, changes in ion concentration and pH, and trauma
Clinical stages Asymptomatic hyperuricemia
Acute gouty arthritis
Tophaceous gout
Contracture Muscle fiber shortening without an
action potential Caused by failure of the sarcoplasmic
reticulum (calcium pump) even with available ATP
Stress-induced muscle tension Neck stiffness, back pain, clenching
teeth, hand grip, and headache Associated with chronic anxiety
Reduction in the normal size of muscle cells as a result of prolonged inactivity Bed rest, trauma, casting, or nerve damage
Treatment Isometric movements and passive
lengthening exercises
Chronic widespread joint and muscle pain
Vague symptoms Increased sensitivity to touch, absence of
inflammation, fatigue, and sleep disturbances
The most common cause of toxic myopathy is alcohol abuse:
Acute attack of muscle weakness, pain, and swelling
Chronic weakness in a drinker of long duration
Necrosis of individual muscle fibers▪ Disturbance of energy turnover, gene dysregulation,
and initiation of apoptosis
May originate from bone cells, cartilage, fibrous tissue, marrow, or vascular tissue
Osteogenic, chondrogenic, collagenic, and myelogenic
Osteosarcoma 38% of bone tumors
Predominant in adolescents and young adults; occurs in seniors if they have a history of radiation therapy
Contain masses of osteoid ▪ “Streamers”: noncalcified bone matrix and callus
Located in the metaphyses of long bones▪ 50% occur around the knees
Chondrosarcoma Tumor of middle-aged and older adults
Infiltrates trabeculae in spongy bone; frequent in the metaphyses or diaphysis of long bones
The tumor contains lobules of hyaline cartilage that expand and enlarge the bone
Causes erosion of the cortex and can expand into the neighboring soft tissues
Fibrosarcoma Firm, fibrous mass of collagen, malignant
fibroblasts, and osteoclast-like cells
Usually affects metaphyses of the femur or tibia
Metastasis to the lungs is common
Myelogenic tumors Giant cell tumor
▪ Causes extensive bone resorption because of the osteoclastic origin of the giant cells
▪ Located in the epiphyses of the femur, tibia, radius, or humerus
▪ The tumor has a slow, relentless growth rate
Myeloma
Neuro-Pathology!!
KEEP UP WITH YOUR:
1) READING2) Powerpoint Review3) Yoga / Meditation / Positive
Thinking = )