1. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 0

2. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 1 Chapter 7 Diseases and Conditions of the Musculoskeletal System Copyright © 2005 by Elsevier Inc. All rights reserved.

3. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 2 Learning Objectives  List the functions of the normal skeletal system.  Distinguish among the pathologic features of lordosis, kyphosis, and scoliosis.  Describe the signs and symptoms of the most common form of arthritis.  Explain the importance of early diagnosis and treatment of Lyme disease.

4. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 3 Learning Objectives (cont’d.)  Describe the treatment of bone tumors, both benign and malignant.  Discuss the specifics of a physical examination when fibromyalgia is suspected.  Explain why joint disability results from gout.  Describe the picture of osteomyelitis and explain how it is treated.

5. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 4 Learning Objectives (cont’d.)  Describe the disability that results from advanced osteoporosis.  Explain why osteomalacia is termed a metabolic bone disease.  Distinguish between hallus valgus and hallus rigidus.  Distinguish between a strain and a sprain.  Explain the importance of proper treatment of dislocations.

6. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 5 Learning Objectives (cont’d.)  Describe the cause of shin splints.  List some factors that contribute to the development of plantar fasciitis.  Explain how torn meniscus is treated.  Describe the signs and symptoms of rotator cuff tears.

7. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 6 Chapter 7 Lesson 7.1

8. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 7 The Muscular System

9. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 8 The Muscular System (cont.)  The 3 Types of Muscles  striated (skeletal)  nonstriated (smooth)  cardiac

10. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 9 The Muscular System (cont’d.)

11. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 10 The Skeletal System

12. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 11 The Skeletal System (cont.)  Types of Bones  long bones – humerus (upper arm)  short bones – carpal (wrist)  flat bones – scapula (shoulder)  sesamoid bones – patella (kneecap)

13. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 12 Joints

14. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 13 Skeletal tissue Ligaments: tough, dense, fibrous bands of connective tissue that hold bones together Tendons: strong, tough cords of dense connective tissue that usually attach muscle to bone Cartilage: semi-smooth, dense, supporting connective tissue

15. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 14 Fibromyalgia Fibromyalgia: a chronic pain condition associated with stiffness and tenderness that affects muscles, tendons, and joints throughout the body. The cause is unknown. Eighteen tender points used in diagnosis Treatment options Stress reduction Physical activity Medications

16. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 15 Major 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

17. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 16 Lordosis - Treatment Options  Weight loss  Exercises to strengthen abdomen  Pelvic tilt exercises

18. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 17 Kyphosis - Treatment Options  Exercises to strengthen muscles and ligaments  Back brace to stabilize condition  Spinal fusion and temporary immobilization  Vertebroplasty

19. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 18 Scoliosis - Treatment Options  Exercise to strengthen weak muscles  Back brace  Fusion of the vertebrae

20. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 19 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

21. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 20 Osteoarthritis (cont’d.)  Signs and symptoms  Spur formations on fingers  Degeneration of spinal vertebrae and pelvic joints  Diagnosis  Radiographic testing to exclude other causes  Treatment  Reduce inflammation, minimize pain

22. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 21 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 flu-like symptoms such as headache, fever, joint pain, and fatigue

23. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 22 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

24. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 23 Osteomyelitis Osteomyelitis: a serious infection of bone that requires aggressive antibiotic treatment  Caused by bacterial organisms, viruses, and fungi  Characterized by inflammation, swelling, redness, pain, localized heat, and tenderness

25. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 24 Osteomyelitis (cont’d.)  Treatment  long-term antibiotic treatment  increased intake of proteins and vitamins A, B, and C  bed rest  control of chronic conditions  Immobilization of affected part

26. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 25 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

27. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 26 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

28. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 27 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

29. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 28 Musculoskeletal Tumors (cont’d.)  Symptoms  palpable mass; dull, localized pain  pathologic fracture, commonly in acetabulum or proximal femur  Diagnosis  radiographic studies  elevated serum alkaline phosphatase  elevated serum calcium  Treatment  surgical excision  chemotherapy/radiation therapy

30. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 29 Chapter 7 Lesson 7.2

31. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 30 Osteoporosis Osteoporosis: a condition that features the loss of normal bone density due to imbalance between breakdown of old bone tissue and manufacture of new bone

32. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 31 Osteoporosis (cont’d.)  Symptoms  asymptomatic until bone breaks  spontaneous fractures and loss of height are the most common signs  Treatment  increased intake of calcium and vitamin D  estrogen replacement therapy  bisphosphonate medications  moderate exercise

33. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 32 Osteomalacia Osteomalacia: a disease characterized by a defective mineralization of the bones, causing them to become soft, flexible, and deformed  When osteomalacia occurs in children, it affects the growing skeleton and is called rickets

34. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 33 Osteomalacia (cont’d.)  Symptoms  general fatigue  muscle weakness  progressive stiffness  tender, painful bones  Treatment  vitamin D supplements  add vitamin D, calcium, and calcitonin to diet  exposure to sunlight

35. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 34 Hallus Valgus & Hallus Rigidus Hallus Valgus (Bunion): a localized area of enlargement of the inner portion of the metatarsophalangeal (MTP) joint at the base of the big toe Hallus Rigidus (Rigid Big Toe): a stiff big toe that develops as a result of degeneration of the cartilage of the first metatarsophalangeal (MTP) joint

36. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 35 Hallus Valgus & Hallus Rigidus (cont’d.)  Symptoms  painful bunions  MTP joint becomes stiff, painful, and swollen  Treatment  wearing shoes with more room  application of ice  anti-inflammatory agents  for hallux rigidus, removal of bone spurs

37. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 36 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

38. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 37 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

39. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 38 Traumatic and Sports Injuries (cont’d.)

40. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 39 Traumatic and Sports Injuries (cont’d.)

41. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 40 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

42. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 41 Treatment of Strains and Sprains  Elevation and rest of affected limb  Immobilization with elastic bandage  Application of ice  Analgesics and anti-inflammatory agents

43. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 42 Traumatic and Sports Injuries (cont’d.)  Dislocation: the forcible displacement of a bone from its joint, causing loss of joint function  Treatment  Proper repositioning of joint within 30 minutes of injury

44. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 43 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)

45. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 44 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

46. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 45 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  anti-inflammatory medication  heel pads  cortisone

47. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 46 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

48. Copyright 2005 © by Elsevier Inc. All rights reserved. Slide 47 Traumatic and Sports Injuries (cont’d.)  The rotator cuff: the four tendons of the rotator cuff, formed by the muscles of the shoulder, partially surround the head of the humerus and stabilize it in the glenoid cavity of the socket  Rotator cuff tears: tears to any of the rotator cuff tendons that limit the function of the shoulder