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 = )