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Musculoskeletal DiseaseMusculoskeletal Disease

Long Bone FormationLong Bone Formation Long Bone FormationLong Bone Formation

Membranous BoneMembranous Bone Articular Joint FormationArticular Joint Formation

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Articular Joint FormationArticular Joint Formation

Lamellar Bone vs. WovenLamellar Bone vs. Woven

Lamellar BoneLamellar Bone Bone StructureBone Structure

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Bone MetabolismBone Metabolism

Congenital ProblemsCongenital Problems

Matrix problemsMatrix problemsPremature Premature epiphyses closureepiphyses closurePituitaryPituitaryMalabsorptionMalabsorption

Osteogensis ImperfectaOsteogensis Imperfecta

Brittle Bones Dis.Brittle Bones Dis.Multiple SubtypesMultiple Subtypes

Auto DominantAuto DominantAuto RecessiveAuto Recessive

Collagen defectCollagen defectBad bone matrixBad bone matrix

Blue scleraBlue sclera

Osteogenesis ImperfectaOsteogenesis Imperfecta OsteopetrosisOsteopetrosis

RockRock--like boneslike bonesActually Actually ‘‘ChalkChalk’’Osteoclast defectOsteoclast defectCanCan’’t resorbt resorbMany FrxsMany Frxs

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Lamellar Bone vs. WovenLamellar Bone vs. Woven AchondroplasiaAchondroplasia

Premature Premature closure of closure of epiphysesepiphysesAuto dominantAuto dominantHomozygous is Homozygous is lethallethal

OsteochondromaOsteochondroma

Mechanical injury to growth line.Mechanical injury to growth line.Continues to grow as a unit for years.Continues to grow as a unit for years.Problem of diagnosis.Problem of diagnosis.

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EnchondromaEnchondroma

Small rest of Small rest of hyaline cartilagehyaline cartilageDevelopmentalDevelopmentalBony defectBony defectFracturesFracturesSyndrome of Syndrome of multiple multiple enchondromasenchondromasVery disfiguringVery disfiguring

Multiple EnchondromasMultiple Enchondromas

Nonossifying FibromaNonossifying Fibroma

Very commonVery commonDevelopmentalDevelopmentalFibrous cortical Fibrous cortical defectdefectSize determines Size determines what we call what we call them.them.

55--6 cm6 cm

OsteoporosisOsteoporosis

Loss of bone Loss of bone massmassNot problem of Not problem of calcium calcium metabolismmetabolismPeak bone massPeak bone massWomenWomenFracturesFracturesHRTHRT

OsteoporosisOsteoporosis

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OsteoporosisOsteoporosis

Collapse of vertebral Collapse of vertebral bodiesbodiesKyphosisKyphosisLoss of heightLoss of heightHip fracturesHip fracturesPeak bone massPeak bone massPhysical activityPhysical activityGeneticsGenetics

Vitamin D DeficiencyVitamin D Deficiency

RicketsRicketsDeveloping boneDeveloping boneCanCan’’t convert cartilage t convert cartilage model to bonemodel to bonePermanent deformityPermanent deformity

OsteomalaciaOsteomalaciaAdultsAdultsCanCan’’t remodelt remodelSoftening of boneSoftening of bone

HyperparathyroidismHyperparathyroidism HyperparathyroidismHyperparathyroidism

Renal Renal OsteodystrophyOsteodystrophy

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PagetPaget’’s Diseases Disease

Viral infectionViral infectionDestructive and Destructive and proliferativeproliferativeSclerosis of marrow Sclerosis of marrow spacespaceSkull and pelvisSkull and pelvisIncreased incidence Increased incidence of primary bone of primary bone tumortumor

PagetPaget’’s Diseases Disease

ClubbingClubbing

Hypertrophic Hypertrophic osteoarthropathyosteoarthropathySoft tissue and Soft tissue and periosteal boneperiosteal boneCOPDCOPD

Pure emphysema, rarePure emphysema, rare

Lung cancerLung cancerHeart defectsHeart defects

OsteomyelitisOsteomyelitis

Direct infection of Direct infection of bone.bone.Bacterial most oftenBacterial most often

StaphylococcusStaphylococcusSalmonellaSalmonella

Sickle Cell DiseaseSickle Cell Disease

TuberculosisTuberculosisSpine firstSpine first

SyphilisSyphilisPeriosteumPeriosteum

Avascular Necrosis, Avascular Necrosis, Legg-Perthes

Weight bearing jts.Weight bearing jts.Developmental?Developmental?Physically active.Physically active.Compression and Compression and necrosis of bone and necrosis of bone and articular cartilage.articular cartilage.

Legg-Perthes

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FracturesFractures

AnthropologyAnthropologyForensicsForensics

IdentificationIdentificationPattern in child Pattern in child abuseabuse

Bumper heightBumper heightPathologicalPathological

TumorTumorGummaGummaDevelopmental Developmental defectdefect

Greenstick FractureGreenstick Fracture

PseudoarthrosisPseudoarthrosis

Bone TumorsBone Tumors

Benign vs. MalignantBenign vs. MalignantPrimary vs. MetastaticPrimary vs. MetastaticSymptomsSymptoms

PainPainEnlargementEnlargementFracture at site of tumorFracture at site of tumor

Fibrous DysplasiaFibrous Dysplasia

DevelopmentalDevelopmentalMonostoticMonostoticPolyostoticPolyostoticBonesBones

Ribs, femur, jaw, Ribs, femur, jaw, humerushumerus……..

McCuneMcCune--AlbrightAlbrightPolyostoticPolyostoticCafCaféé--auau--lait spotslait spotsSexual precocitySexual precocityHyperthyroidismHyperthyroidismPituitary adenomasPituitary adenomas

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McCuneMcCune--AlbrightAlbright Bone CystsBone Cysts

Fairly commonFairly commonBenignBenignRibsRibsWeakened area tends Weakened area tends to fractureto fracture

Osteoid OsteomaOsteoid Osteoma

TibiaTibiaInjury?Injury?CorticalCorticalVery painfulVery painfulAspirinAspirin

Malignant tumors, metastaticMalignant tumors, metastatic

From practically any From practically any cancercancer

BreastBreastProstateProstateLungLung

To any boneTo any boneVertebraeVertebraeLong bonesLong bones

Osteosarcoma, Primary MalignancyOsteosarcoma, Primary Malignancy

Weight bearingWeight bearingLong bonesLong bonesYoung peopleYoung peopleOsteoblast is malignant Osteoblast is malignant cellcellGenetics of tumor being Genetics of tumor being unraveledunraveled

Rb geneRb geneP53P53MDM2MDM2St. Bernards and Great St. Bernards and Great DanesDanes

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Osteosarcoma, Primary MalignancyOsteosarcoma, Primary Malignancy CodmanCodman’’s Triangles Triangle

XX--Ray findingRay findingLifting of Lifting of periostiumperiostiumby tumorby tumor

ChondrosarcomaChondrosarcomaEwing SarcomaEwing Sarcoma

‘‘Small blue tumorSmall blue tumor’’Primitive neuroectodermal Primitive neuroectodermal tumor (PNET)tumor (PNET)Children and young adults.Children and young adults.Oseous and extraOseous and extra--oseousoseous‘‘Fusion genesFusion genes’’t(11;22)(q24;q12)t(11;22)(q24;q12)

Giant Cell TumorGiant Cell Tumor

OsteoclastsOsteoclastsBenignBenignLocally destructiveLocally destructiveEpiphysesEpiphyses

AdolescentsAdolescents

MetaphysesMetaphysesKneeKneeSolitarySolitary

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ArthritisArthritis

Inflammation of the jointsInflammation of the jointsArticular surface and/or joint capsule.Articular surface and/or joint capsule.

InfectiousInfectiousGCGCLyme & othersLyme & others

Immune mediated, rheumatic feverImmune mediated, rheumatic feverStreptococcal triggerStreptococcal trigger

Autoimmune, rheumatoid arthritisAutoimmune, rheumatoid arthritisWear and Tear, osteoarthritisWear and Tear, osteoarthritisCrystal arthritis, goutCrystal arthritis, gout

Rheumatic Heart DiseaseRheumatic Heart Disease

Rheumatoid Arthritis Rheumatoid Arthritis –– Systemic DiseaseSystemic Disease

Genetically Genetically susceptiblesusceptibleTriggerTrigger

Virus? EBVirus? EB

Autoimmune Autoimmune destructiondestruction

Rheumatoid factorRheumatoid factor

Loss of articular Loss of articular cartilagecartilageJoint fusionJoint fusion

Rheumatoid ArthritisRheumatoid ArthritisRheumatoid FactorsRheumatoid Factors

Present in about 80% of casesPresent in about 80% of casesSome healthy people and other CT diseasesSome healthy people and other CT diseasesRA need titerRA need titerDonDon’’t screen with thist screen with thisIgM generated against persons IgM generated against persons IgGIgG

Rarely Rarely IgGIgG or or IgAIgATargeted against Fc portion of antibodyTargeted against Fc portion of antibody

SelfSelf--associate to form immune complexesassociate to form immune complexesActivate complement, causing cartilage destructionActivate complement, causing cartilage destructionThese circulating immune complexes bring about These circulating immune complexes bring about many of the extramany of the extra--arthritic symptomsarthritic symptoms

TNF, ILTNF, IL--1, IL1, IL--6, IL6, IL--1515

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Rheumatoid FactorRheumatoid Factor

Rheumatoid ArthritisRheumatoid Arthritis Rheumatoid ArthritisRheumatoid Arthritis

Rheumatoid NodulesRheumatoid Nodules Rheumatoid NoduleRheumatoid Nodule

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AnkylosingAnkylosing SpondylitisSpondylitis ReiterReiter’’s Syndromes Syndrome

OsteoarthritisOsteoarthritis

Wear and tear on Wear and tear on joint cartilagejoint cartilageNormally there is very Normally there is very little friction.little friction.Minimal damage leads Minimal damage leads to cartilage fractures.to cartilage fractures.Synovial fluid into Synovial fluid into underlying bone.underlying bone.Microcysts and bone Microcysts and bone necrosis.necrosis.

OsteoarthritisOsteoarthritis

Weight bearing Weight bearing jointsjointsInjury to Injury to cartilagecartilageProgressiveProgressiveMiddleMiddle--age and age and olderolder

OsteoarthritisOsteoarthritis

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Crystal ArthritisCrystal Arthritis GoutGout

Crystal ArthritisCrystal Arthritis

GoutGoutUric acid crystalsUric acid crystalsGenetics and dietGenetics and dietCrystals in joint space Crystals in joint space and soft tissuesand soft tissues

Tophi in soft tissueTophi in soft tissue

Intense inflammatory Intense inflammatory reaction in jointreaction in jointVery PainfulVery Painful

GoutGout

GoutGout GoutGout

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GoutGout PseudogoutPseudogout

Similar symptomsSimilar symptomsCalcium pyrophosphateCalcium pyrophosphateSmallerSmaller

Gout or Pseudogout?Gout or Pseudogout?

Tumors of Soft TissueTumors of Soft Tissue

Nodular FasciitisNodular Fasciitis

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FasciitisFasciitis Myositis OsificansMyositis Osificans

LegsLegsPalmsPalms

Auto mechanicsAuto mechanics

Hematoma that becomes Hematoma that becomes calcifiedcalcifiedOvert bone formationOvert bone formation

Even bone marrowEven bone marrow

DesmoidDesmoid LiposarcomaLiposarcoma

RhabdomyosarcomaRhabdomyosarcoma FibrosarcomaFibrosarcoma

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Malignant Fibrous HistiocytomaMalignant Fibrous Histiocytoma Synovial SarcomaSynovial Sarcoma