Alterations of Musculoskeletal Function Chapter 42 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

2 Overview Musculoskeletal injuries Musculoskeletal injuries Fractures, dislocations, sprains, and strains Fractures, dislocations, sprains, and strains Alterations in bones, joints, and muscles Alterations in bones, joints, and muscles Cause: metabolic disorders, infections, inflammatory/noninflammatory diseases, or tumors Cause: metabolic disorders, infections, inflammatory/noninflammatory diseases, or tumors Trauma: leading cause of death of people ages 1 to 44 years of all races and socioeconomic levels Trauma: leading cause of death of people ages 1 to 44 years of all races and socioeconomic levels

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 3 Musculoskeletal Injuries Fracture Fracture A break in the continuity of a bone A break in the continuity of a bone Occurs when force is applied that exceeds the tensile or compressive strength of the bone Occurs when force is applied that exceeds the tensile or compressive strength of the bone

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 4 Musculoskeletal Injuries Fracture classifications Fracture classifications Complete or incomplete Complete or incomplete Closed or open Closed or open Comminuted Comminuted Linear Linear Oblique Oblique Spiral Spiral

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 5 Fracture Classifications Transverse Transverse Greenstick Greenstick Torus Torus Bowing Bowing Pathologic Pathologic Stress Stress Fatigue and insufficiency Fatigue and insufficiency Transchondral Transchondral

7 Bone Fractures Broken bone can damage the surrounding tissue, the periosteum, and the blood vessels in the cortex and marrow Broken bone can damage the surrounding tissue, the periosteum, and the blood vessels in the cortex and marrow Hematoma formation Hematoma formation Bone tissue destruction triggers an inflammatory response Bone tissue destruction triggers an inflammatory response Procallus formation Procallus formation

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 9 Bone Fractures Manifestations Manifestations Unnatural alignment, swelling, muscle spasm, tenderness, pain, impaired sensation, and possible muscle spasms Unnatural alignment, swelling, muscle spasm, tenderness, pain, impaired sensation, and possible muscle spasms Treatment Treatment Closed manipulation, traction, open reduction Closed manipulation, traction, open reduction Improper reduction or immobilization Improper reduction or immobilization Nonunion, delayed union, and malunion Nonunion, delayed union, and malunion

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 10 Bone Fractures Improper reduction or immobilization Improper reduction or immobilization Nonunion Nonunion Failure of the bone ends to grow together Failure of the bone ends to grow together Gap between the broken ends of the bone fills with dense fibrous and fibrocartilaginous tissue Gap between the broken ends of the bone fills with dense fibrous and fibrocartilaginous tissue Occasionally the fibrous tissue contains a fluid-filled space that resembles a joint and is termed a false joint, or pseudarthrosis Occasionally the fibrous tissue contains a fluid-filled space that resembles a joint and is termed a false joint, or pseudarthrosis

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 11 Bone Fractures Improper reduction or immobilization Improper reduction or immobilization Delayed union Delayed union Does not occur until about 8 to 9 months after a fracture Does not occur until about 8 to 9 months after a fracture Malunion Malunion Healing of a bone in a nonanatomic position Healing of a bone in a nonanatomic position Treatment of delayed union and nonunion includes modalities designed to stimulate new bone formation Treatment of delayed union and nonunion includes modalities designed to stimulate new bone formation Implantable or external electric current devices, electromagnetic field generations, and low-density ultrasound Implantable or external electric current devices, electromagnetic field generations, and low-density ultrasound Gene therapy Gene therapy Large defects in bone can be filled with bone graft or synthetic materials, such as calcium phosphate cement Large defects in bone can be filled with bone graft or synthetic materials, such as calcium phosphate cement

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 14 Bone Fractures Dislocation Dislocation Temporary displacement of two bones Temporary displacement of two bones Loss of contact between articular cartilage Loss of contact between articular cartilage Subluxation Subluxation Contact between articular surfaces is only partially lost Contact between articular surfaces is only partially lost Dislocation and subluxation associated with fractures, muscle imbalance, rheumatoid arthritis, other joint instability Dislocation and subluxation associated with fractures, muscle imbalance, rheumatoid arthritis, other joint instability

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 15 Support Structure Injuries Strain Strain Tear or injury to a tendon Tear or injury to a tendon Sprain Sprain Tear or injury to a ligament Tear or injury to a ligament Avulsion Avulsion Complete separation of a tendon or ligament from its bony attachment site Complete separation of a tendon or ligament from its bony attachment site

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 16 Tendinopathy and Bursitis Tendinitis Tendinitis Inflammation of a tendon Inflammation of a tendon Tendinosis Tendinosis Painful degradation of collagen fibers Painful degradation of collagen fibers Bursitis Bursitis Inflammation of a bursa Inflammation of a bursa Skin over bone, skin over muscle, and muscle and tendon over bone Skin over bone, skin over muscle, and muscle and tendon over bone Caused by repeated trauma Caused by repeated trauma Septic bursitis is caused by a wound infection Septic bursitis is caused by a wound infection

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 17 Tendinopathy and Bursitis Epicondylitis Epicondylitis Inflammation of a tendon where it attaches to a bone Inflammation of a tendon where it attaches to a bone Tennis elbow (lateral epicondylitis) Tennis elbow (lateral epicondylitis) Golfers elbow (medial epicondylitis) Golfers elbow (medial epicondylitis)

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 20 Muscle Strain Sudden, forced motion causing the muscle to become stretched beyond its normal capacity Sudden, forced motion causing the muscle to become stretched beyond its normal capacity Local muscle damage Local muscle damage Muscle strains can also involve the tendons Muscle strains can also involve the tendons

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 21 Myositis Ossificans Complication of local muscle injury Complication of local muscle injury Inflammation of muscular tissue with subsequent calcification and ossification of the muscle Inflammation of muscular tissue with subsequent calcification and ossification of the muscle Riders bone in equestrians Riders bone in equestrians Drill bone in infantry soldiers Drill bone in infantry soldiers Thigh muscles in football players Thigh muscles in football players

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 22 Rhabdomyolysis Rhabdomyolysis (myoglobinuria) is a life- threatening complication of severe muscle trauma with muscle cell loss Rhabdomyolysis (myoglobinuria) is a life- threatening complication of severe muscle trauma with muscle cell loss Crush syndrome Crush syndrome Compartment syndromes Compartment syndromes

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 23 Osteoporosis Porous bone Porous bone Poorly mineralized bone Poorly mineralized bone Bone density Bone density Normal bone Normal bone 833 mg/cm 2 833 mg/cm 2 Osteopenic bone Osteopenic bone 833 to 648 mg/cm 2 833 to 648 mg/cm 2 Osteoporosis Osteoporosis <648 mg/cm 2 <648 mg/cm 2

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 24 Osteoporosis Potential causes Potential causes Decreased levels of estrogen and testosterone Decreased levels of estrogen and testosterone Decreased activity level Decreased activity level Inadequate levels of vitamins D and C, or Mg ++ Inadequate levels of vitamins D and C, or Mg ++ Reduced bone mass/density and an imbalance of bone resorption and formation Reduced bone mass/density and an imbalance of bone resorption and formation Bone histology is usually normal but it lacks structural integrity Bone histology is usually normal but it lacks structural integrity

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 27 Osteoporosis Perimenopausal osteoporosis Perimenopausal osteoporosis Iatrogenic osteoporosis Iatrogenic osteoporosis Regional osteoporosis Regional osteoporosis Postmenopausal osteoporosis Postmenopausal osteoporosis Glucocorticoid-induced osteoporosis Glucocorticoid-induced osteoporosis Age-related bone loss Age-related bone loss Manifestations Manifestations Pain, bone deformity, fractures, kyphosis Pain, bone deformity, fractures, kyphosis

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 28 Osteoporosis Postmenopausal osteoporosis Postmenopausal osteoporosis Occurs in middle-aged and older women Occurs in middle-aged and older women Serum androgens influence bone density Serum androgens influence bone density Androgens (i.e., testosterone and dihydrotestosterone) stimulate bone formation Androgens (i.e., testosterone and dihydrotestosterone) stimulate bone formation Testosterone converted to estradiol by the enzyme aromatase is associated with declining levels of estrogen Testosterone converted to estradiol by the enzyme aromatase is associated with declining levels of estrogen Progesterone deficiency may also be related to osteoporosis Progesterone deficiency may also be related to osteoporosis

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 29 Osteoporosis Postmenopausal osteoporosis Postmenopausal osteoporosis Probably caused by changes in osteoprotegerin, insulin-like growth factor (IGF), a combination of inadequate dietary calcium intake and lack of vitamin D, decreased magnesium, lack of exercise, decreased levels of estrogen, and family history Probably caused by changes in osteoprotegerin, insulin-like growth factor (IGF), a combination of inadequate dietary calcium intake and lack of vitamin D, decreased magnesium, lack of exercise, decreased levels of estrogen, and family history IGF levels significantly decline by age 60. Excessive phosphorus intake, chiefly through sodas and junk foods, interferes with the calcium/phosphorus balance; results in increased risk of brittle bones IGF levels significantly decline by age 60. Excessive phosphorus intake, chiefly through sodas and junk foods, interferes with the calcium/phosphorus balance; results in increased risk of brittle bones

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 30 Osteomalacia Deficiency of vitamin D lowers the absorption of calcium from the intestines Deficiency of vitamin D lowers the absorption of calcium from the intestines Inadequate or delayed mineralization Inadequate or delayed mineralization Bone formation progresses to osteoid formation but calcification does not occur; the result is soft bones Bone formation progresses to osteoid formation but calcification does not occur; the result is soft bones Pain, bone fractures, vertebral collapse, bone malformation Pain, bone fractures, vertebral collapse, bone malformation

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 31 Paget Disease Also called osteitis deformans Also called osteitis deformans Excessive resorption of spongy bone and accelerated formation of softened bone Excessive resorption of spongy bone and accelerated formation of softened bone Disorganized, thickened, but soft bones Disorganized, thickened, but soft bones Most often affects the axial skeleton Most often affects the axial skeleton Thickened bones can cause abnormal bone curvatures, brain compression, impaired motor function, deafness, atrophy of the optic nerve Thickened bones can cause abnormal bone curvatures, brain compression, impaired motor function, deafness, atrophy of the optic nerve

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 32 Osteomyelitis Usually caused by a staphylococcal infection Usually caused by a staphylococcal infection Often from open wound (exogenous); also can be from a blood-borne (endogenous) infection Often from open wound (exogenous); also can be from a blood-borne (endogenous) infection Manifestations Manifestations Acute and chronic inflammation, fever, pain, necrotic bone Acute and chronic inflammation, fever, pain, necrotic bone Treatment Treatment Antibiotics, débridement, surgery, hyperbaric oxygen therapy Antibiotics, débridement, surgery, hyperbaric oxygen therapy

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 34 Bone Tumors May originate from bone cells, cartilage, fibrous tissue, marrow, or vascular tissue May originate from bone cells, cartilage, fibrous tissue, marrow, or vascular tissue Osteogenic, chondrogenic, collagenic, and myelogenic Osteogenic, chondrogenic, collagenic, and myelogenic Malignant bone tumors Malignant bone tumors Increased nuclear/cytoplasmic ratio, irregular borders, excess chromatin, a prominent nucleolus, and an increase in the mitotic rate Increased nuclear/cytoplasmic ratio, irregular borders, excess chromatin, a prominent nucleolus, and an increase in the mitotic rate

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 36 Bone Tumors Patterns of bone destruction Patterns of bone destruction Geographic pattern Geographic pattern Moth-eaten pattern Moth-eaten pattern Permeative pattern Permeative pattern

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 37 Bone Tumors Osteosarcoma Osteosarcoma 38% of bone tumors 38% of bone tumors Predominant in adolescents and young adults; occurs in seniors if a history of radiation therapy Predominant in adolescents and young adults; occurs in seniors if a history of radiation therapy Contain masses of osteoid Contain masses of osteoid Streamers: noncalcified bone matrix and callus Streamers: noncalcified bone matrix and callus Located in the metaphyses of long bones Located in the metaphyses of long bones 50% occur around the knees 50% occur around the knees

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 39 Bone Tumors Chondrosarcoma Chondrosarcoma Tumor of middle-aged and older adults Tumor of middle-aged and older adults Infiltrates trabeculae in spongy bone; frequent in the metaphyses or diaphysis of long bones Infiltrates trabeculae in spongy bone; frequent in the metaphyses or diaphysis of long bones The tumor contains lobules of hyaline cartilage that expand and enlarge the bone The tumor contains lobules of hyaline cartilage that expand and enlarge the bone Causes erosion of the cortex and can expand into the neighboring soft tissues Causes erosion of the cortex and can expand into the neighboring soft tissues

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 41 Bone Tumors Fibrosarcoma Fibrosarcoma Firm, fibrous mass of collagen, malignant fibroblasts, and osteoclast-like cells Firm, fibrous mass of collagen, malignant fibroblasts, and osteoclast-like cells Usually affects metaphyses of the femur or tibia Usually affects metaphyses of the femur or tibia Metastasis to the lungs is common Metastasis to the lungs is common

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 42 Bone Tumors Myelogenic tumors Myelogenic tumors Giant cell tumor Giant cell tumor Causes extensive bone resorption due to the osteoclastic origin of the giant cells Causes extensive bone resorption due to the osteoclastic origin of the giant cells Located in the epiphyses of the femur, tibia, radius, or humerus Located in the epiphyses of the femur, tibia, radius, or humerus The tumor has a slow, relentless growth rate The tumor has a slow, relentless growth rate Myeloma Myeloma

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 44 Inflammatory vs. Noninflammatory Joint Disease Differentiated by: Differentiated by: Absence of synovial membrane inflammation Absence of synovial membrane inflammation Lack of systemic signs and symptoms Lack of systemic signs and symptoms Normal synovial fluid analysis Normal synovial fluid analysis

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 45 Osteoarthritis Degeneration and loss of articular cartilage, sclerosis of bone underneath cartilage, and formation of bone spurs (osteophytes) Degeneration and loss of articular cartilage, sclerosis of bone underneath cartilage, and formation of bone spurs (osteophytes) Also called degenerative joint disease Also called degenerative joint disease Incidence increases with age Incidence increases with age Primary disease is idiopathic Primary disease is idiopathic

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 46 Osteoarthritis Local areas of damage and loss of articular cartilage, new bone formation of joint margins, subchondral bone changes, and variable degrees of mild synovitis and thickening of the joint capsule Local areas of damage and loss of articular cartilage, new bone formation of joint margins, subchondral bone changes, and variable degrees of mild synovitis and thickening of the joint capsule Manifestations Manifestations Pain, stiffness, enlargement of the joint, tenderness, limited motion, and deformity Pain, stiffness, enlargement of the joint, tenderness, limited motion, and deformity

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 49 Inflammatory Joint Disease Commonly called arthritis Commonly called arthritis Inflammatory damage or destruction in synovial membrane or articular cartilage and by systemic signs of inflammation Inflammatory damage or destruction in synovial membrane or articular cartilage and by systemic signs of inflammation Fever, leukocytosis, malaise, anorexia, and hyperfibrinogenemia Fever, leukocytosis, malaise, anorexia, and hyperfibrinogenemia Infectious or noninfectious Infectious or noninfectious

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 50 Rheumatoid Arthritis (RA) Inflammatory joint disease Inflammatory joint disease Systemic autoimmune damage to connective tissue, primarily in joints (synovial membrane) Systemic autoimmune damage to connective tissue, primarily in joints (synovial membrane) Similar symptoms to osteoarthritis Similar symptoms to osteoarthritis Presence of rheumatoid factors (RA or RF test) Presence of rheumatoid factors (RA or RF test) Antibodies (IgG and IgM) against antibodies Antibodies (IgG and IgM) against antibodies Joint fluid presents with inflammatory exudate Joint fluid presents with inflammatory exudate

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 51 Rheumatoid Arthritis (RA) Pathogenesis Pathogenesis CD4 T helper cells and other cells in the synovial fluid become activated and release cytokines CD4 T helper cells and other cells in the synovial fluid become activated and release cytokines Recruitment and retention of inflammatory cells in the joint sublining region Recruitment and retention of inflammatory cells in the joint sublining region Cycle of altered cytokine and signal transduction pathways Cycle of altered cytokine and signal transduction pathways Possible immune complex deposition and inflammatory cytokine release Possible immune complex deposition and inflammatory cytokine release RANKL release and osteoclast activation RANKL release and osteoclast activation Angiogenesis in the synovium Angiogenesis in the synovium

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 52 Rheumatoid Arthritis (RA) Evaluation (4 or more of the following) Evaluation (4 or more of the following) Morning joint stiffness lasting at least 1 hour Morning joint stiffness lasting at least 1 hour Arthritis of three or more joint areas Arthritis of three or more joint areas Arthritis of the hand joints Arthritis of the hand joints Symmetric arthritis Symmetric arthritis Rheumatoid nodules Rheumatoid nodules Abnormal amounts of serum rheumatoid factor Abnormal amounts of serum rheumatoid factor Radiographic changes Radiographic changes

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 55 Ankylosing Spondylitis (AS) Inflammatory joint disease of the spine or sacroiliac joints causing stiffening and fusion of the joints Inflammatory joint disease of the spine or sacroiliac joints causing stiffening and fusion of the joints Systemic, immune inflammatory disease Systemic, immune inflammatory disease Primary proposed site is the enthesis Primary proposed site is the enthesis Site where ligaments, tendons, and the joint capsule are inserted into bone Site where ligaments, tendons, and the joint capsule are inserted into bone Cause unknown, but strong association with HLA-B27 antigen Cause unknown, but strong association with HLA-B27 antigen

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 56 Ankylosing Spondylitis (AS) Begins with the inflammation of fibrocartilage, particularly in the vertebrae and sacroiliac joint Begins with the inflammation of fibrocartilage, particularly in the vertebrae and sacroiliac joint Inflammatory cells infiltrate, erode fibrocartilage Inflammatory cells infiltrate, erode fibrocartilage As repair begins, scar tissue ossifies and calcifies; joint eventually fuses As repair begins, scar tissue ossifies and calcifies; joint eventually fuses Early symptoms Early symptoms Low back pain, stiffness, pain, and restricted motion Low back pain, stiffness, pain, and restricted motion Loss of normal lumbar curvature Loss of normal lumbar curvature

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 58 Gout Metabolic disorder that disrupts the bodys control of uric acid production or excretion Metabolic disorder that disrupts the bodys control of uric acid production or excretion Manifests high levels of uric acid in the blood and other body fluids Manifests high levels of uric acid in the blood and other body fluids Occurs when the uric acid concentration increases to high enough levels to crystallize Occurs when the uric acid concentration increases to high enough levels to crystallize Crystals deposit in connective tissues throughout the body Crystals deposit in connective tissues throughout the body When these crystals occur in the synovial fluid, the inflammation is known as gouty arthritis When these crystals occur in the synovial fluid, the inflammation is known as gouty arthritis

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 59 Gout Related to purine (adenine and guanine) metabolism Related to purine (adenine and guanine) metabolism Affected people can have accelerated purine synthesis, breakdown, or poor uric acid secretion in the kidneys Affected people can have accelerated purine synthesis, breakdown, or poor uric acid secretion in the kidneys Mechanisms for crystal deposition Mechanisms for crystal deposition Lower body temperatures, decreased albumin or glycosaminoglycan levels, changes in ion concentration and pH, and trauma Lower body temperatures, decreased albumin or glycosaminoglycan levels, changes in ion concentration and pH, and trauma

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 60 Gout Clinical stages Clinical stages Asymptomatic hyperuricemia Asymptomatic hyperuricemia Acute gouty arthritis Acute gouty arthritis Tophaceous gout Tophaceous gout

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 63 Disorders of Skeletal Muscle Contracture Contracture Muscle fiber shortening without an action potential Muscle fiber shortening without an action potential Cause: failure of the sarcoplasmic reticulum (calcium pump) even with available ATP Cause: failure of the sarcoplasmic reticulum (calcium pump) even with available ATP Stress-induced muscle tension Stress-induced muscle tension Neck stiffness, back pain, clenching teeth, hand grip, and headache Neck stiffness, back pain, clenching teeth, hand grip, and headache Associated with chronic anxiety Associated with chronic anxiety

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 64 Fibromyalgia Chronic widespread joint and muscle pain Chronic widespread joint and muscle pain Vague symptoms Vague symptoms Increased sensitivity to touch, absence of inflammation, fatigue, sleep disturbances Increased sensitivity to touch, absence of inflammation, fatigue, sleep disturbances Possible factors Possible factors Flu-like viral illness, chronic fatigue syndrome, HIV infection, Lyme disease, medications, physical or emotional trauma Flu-like viral illness, chronic fatigue syndrome, HIV infection, Lyme disease, medications, physical or emotional trauma Scientific studies are unclear Scientific studies are unclear

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 66 Disuse Atrophy Reduction in the normal size of muscle cells due to prolonged inactivity Reduction in the normal size of muscle cells due to prolonged inactivity Bed rest, trauma, casting, or nerve damage Bed rest, trauma, casting, or nerve damage Treatment Treatment Isometric movements and passive lengthening exercises Isometric movements and passive lengthening exercises

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 67 Muscle Membrane Abnormalities Myotonia Myotonia Periodic paralysis Periodic paralysis Hypokalemic periodic paralysis Hypokalemic periodic paralysis Hyperkalemic periodic paralysis Hyperkalemic periodic paralysis

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 68 Diseases of Energy Metabolism McArdle disease McArdle disease Myophosphorylase deficiency Myophosphorylase deficiency Acid maltase deficiency Acid maltase deficiency Pompe disease Pompe disease Myoadenylate deaminase deficiency (MDD) Myoadenylate deaminase deficiency (MDD) Lipid deficiencies Lipid deficiencies

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 69 Polymyositis and Dermatomyositis Collectively described as myositis Collectively described as myositis Viral, bacterial, and parasitic myositis Viral, bacterial, and parasitic myositis Staphylococcus aureus infections Staphylococcus aureus infections Trichinosis Trichinosis Trichinella infection Trichinella infection Toxoplasmosis Toxoplasmosis

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 71 Toxic Myopathies Most common cause is alcohol abuse Most common cause is alcohol abuse Acute attack of muscle weakness, pain, and swelling Acute attack of muscle weakness, pain, and swelling Chronic weakness in a drinker of long duration Chronic weakness in a drinker of long duration Necrosis of individual muscle fibers Necrosis of individual muscle fibers Disturbance of energy turnover, gene dysregulation, and initiation of apoptosis Disturbance of energy turnover, gene dysregulation, and initiation of apoptosis

Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 72 Muscle Tumors Rhabdomyosarcoma Rhabdomyosarcoma Malignant tumor of striated muscle Malignant tumor of striated muscle Usually muscles of the tongue, neck, larynx, nasal cavity, axilla, vulva, and heart Usually muscles of the tongue, neck, larynx, nasal cavity, axilla, vulva, and heart Highly malignant with rapid metastasis Highly malignant with rapid metastasis Types Types Pleomorphic, embryonal, and alveolar Pleomorphic, embryonal, and alveolar

Alterations of Musculoskeletal Function Chapter 42 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

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Alterations of Musculoskeletal Function Chapter 42 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

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