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8/4/2019 Year 2 Semester 2
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THEME CONVENOR MRS. L.MATAITINI.
YEAR 2 – SEMESTER 2, 2011 08/08/11
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This week, we will introduce you to thedisorders of the musculoskeletal system.
Musculoskeletal system includes the bones, joints and muscles of the body togetherwith the associated structures such as theligaments and tendons. These disorders
affects person of all age groups and allwalks of life, causing pain and disability.
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At the end of this session the studentshould be able to:
Define the key terms
Discuss the different causes of musculoskeletal disorders.
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Explain the clinical manifestations of eachdisorders.
Discuss the pathophysiological problems of each musculoskeletal system.
Discuss the different types of therapeutic
procedures available for each disorders.
Discuss the different drugs available to treat
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Pathophysiological changes of themusculoskeletal.
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Musculoskeletal disorders divides up intothree according to the structures:
(i) Tissue(ii) Joints(iii)Bones
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Physical forces such as:
Blunt tissue trauma.
Disruptions of tendons and ligaments Fractures of the bony structures. Other causes: Motor vehicle accident Motorcycle accident
Falls
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rugby athletes
other sports
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SOFT TISSUE INJURY.
•Contusion
•Hematoma
•
Laceration
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It is the injury to softtissue that results fromdirect trauma and isusually caused bystriking a body partagainst a hard object.
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CLINICAL MANIFESTATIONS
ecchymosis-due to hemorrhagediscoloration gradually changes tobrown and yellow as the blood isreabsorbed.
Hematoma- blood accumulates and exertspressure on nerve endings.
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CLINICAL MANIFESTATIONpain- increases with movement swelling
infection due to bacterial growth split skindue to increase pressures and producedrainage of the hematoma
TREATMENT:
apply cold compress during the 1st
24hrs of injury.
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After the 1st 24hrs, heat or coldcompression to be doneintermittently for 20mins at a time.
Laceration:Injury in which the skin is torn or its
continuity is disrupted. The
seriousness of the lacerationdepends on the size and depth of the wound.
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Punctured wounds from nails or rustedmaterial provide the setting for growth of
anaerobic bacteria such as those that causetetanus and gas gangrene.
TREATMENT:
Wound closure after cleaning the wound well
and apply sterile dressing antibiotics.
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Strains
Sprains
Dislocation
Knee injuries
Meniscus injuries.
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STRAINS:
A strain is a stretching injury to a muscle or amusculotendinous(joint)unit caused by amechanical overloading.
.
CAUSE : unusual muscle contraction.
excessive forcible stretch . overweight or excessive exercises.
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Pain.
Stiffness.
Swelling.
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Lower back Cervical region of the spine Elbow
Shoulder foot
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TREATMENT:
Bed rest. traction. application of heat. massage. cold compression for the 1st 24hrs
to educe pain and swelling of the
affected area.
exercises, correct posture and goodbody mechanics.
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SPRAINS:Involves the ligamentous structuressurrounding the joints, resemble astrain, but the pain and swelling
subsides slowly.CAUSE:abnormal and excessive movement
of the joint.
CLINICAL MANIFESTATIONS:
pain.
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Rapid swelling.Heat.Disability.Discoloration Limitation of function
DIAGNOSTIC TESTS: history of the injury. x-ray.
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Dislocations can be congenital, traumatic orpathologic.
Traumatic dislocations occur after falls,blows, or rotational injuries.
CAUSE: trauma .
motor vehicle accidents. fall. sports.
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CLINICAL MANIFESTATIONS.
pain.limitation of movementswellingdeformity
DIAGONISTIC TESTS.history.physical examination
x-ray.TREATMENT.Bed rest.manipulation
surgical repair.
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It is a common site of injury, particularly sport
related injuries in which the knee is subjectedto abnormal twisting and compression forces.
These forces can result in injury to themeniscus, patella sublaxation and
dislocation .
MENISCUS INJURY:
Meniscus injury commonly occurs as the
result of rotational injury from a sudden orsharp instrument or a direct blow to the knee,as in hockey, basketball or football.
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CLINICAL MANIFESTATIONS.pain .
swelling DIAGNOSTIC TEST:
physical examinationx-ray.
arthroscopy TREATMENT:
conservative
rest
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A break in the continuity of the bone. A fractureoccurs when the stress placed on the bone isgreater than the bone can absorb.
TYPES OF FRACTURE:open fracture –skin involve
closed fracture-skin not involve
complete fracture-involves the entire
cross section of the bonepathologic fracture-through an area of
diseased bone.
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Greenstick-one side of the bone is broken
Transverse-straight across the bone. Oblique –at an angle across the bone. Spiral-twists around the shaft of the bone. Comminuted-bone splinted into more than
three fragments. Depressed-fragments indriven. Compression-bone collapses in on itself. Avulsion –fragment of bone pulled of by
ligament. Impacted-fragment of bone wedged into other
bone fragment.
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Pain
Tenderness Swelling Loss of function Deformity of the affected side Angulations Shortening of the bones Rotation deformity
Crepitus or grating may be felt as the bonefragments rub each other.
Bleeding
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PICS SUPPLEMENT
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Hypovolemic shock due to bleeding.
◦ Numbness of the affected area.
DIAGNOSTIC AND THERAPEUTIC.
history
physical examination
x-ray examination
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Reduction-to align the bones Immobilization-prevents movement of the
bones External fixation
COMPLICATIONS OF FRACTURES. fracture blisters Compartment syndrome Muscle wasting Fat embolism
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Direct extension or contamination of
the open fracture.Wide variety of microorganisms
introduced during injury, operativeprocedures or from the blood
stream.Usually bacteria in origin; isolatedorganisms which include :
staphylococcusaureus
Escherichia coli
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PATHOPHYSIOLOGY:
1. Site inoculated.
2.Inflammatory and immunologic response;pus formationedema.vascular congestion.
3. Vascular occlusion leads to ;
ischemiabone necrosis.
4. Infections spread through the bone viaVolkmann's and haversian canals,
causing further vascular occlusions
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Ischemia allows necrotic bone to separatefrom the living bone, forming sequestra.
Sequestra enlarge, spreading toward andbreaching the cortex, forming asubperiosteal
abscess, further interfering with thevascular
supply. Vascular supply may remain sufficient to
maintain life of bone tissue.
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Large pieces of dead bone cannot be
destroyed . Central residual remains a sequestrum
composed of cancellous New bone is laid down beneath the elevated
periosteum and tends to form anencasement
around the sequestrum. Pockets of infection are walled off in which
organisms can lie dormant long periods Chronic sinuses may form that eventually
reach the surface and drain
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Drainage continues until infection quietsonce more. Channels become pluggedwith granulations and remain closed untilthe pressure of the pus builds up andcauses the sinuses to reopen or reachthe surface through new channels(chronicosteomyelitis)
Complete healing takes place only whenall the dead bone has destroyed,discharged or excised
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COMPLICATIONS: Chronic osteomyelitis Pathological fracture
Joint destruction Skeletal deformities Limb length discrepancies Life threatening if untreated
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CLINICAL MANIFESTATIONS Localised pain Swelling
Erythema Fever Malaise Irritability.
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Development dysplasia of the hip:congenital dislocation of the hip.
CAUSE:
Unknown Hereditory-high risk with family history Increased ligamentous laxity secondary to
maternal hormones.
Breach presentation First born In-utero restrictions to fetal movement
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Swaddling in the postnatal period, where thehips are in abduction and extension
PATHOPHYSIOLOGY:
Acetabelum tends to be shallow and oblique Head of the femur tends to smaller than
normal. Ossification centers are delayed in
appearance. Dysplasia-shallow acetabelum, roof slants
upward
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Sublaxation –acetabular surface of thefemoral head is in contact with shallowdysplastic.
Dislocation-articular cartilage of completely displaced femoral head doesnot contact acetabular articular cartilage
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COMPLICATION: Avascular necrosis of femoral head
Loss of range of movement. Leg length inequality. Early osteoarthritis
Recurrent dislocation or unstable hip.
CLINICAL MANIFESTATIONS: Asymmetry of high or gluteal folds Abnormal gait pattern Ortolani’s sign and positive Barlow’s test.
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DIAGNOSTIC TEST: X-ray-cartilagenous femoral head is difficult
to visualise in the newborn Ultrasound examination Arthrogram- outline the cartilagenous
portions of the acetabulum and femoral head Physical examination
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Congenital anomaly characterised by a threepart deformity of the foot, consisting of theheel(varus), adduction and supination of theforefoot, and ankle equinus.
CAUSE: Unknown. Suggested contributing factor;
.intrauterine position..primary arrest in fetal
development.
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Familial tendency.
PATHOPHYSIOLOGY:
Foot is planter flexed at the ankle and thesubtalar joints. Hind foot is inverted. Midfoot and hind forefoot are adducted and
inverted. Contractures of the soft tissues maintain the
malalignments.
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COMPLICATIONS:
Deformity becomes fixed if untreated. Disturbances in epiphyseal plates from
overaggressive manipulations Child bearing weight on lateral border of foot Gait is awkward
Recurrent deformity
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CLINICAL MANIFESTATION:
Deformity is obvious at birth with varyingdegree rigidity and ability to correct position.
DIAGNOSTIC TEST: clinical presentation
Physical examination X-ray
TREATMENT: Manipulation-pop cast Corrective footwear Surgical intervention
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Congenital scoliosis exact cause is unknown Neuromuscular scoliosis-child has a definite
neuromuscular condition that directlycontributes to the deformity.
PATHOPHYSIOLOGY: Vertebral column develops lateral curvature Vertebral rotate to the convex side of the
curve Vertebral become wedged shape Disk shape is altered
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Deformity progress, changes in the thoraciccage worsened.
Changes in the thoracic cage, ribs andsternum lead to further characteristics
deformities such as “rib hump”. Neurological compromise-very rare.
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CLINICAL MANIFESTATIONS:
Poor posture Uneven should height One hip appears more prominent Crooked neck Lump on the neck Rib hump Uneven waistline
Uneven breast size Visualization deformity Back pain
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DIAGNOSTIC TEST: X-ray of the spine –upright position Myelogram Tomograms
C.T. Scan
TREATMENT: Medical management Exercise therapy Surgical intervention
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OSTEOPOROSIS: DEFINITION:Condition in which the bone matrix is lost,
thereby weakening the bones and makingthem susceptible to fractures.
PATHOPHYSIOLOGY: The rate of bone resorption increases over
the rate of bone formation, causing loss of bone mass .Calcium and phosphate salts are lost-
creating brittle bones.Occurs most frequently in postmenopausal
women.
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Age
Inactivity Chronic illness Medications such as corticosteroids
Calcium and vitamin D deficiency Family history Smoking Diet –caffeine is a risk factor
Race white and Asians have higher risk
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Computed Tomography (CT Scan) Bone biopsy.
COMPLICATION Fracture
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DEFINITION:
Degenerative joint disease is a chronic noninflammatory, slowly progressing disorderthat causes deterioration of articularcartilage
It affects weight- bearing joints( hips andknees) as well as joints of the distalinterphalanges and of the fingers.
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PATHOPHYSIOLOGY:Changes in particular cartilage occurs firstSoft tissue changes may occur next.
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Progressive wear and tear on cartilage leads
to thinning of joint surface Ulceration into bone Inflammation of the joint and increased
blood flow.. Hypertrophy of suprachondral bone . New cartilage and bone formation at joint
margin results in osteophytosis altering the
size and shape of bone
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CAUSE: unknown Aging and obesity are contributing factors Previous trauma may cause secondary
osteoarthritis
DIAGNOSTIC TESTS: Physical examination X-ray of affected joints
Bone scan Analysis of synovial fluid differentiates
osteoarthritis and rheumatoid arthritis
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DEFINITION:Musculoskeletal neoplasm include primary
sarcoma, metastic bone disease, andbenign tumors of the bone.
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PATHOPHYSIOLOGY Benign bone tissue
Osteoid osteomaChondroma
Osteoclastoma
Malignant bone tumorsChondrosarcoma and osteosarcoma
are examples of primary malignantbone tumors
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CLINICAL MANIFESTATIONS: Pain in the involved bone-worst at night. Swelling and limitations of motion and joint
effusions
Physical findings-palpable, tender fixedboney mass. Increase in skin temperatureover the mass. Superficial veins dilated andprominent.
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TREATMENT:
Surgery Chemotherapy Radiotherapy
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