PATHOLOGIES OF THE SKELETAL SYSTEM

Osteosarcoma

Definition: Rare form of cancer that originates in bone tissue

Not the same as metastasis to bone Most common in adolescents and young adults

Osteosarcoma, cont.

Etiology: what happens? Bone grows most quickly in young people; this is

where cancer is most likely to occur. Usually grows as one major tumor at a time, near

growth plates of long bones. No risk factors identified other than

Age Childhood exposure to radiation Genetic predisposition

Osteosarcoma, cont.

Signs and Symptoms: Silent until well established Pain with activity, then also at rest (looks like “growing pains”) Palpable mass on affected bone Metastasis to lung with respiratory symptoms

Osteosarcoma, cont.

Treatment: Surgery

Medications: Chemotherapy (high relapse rate) Drugs to manage chemotherapy side effects

Osteosarcoma, cont.

Massage Risks: Early symptoms may lead patients to seek

massage. In established cases, fractures are possible. Always accommodate for cancer treatment challenges.

Benefits: Massage can improve mood, lessen anxiety and depression, promote sleep, and mitigate some side effects of treatment. A client who has fully recovered can also enjoy massage.

Osgood-Schlatter Disease

Definition: Irritation and inflammation at quadriceps attachment

on tibia AKA: tibial tuberosity apophysitis

Osgood-Schlatter Disease, cont.

Etiology: what happens? Rapid bone growth, especially at tibia and femur

during adolescence Soft tissues may not keep up Quads are taxed with athletics

Stress at attachment leads to pain and inflammation Tibial tuberosity enlarges; microscopic fractures,

possible avulsion Usually unilateral

Osgood-Schlatter Disease, cont.

Signs and Symptoms: Almost always among athletic teens Acute: tibial tuberosity is hot, swollen, painful Subacute: permanent remodeling of tibial tuberosity

Osgood-Schlatter Disease, cont.

Treatment: Goals: reduce pain, limit damage to quad attachment

Careful heating, warming up before activity Cooling down and stretching Rest if necessary Brace or cast followed by rehabilitative exercises Surgery if necessary

Medications: NSAIDs for pain and inflammation

Osgood-Schlatter Disease, cont. Massage

Risks: Local massage may exacerbate symptoms during acute flares.

Benefits: Lymphatic work may help reduce edema and pain. Later, any work around the knee and generally that is well-tolerated is fine to ease pain, increase flexibility, and reduce tension in the quads.

Osteoporosis

Definition: Porous bones: calcium is removed faster than

replaced Affects about 10 million in US

Many more are osteopenic Women vastly outnumber men

Osteoporosis, cont.

Etiology: what happens? Bone density increases until about age 30

Then bone density remains stable or decreases

Osteoporosis, cont.

Noncontrollable risk factors: Being female Body size Ethnicity Family history

Osteoporosis, cont. Controllable risk factors:

Hormone levels History of anorexia Calcium, vitamin D Medications Sedentariness Diet Cigarette, alcohol use

Osteoporosis, cont.

Factors that affect bone health: Calcium absorption from diet

Requires highly acidic environment, vitamin D, vitamin K

Calcium loss Accelerated with caffeine, soda, some medications,

smoking, alcohol use, some conditions Bone density maintenance

Hormonal signals, especially to trabecular bone

Osteoporosis, cont.

Signs and Symptoms: Silent while early Pathologically weak bones, spontaneous fractures

Hip, vertebral bodies, wrists Slow healing

Osteoporosis, cont.

Treatment: Pharmaceutical interventions plus Exercise Dietary adjustments

Medications: Vitamin and mineral supplements Hormone replacement therapy SERMs Bisphosphonates Parathyroid hormone RANK ligand inhibitors

Osteoporosis, cont. Massage

Risks: Beware of fracture risk, positioning; elderly clients may have other disorders along with osteoporosis.

Benefits: Massage won’t reverse this, but it can ease pain and may improve range of motion.

Options: Clients may need imaginative bolstering to be comfortable on the table.

Postural Deviations Definition:

Overdeveloped spinal curves: Hyperkyphosis (“humpback”) Hyperlordosis (“swayback”) Scoliosis (“S”, “C” or “Reverse- C” curve)

Postural Deviations, cont. Etiology: what happens?

Functional problem: soft tissue tension Structural problem: bony distortion Most cases are idiopathic

Some related to congenital problems: Cerebral palsy, polio, muscular dystrophy, osteogenesis

imperfecta, spina bifida…

Postural Deviations, cont.Types of postural deviations

Hyperkyphosis: over-developed thoracic curve, can be complication of osteoporosis, ankylosing spondylitis Scheuermann disease: mostly affects young men,

can create extreme “hunchback” appearance Hyperlordosis: over-developed lumbar curve, can

cause severe low back pain Scoliosis, rotoscoliosis: common among teens,

especially girls. Bending with twisting is rotoscoliosis.

Postural Deviations, cont. Signs and Symptoms:

Can be subtle or extreme Muscle tension, nerve impingement, chronic ache, loss of range of motion

Can lead to breathing and cardiac problems

Postural Deviations, cont. Treatment:

If treated at all, mild cases are treated with osteopathic, chiropractic, or massage therapy.

Bracing if necessary Surgery for very extreme cases

Postural Deviations, cont. Massage

Risks: postural deviations that are a complication of underlying neurological disorders may not respond well to massage. Hyperkyphosis may be related to other issues that require adjustments in bodywork.

Benefits: massage may help to address the soft tissue influences on functional postural deviations (as opposed to structural deviations).

Options: addressing both hyper and hypotonicity appears to achieve the best results.

Bone Landmarks

Bone Landmarks Distinctive lines, grooves, bumps, and

projections make each bone unique (see Table 5-2)

Landmarks serve as attachment points for muscles or passageways for blood vessels and nerves

Some landmarks can be felt when palpating superficial tissue

Important to manual therapists because they help locate internal structures

Landmarks of Thorax Sternum

Manubrium Xiphoid process

23 pairs of costals (see Figure 5-14) True ribs False ribs

Floating ribs

Landmarks of Pectoral Girdle Clavicle

Clavicular notch Sternoclavicular (SC) joint Acromioclavicular (AC) joint

Scapula (see Figure 5-15) Superior and inferior angles Axillary and vertebral borders Fossae and processes

Landmarks of Upper Extremity Glenohumeral (shoulder) joint Humerus, radius, and ulna Wrist and hand See Figures 5-16 to 5-18

Landmarks of Pelvic Girdle Sacrum and os coxae (ilium, ischium, pubis) Acetabulum Obturator foramen Pelvic inlet Anterior and posterior superior iliac spines Iliac fossa Ischial tuberosity See Figure 5-19

Landmarks of Lower Extremity Hip joint Femur, tibia, fibula, patella Ankle and foot See Figures 5-20 to 5-22

Surface Anatomy for Manual Therapists Upper body anterior view

Surface Anatomy for Manual Therapists Upper body posterior view

Surface Anatomy for Manual Therapists Lower body anterior view

Surface Anatomy for Manual Therapists Lower body posterior view