Diseases and Conditions of the Musculoskeletal System Chapter 7 Diseases and Conditions of the Musculoskeletal System Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 1

The Musculoskeletal System Discuss the functions of the muscular system. What is muscle fiber made of? How is movement of the body and its internal organs accomplished? Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 2

The Musculoskeletal System (Cont’d.) The Three Types of Muscles Striated (skeletal) Nonstriated (smooth) Cardiac What are differences among the three types of muscles? Refer to Figure 7-2 (p. 300). How do voluntary and involuntary muscle classifications differ? What is the difference between origin and insertion of a muscle? Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 3

Fibromyalgia Fibromyalgia: chronic pain condition associated with stiffness and tenderness that affects muscles, tendons, and joints throughout the body Cause is unknown Eighteen tender points used in diagnosis Treatment options Stress reduction Physical activity Medications Besides stiffness and tenderness, what are some of the other characteristics of fibromyalgia? What is substance P? What other conditions must be excluded before a diagnosis of fibromyalgia can be made? Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 4

Spinal Disorders Lordosis: an exaggerated inward curvature of the spine Kyphosis: an abnormal outward curvature of the spine Scoliosis: a lateral (sideways) curvature of the spine What are some of the possible causes of lordosis? What is Scheuermann's disease? What is a probable cause of hunchback in older persons and postmenopausal women? What age and gender group is most likely to develop scoliosis? Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. . 5

Osteoarthritis Osteoarthritis: the breakdown and eventual loss of cartilage of one or more joints Causes Aging process Heredity Injury Chronic diseases such as diabetes and obesity What is the most common form of arthritis? In which parts of the body does osteoarthritis usually appear? Why is osteoarthritis such a growing problem today? Discuss advertising for today's prescription and OTC arthritis drugs. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 6

Lyme Disease Lyme disease: an infectious bacteriological disease spread by deer tick bites Caused by the bacterium Borrelia burgdorferi Characterized by red, itchy rash with a red circle center (“bull's-eye” rash) Often characterized by flulike symptoms such as headache, fever, joint pain, and fatigue What areas of the body can be affected by Lyme disease? What precautions can be taken to help prevent Lyme disease? What are methods of removing ticks? What diseases can Lyme disease be mistaken for? Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 7

Lyme Disease (Cont’d.) Treatment Removal of tick Oral antibiotics Intravenous antibiotics Bed rest and physical therapy Prevention Avoid tick bites by wearing long clothing Inspect clothes and body for ticks Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 8

Gout Gout: a chronic disorder of uric acid metabolism that manifests an acute, episodic form of arthritis Causes Overproduction or decreased excretion of uric acid High levels of uric acid in the blood High levels of uric acid in synovial fluid in joints and tissues What area of the body does gout typically affect? What dietary modifications can help in treatment of gout? How is kidney function related to gout? Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 9

Gout (Cont’d.) Treatment Bed rest to reduce pressure on affected joints Application of ice to inflamed joints NSAIDs and corticosteroids Low-purine diet and frequent fluid intake Antihyperuricemic medications Gradual weight reduction in those who are overweight Dairy products have been shown to reduce frequency of gouty arthritis. Pain can be acute and severe with mild systemic symptoms. Treatment with pain medication is urgent with gouty arthritis. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 10

Musculoskeletal Tumors Bone tumor: any abnormal growth (whether benign or malignant) in the bone Chondrogenic (from cartilage) Osteogenic (from bone) Fibrogenic (from fibrous tissue) Muscle tumor: muscle neoplasms, benign or malignant sarcomas that may arise at any site in the body What is the most common type of primary bone neoplasm? What is the most common presenting complaint for bone tumors? What is a pathologic fracture? What areas of the body are most commonly affected by muscle tumors? Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 11

Musculoskeletal Tumors (Cont’d.) Symptoms Malignant tumors have characteristic signs Palpable mass; dull, localized pain Pathologic fracture, commonly in acetabulum or proximal femur Diagnosis Radiographic studies, MRI, CT scan, biopsy Elevated serum alkaline phosphatase Elevated serum calcium Treatment Surgical excision Chemotherapy/radiation therapy Are most muscle tumors malignant or benign? Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 12

Traumatic and Sports Injuries Fractures (broken bones): caused by stress on the bones resulting from a traumatic insult to the musculoskeletal system, severe muscle spasm, or bone disease http://www.bing.com/videos/search?q=sports+injuries+youtube&qs=NL&sk=&FORM=QBVR&pq=sports%20injuries%20on%20yout&sc=2-23&sp=1&qs=NL&sk=#view=detail&mid=D622557A1B489BA808F1D622557A1B489BA808F1 Discuss different types of fractures. Refer to Figure 7-25 (p. 330). Name some of the technologies used in diagnosing fractures. What are some immobilization techniques? Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 13

Traumatic and Sports Injuries (Cont’d.) General treatment of fractures depends on location, severity, type, and cause Simple fracture of long bone: reduction and immobilization Compound fracture: cleaning, debriding, reduction, immobilization Internal fixation (open reduction) Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 14

Traumatic and Sports Injuries (Cont’d.) Strains: injured tendons, muscles or other tissues resulting from overuse, overstretching, or excessive forcible stretching of the tissue beyond its functional capacity Sprains: acute partial tears of a ligament Discuss the differences between strains and sprains. Which is considered the more serious injury? Which symptoms do strains and sprains have in common? What is the difference between acute and chronic trauma? How long does it normally take for strains and sprains to heal? Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 15

Traumatic and Sports Injuries (Cont’d.) Treatment of Strains and Sprains Elevation and rest of affected limb Immobilization with elastic bandage Application of ice Analgesics and antiinflammatory agents Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 16

Traumatic and Sports Injuries (Cont’d.) Dislocation: the forcible displacement of a bone from its joint, causing loss of joint function Treatment: a physician should be seen immediately for proper repositioning of the joint Discuss the three most common causes of dislocation. What are possible consequences of untreated dislocation? Which joints are especially susceptible to recurring dislocation? What is Ehlers-Danlos syndrome? Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 17

Traumatic and Sports Injuries (Cont’d.) Severed tendon: caused by injury or laceration; involves the forearm, hand, calf, or foot; the severed ends snap away from each other Symptoms: immediate, severe pain, inflammation and immobility Treatment: tenorrhaphy (suturing of the two ends of the tendon) Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 18

Traumatic and Sports Injuries (Cont’d.) Shin splints: a painful condition involving inflammation of the periosteum, the extensor muscles of the lower leg, and the surrounding tissues Symptoms: inflammation, edema, pain on inner aspect of the tibia Treatment: rest plus applications of ice or heat What are the two most common causes of shin splints? Discuss the relationship of pronation to shin splints. When do shin splints usually begin to appear? Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 19

Traumatic and Sports Injuries (Cont’d.) Plantar fasciitis: an inflammatory response at the bottom of the heel bone, generally caused by overuse Symptoms: pain on bottom of foot Treatment Application of ice Antiinflammatory medication Heel pads Cortisone What is plantar fascia and what is its function? Refer to Figure 7-30 (p. 339). What conditions must be ruled out before plantar fasciitis can be diagnosed? Which people are most susceptible to plantar fasciitis? Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 20

Traumatic and Sports Injuries (Cont’d.) Torn meniscus: a crack or fissure to the meniscus cartilage in the knee joint Symptoms Acute pain when putting full weight on affected leg and knee Snapping or clicking on flexion or extension Treatment Immobilization and elevation Surgery What are the two types of meniscus cartilage in the knee joint? Refer to Figure 7-32 (p. 341). What is the preferred technology for diagnosing torn meniscus? Discuss arthroscopic surgery. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. 21