Essentials of Human Diseases Essentials of Human Diseases and Conditions and Conditions

44thth edition edition

Margaret Schell FrazierMargaret Schell Frazier

Jeanette Wist DrzymkowskiJeanette Wist Drzymkowski

Chapter 7Chapter 7Dieases and Conditions of the Dieases and Conditions of the

Musculoskeletal SystemMusculoskeletal System

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Learning ObjectivesLearning Objectives

List the functions of the normal skeletal system.List the functions of the normal skeletal system. Distinguish among the pathologic features of lordosis, Distinguish among the pathologic features of lordosis,

kyphosis, and scoliosis.kyphosis, and scoliosis. Describe the signs and symptoms of the most Describe the signs and symptoms of the most

common form of arthritis.common form of arthritis. Explain the importance of early diagnosis and Explain the importance of early diagnosis and

treatment of Lyme disease.treatment of Lyme disease.

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Learning Objectives Learning Objectives (cont’d.)(cont’d.)

Describe the treatment of bone tumors, both benign Describe the treatment of bone tumors, both benign and malignant.and malignant.

Discuss the specifics of a physical examination when Discuss the specifics of a physical examination when fibromyalgia is suspected. fibromyalgia is suspected.

Explain why joint disability results from gout.Explain why joint disability results from gout. Describe the picture of osteomyelitis and explain how Describe the picture of osteomyelitis and explain how

it is treated.it is treated.

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Learning Objectives Learning Objectives (cont’d.)(cont’d.)

Describe the disability that results from advanced Describe the disability that results from advanced osteoporosis.osteoporosis.

Explain why osteomalacia is termed a metabolic bone Explain why osteomalacia is termed a metabolic bone disease.disease.

Distinguish between hallus valgus and hallus rigidus.Distinguish between hallus valgus and hallus rigidus. Distinguish between a strain and a sprain.Distinguish between a strain and a sprain. Explain the importance of proper treatment of Explain the importance of proper treatment of

dislocations.dislocations.

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Learning Objectives Learning Objectives (cont’d.)(cont’d.)

Describe the cause of shin splints.Describe the cause of shin splints. List some factors that contribute to the List some factors that contribute to the

development of plantar fasciitis.development of plantar fasciitis. Explain how torn meniscus is treated.Explain how torn meniscus is treated. Describe the signs and symptoms of rotator Describe the signs and symptoms of rotator

cuff tears.cuff tears.

Chapter 7Lesson 7.1

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The Muscular SystemThe Muscular System

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The Muscular System The Muscular System (cont’d.)(cont’d.)

The 3 Types of MusclesThe 3 Types of Muscles striated (skeletal)striated (skeletal) nonstriated (smooth)nonstriated (smooth) cardiaccardiac

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The Muscular System The Muscular System (cont’d.)(cont’d.)

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The Skeletal The Skeletal SystemSystem

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The Skeletal System The Skeletal System (cont’d.)(cont’d.)

Types of BonesTypes of Bones long bones – humerus (upper arm)long bones – humerus (upper arm) short bones – carpal (wrist)short bones – carpal (wrist) flat bones – scapula (shoulder)flat bones – scapula (shoulder) sesamoid bones – patella (kneecap)sesamoid bones – patella (kneecap)

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JointsJoints

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Skeletal tissueSkeletal tissue

Ligaments:Ligaments: tough, dense, fibrous bands of tough, dense, fibrous bands of connective tissue that hold bones togetherconnective tissue that hold bones together

Tendons:Tendons: strong, tough cords of dense strong, tough cords of dense connective tissue that usually attach muscle connective tissue that usually attach muscle to boneto bone

Cartilage:Cartilage: semi-smooth, dense, supporting semi-smooth, dense, supporting connective tissueconnective tissue

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Fibromyalgia:Fibromyalgia: a chronic pain condition associated with a chronic pain condition associated with stiffness and tenderness that affects muscles, stiffness and tenderness that affects muscles, tendons, and joints throughout the body. The cause tendons, and joints throughout the body. The cause is unknown. is unknown.

• Eighteen tender points used in diagnosisEighteen tender points used in diagnosis• Treatment optionsTreatment options

• Stress reductionStress reduction• Physical activityPhysical activity• MedicationsMedications

FibromyalgiaFibromyalgia

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Lordosis:Lordosis: an exaggerated inward curvature of an exaggerated inward curvature of the spinethe spine

Kyphosis:Kyphosis: an abnormal outward curvature of an abnormal outward curvature of the spinethe spine

Scoliosis:Scoliosis: a lateral (sideways) curvature of the a lateral (sideways) curvature of the spinespine

Major Spinal DisordersMajor Spinal Disorders

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Weight lossWeight loss Exercises to strengthen abdomenExercises to strengthen abdomen Pelvic tilt exercisesPelvic tilt exercises

Lordosis - Treatment OptionsLordosis - Treatment Options

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Exercises to strengthen muscles and Exercises to strengthen muscles and ligamentsligaments

Back brace to stabilize conditionBack brace to stabilize condition Spinal fusion and temporary immobilizationSpinal fusion and temporary immobilization VertebroplastyVertebroplasty

Kyphosis - Treatment OptionsKyphosis - Treatment Options

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Exercise to strengthen weak musclesExercise to strengthen weak muscles Back braceBack brace Fusion of the vertebraeFusion of the vertebrae

Scoliosis - Treatment OptionsScoliosis - Treatment Options

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Osteoarthritis Osteoarthritis

Osteoarthritis:Osteoarthritis: the breakdown and eventual loss of the breakdown and eventual loss of cartilage of one or more jointscartilage of one or more joints

Causes:Causes: aging processaging process heredityheredity injuryinjury chronic diseases such as diabetes and chronic diseases such as diabetes and obesityobesity

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Osteoarthritis Osteoarthritis (cont’d.)(cont’d.)

Signs and symptomsSigns and symptoms Spur formations on fingersSpur formations on fingers Degeneration of spinal vertebrae and pelvic jointsDegeneration of spinal vertebrae and pelvic joints

DiagnosisDiagnosis Radiographic testing to exclude other causesRadiographic testing to exclude other causes

TreatmentTreatment Reduce inflammation, minimize painReduce inflammation, minimize pain

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Lyme Disease Lyme Disease

Lyme disease:Lyme disease: an infectious bacteriological disease an infectious bacteriological disease spread by deer tick bitesspread by deer tick bites

Caused by the bacterium Borrelia burgdorferiCaused by the bacterium Borrelia burgdorferi Characterized by red, itchy rash with a red circle center Characterized by red, itchy rash with a red circle center

(“bull’s-eye” rash)(“bull’s-eye” rash) Often characterized by flu-like symptoms such as headache, Often characterized by flu-like symptoms such as headache,

fever, joint pain, and fatiguefever, joint pain, and fatigue

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Lyme Disease Lyme Disease (cont’d.)(cont’d.)

TreatmentTreatment removal of tickremoval of tick oral antibioticsoral antibiotics intravenous antibioticsintravenous antibiotics bed rest and physical therapybed rest and physical therapy

PreventionPrevention avoid tick bites by wearing long clothingavoid tick bites by wearing long clothing inspect clothes and body for ticksinspect clothes and body for ticks

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Osteomyelitis Osteomyelitis

OsteomyelitisOsteomyelitis: a serious infection of bone that : a serious infection of bone that requires aggressive antibiotic treatmentrequires aggressive antibiotic treatment Caused by bacterial organisms, viruses, and fungiCaused by bacterial organisms, viruses, and fungi Characterized by inflammation, swelling, redness, Characterized by inflammation, swelling, redness,

pain, localized heat, and tendernesspain, localized heat, and tenderness

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Osteomyelitis Osteomyelitis (cont’d.)(cont’d.)

TreatmentTreatment long-term antibiotic treatmentlong-term antibiotic treatment increased intake of proteins and vitamins A, B, increased intake of proteins and vitamins A, B,

and Cand C bed restbed rest control of chronic conditionscontrol of chronic conditions Immobilization of affected partImmobilization of affected part

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GoutGout

Gout:Gout: a chronic disorder of uric acid a chronic disorder of uric acid metabolism that manifests an acute, episodic metabolism that manifests an acute, episodic form of arthritisform of arthritis

CausesCauses Overproduction or decreased excretion of uric acidOverproduction or decreased excretion of uric acid high levels of uric acid in the bloodhigh levels of uric acid in the blood high levels of uric acid in synovial fluid in joints high levels of uric acid in synovial fluid in joints

and tissuesand tissues

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Gout Gout (cont’d.)(cont’d.)

TreatmentTreatment bed rest to reduce pressure on affected jointsbed rest to reduce pressure on affected joints application of ice to inflamed jointsapplication of ice to inflamed joints NSAIDs and corticosteroidsNSAIDs and corticosteroids low-purine diet and frequent fluid intakelow-purine diet and frequent fluid intake antihyperuricemic medicationsantihyperuricemic medications

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Musculoskeletal TumorsMusculoskeletal Tumors

Bone tumor:Bone tumor: any abnormal growth (whether any abnormal growth (whether benign or malignant) in the bonebenign or malignant) in the bone chondrogenic (from cartilage)chondrogenic (from cartilage) osteogenic (from bone)osteogenic (from bone) fibrogenic (from fibrous tissue)fibrogenic (from fibrous tissue)

Muscle tumor:Muscle tumor: muscle neoplasms, benign or muscle neoplasms, benign or malignant sarcomas, that may arise at any malignant sarcomas, that may arise at any site in the bodysite in the body

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Musculoskeletal Tumors Musculoskeletal Tumors (cont’d.)(cont’d.)

SymptomsSymptoms milignant tumors have characteristic signsmilignant tumors have characteristic signs

palpable mass; dull, localized painpalpable mass; dull, localized pain pathologic fracture, commonly in acetabulum or proximal femur pathologic fracture, commonly in acetabulum or proximal femur

DiagnosisDiagnosis radiographic studies,MRI, CT scan, biopsyradiographic studies,MRI, CT scan, biopsy elevated serum alkaline phosphataseelevated serum alkaline phosphatase elevated serum calciumelevated serum calcium

TreatmentTreatment surgical excisionsurgical excision chemotherapy/radiation therapychemotherapy/radiation therapy

Chapter 7Lesson 7.2

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OsteoporosisOsteoporosis

Osteoporosis:Osteoporosis: a condition characterized by a condition characterized by loss of normal bone mass and density due to loss of normal bone mass and density due to imbalance between breakdown of old bone imbalance between breakdown of old bone tissue and manufacture of new bonetissue and manufacture of new bone

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Osteoporosis Osteoporosis (cont’d.)(cont’d.)

SymptomsSymptoms asymptomatic until bone breaksasymptomatic until bone breaks spontaneous fractures and loss of height are the most spontaneous fractures and loss of height are the most

common signscommon signs TreatmentTreatment

increased intake of calcium and vitamin Dincreased intake of calcium and vitamin D estrogen replacement therapyestrogen replacement therapy bisphosphonate medicationsbisphosphonate medications moderate exercisemoderate exercise

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OsteomalaciaOsteomalacia

Osteomalacia:Osteomalacia: a disease characterized by a a disease characterized by a defective mineralization of the bones, causing defective mineralization of the bones, causing them to become soft, flexible, and deformedthem to become soft, flexible, and deformed When osteomalacia occurs in children, it affects When osteomalacia occurs in children, it affects

the growing skeleton and is called ricketsthe growing skeleton and is called rickets

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Osteomalacia Osteomalacia (cont’d.)(cont’d.)

SymptomsSymptoms general fatiguegeneral fatigue muscle weaknessmuscle weakness progressive stiffnessprogressive stiffness tender, painful bonestender, painful bones

TreatmentTreatment vitamin D supplementsvitamin D supplements add vitamin D, calcium, and calcitonin to dietadd vitamin D, calcium, and calcitonin to diet exposure to sunlightexposure to sunlight

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Hallus Valgus & Hallus RigidusHallus Valgus & Hallus Rigidus

Hallus Valgus (Bunion):Hallus Valgus (Bunion): a localized area of a localized area of enlargement of the inner portion of the enlargement of the inner portion of the metatarsophalangeal (MTP) joint at the base metatarsophalangeal (MTP) joint at the base of the big toeof the big toe

Hallus Rigidus (Rigid Big Toe):Hallus Rigidus (Rigid Big Toe): a stiff big toe a stiff big toe that develops as a result of degeneration of that develops as a result of degeneration of the cartilage of the first metatarsophalangeal the cartilage of the first metatarsophalangeal (MTP) joint(MTP) joint

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Hallus Valgus & Hallus Rigidus Hallus Valgus & Hallus Rigidus (cont’d.)(cont’d.)

SymptomsSymptoms painful bunionspainful bunions MTP joint becomes stiff, painful, and swollenMTP joint becomes stiff, painful, and swollen

TreatmentTreatment wearing shoes with more roomwearing shoes with more room application of iceapplication of ice anti-inflammatory agentsanti-inflammatory agents for hallux rigidus, removal of bone spursfor hallux rigidus, removal of bone spurs

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Traumatic and Sports InjuriesTraumatic and Sports Injuries

Fractures (broken bones):Fractures (broken bones): caused by stress caused by stress on the bones resulting from a traumatic insult on the bones resulting from a traumatic insult to the musculoskeletal system, severe muscle to the musculoskeletal system, severe muscle spasm, or bone diseasespasm, or bone disease

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Traumatic and Sports Injuries Traumatic and Sports Injuries (cont’d.)(cont’d.)

General treatment of fractures depends on General treatment of fractures depends on location, severity, type, and cause location, severity, type, and cause simple fracture of long bone: reduction and simple fracture of long bone: reduction and

immobilizationimmobilization compound fracture: cleaning, debriding, reduction, compound fracture: cleaning, debriding, reduction,

immobilizationimmobilization internal fixation (open reduction)internal fixation (open reduction)

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Traumatic and Sports Injuries Traumatic and Sports Injuries (cont’d.)(cont’d.)

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Traumatic and Sports Injuries Traumatic and Sports Injuries (cont’d.)(cont’d.)

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Traumatic and Sports Injuries Traumatic and Sports Injuries (cont’d.)(cont’d.)

Strains:Strains: injured tendons, muscles or other injured tendons, muscles or other tissues resulting from overuse, tissues resulting from overuse, overstretching, or excessive forcible overstretching, or excessive forcible stretching of the tissue beyond its functional stretching of the tissue beyond its functional capacitycapacity

Sprains:Sprains: acute partial tears of a ligament acute partial tears of a ligament

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Elevation and rest of affected limbElevation and rest of affected limb Immobilization with elastic bandageImmobilization with elastic bandage Application of iceApplication of ice Analgesics and anti-inflammatory agentsAnalgesics and anti-inflammatory agents

Treatment of Strains and SprainsTreatment of Strains and Sprains

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Traumatic and Sports Injuries Traumatic and Sports Injuries (cont’d.)(cont’d.)

Dislocation: the forcible displacement of a Dislocation: the forcible displacement of a bone from its joint, causing loss of joint bone from its joint, causing loss of joint functionfunction

TreatmentTreatment Proper repositioning of joint within 30 minutes of Proper repositioning of joint within 30 minutes of

injuryinjury

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Traumatic and Sports Injuries Traumatic and Sports Injuries (cont’d.)(cont’d.)

Severed tendon: caused by injury or Severed tendon: caused by injury or laceration; involves the forearm, hand, calf, or laceration; involves the forearm, hand, calf, or foot. The severed ends snap away from each foot. The severed ends snap away from each other.other. Symptoms: immediate, severe pain, inflammation Symptoms: immediate, severe pain, inflammation

and immobilityand immobility Treatment: tenorrhaphy (suturing of the two ends Treatment: tenorrhaphy (suturing of the two ends

of the tendon)of the tendon)

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Traumatic and Sports Injuries Traumatic and Sports Injuries (cont’d.)(cont’d.)

Shin splints:Shin splints: a painful condition involving a painful condition involving inflammation of the periosteum, the extensor inflammation of the periosteum, the extensor muscles of the lower leg, and the surrounding muscles of the lower leg, and the surrounding tissuestissues Symptoms: inflammation, edema, pain on inner Symptoms: inflammation, edema, pain on inner

aspect of the tibiaaspect of the tibia Treatment: rest plus applications of ice or heatTreatment: rest plus applications of ice or heat

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Traumatic and Sports Injuries Traumatic and Sports Injuries (cont’d.)(cont’d.)

Plantar fasciitis:Plantar fasciitis: an inflammatory response an inflammatory response at the bottom of the heel bone, generally at the bottom of the heel bone, generally caused by overusecaused by overuse Symptoms: pain on bottom of footSymptoms: pain on bottom of foot Treatment: Treatment:

• application of iceapplication of ice

• anti-inflammatory medicationanti-inflammatory medication

• heel padsheel pads

• cortisone cortisone

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Traumatic and Sports Injuries Traumatic and Sports Injuries (cont’d.)(cont’d.)

Torn meniscus:Torn meniscus: a crack or fissure to the a crack or fissure to the meniscus cartilage in the knee jointmeniscus cartilage in the knee joint SymptomsSymptoms

• acute pain when putting full weight on affected leg and acute pain when putting full weight on affected leg and kneeknee

• snapping or clicking on flexion or extensionsnapping or clicking on flexion or extension TreatmentTreatment

• immobilization and elevationimmobilization and elevation• surgery surgery

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Traumatic and Sports Injuries Traumatic and Sports Injuries (cont’d.)(cont’d.)

The rotator cuff:The rotator cuff: the four tendons of the the four tendons of the rotator cuff, formed by the muscles of the rotator cuff, formed by the muscles of the shoulder, partially surround the head of the shoulder, partially surround the head of the humerus and stabilize it in the glenoid cavity humerus and stabilize it in the glenoid cavity of the socketof the socket

Rotator cuff tears:Rotator cuff tears: tears to any of the rotator tears to any of the rotator cuff tendons that limit the function of the cuff tendons that limit the function of the shouldershoulder