2. Skeletal System - Pathologies Flashcards
Fractures
Any break in a bone
Causes include trauma, low bone density (osteoporosis), vitamin D deficiency
Types of Fractures
Complete - bone is broken in two of more fragments
Incomplete - not in fragments
Avulsion - tendon or ligament pulls off a piece of bone
Fracture repair (4 stages)
- H
- FCF
3: BCF
4: BR
- Haematoma (& inflammation): Blood vessels at fracture line are broken and blood leaks into site. Causes death of local cells and swelling.
- Fibrocartilaginous callus formation: Phagocytes clean up the debris. Fibroblasts invade & lay down collagen forming a ‘soft callus’ (2-3 weeks).
- Bony callus formation: Osteoblasts replace cart with new bone(<3 months).
- Bone remodelling:The callus is mineralised & compact bone laid down. Then Osteoclasts reshape the new bone. Remodelling occurs over months to years.
Sprains
Involve a trauma that fores a joint beyond its normal range, over-straining / tearing ligaments
Subluxation
Incomplete or partial joint dislocation
Dislocation
Complete separation of the two bones at a joint
Kyphosis
Rounding of the upper back.
Lordosis
Increased concavity in the lumbar and cervical spine
Scoliosis
A lateral S-shaped curve in the spine
Osteoporosis
Chronic, progressive thinning of the bone (porous bone).
Characterised by decreased bone mineral density leading to bone fragility & and an increased risk of fracture
Diagnosed by ‘Dual X-Ray Absorptiometry’
Osteoporosis: Risk Factors
Increasing age -> over 30 Female and post-menopausal Poor diet Drugs -> long term corticosteroid therapy GIT diseases Genetics Sedentary lifestyle Endrocrine pathologies (Cushings, hyperparathyroidism) Low body weight High alcohol consumption and smoking Toxins (heavy metals)
Osteoporosis: Signs & Symptoms
Fractures with minor trauma
Focal pain and kyphotic posture with loss of height
Pain is aggravated by prolongued sitting, standing or bending, relieved by lying on side with hips & knees flexed
Osteorporosis: Treatment
Bisphosphonates (AledronicAcid)
HRT
Osteomalacia and Rickets
Inadequate mineralisation of the bone matrix in spongy and compact bone.
Softening of bone
Rickets - prior to epiphyseal plate closure >18yo
Osteomalacia - as adult or adolescent
Osteomalacia and Rickets: Causes
Vitamin D deficiency, possibly due to:
• Insufficient sunlight.
• Insufficient dietary vitamin D.
• Secondary deficiency: malabsorption disorders.
•Reduced receptor sites for vitamin D in tissues
Osteomalacia and Rickets: Signs and Symptoms.
Three points
- Deformed bones (bowed legs) & possible fractures.
- Severe back pain & muscle weakness.
- In Rickets:Delayed closure of fontanelles and skull softening.
Osteomyelitis
A bacterial infection of the bone marrow, resulting in necrosis and hence bone weakness.
Diagnosed by
• Bloods: Elevated inflammatory markers(ESR/CRP) & WBC’s.
• X-ray, MRI.
Osteomyelitis: Causes
- Bacterial infection(staphylococcus aureus) through the blood supply or post-fracture.
- Immunosuppression, diabetes, IV drug users.
Osteomyelitis: Signs and Symptoms
Presents as severe bone pain (often worse at night), with swelling, redness and warmth.
Osteoarthritis
A degenerative wear & tear arthritis of the articular cartilage, typically affecting weight bearing (larger) joints in individuals typically over 50 years of age.
Osteoarthritis: Causes
• Primary:A ssociated with aging. 80% of 65 year old’s have radiological signs of OA.
• Secondary: Associated with predisposing factors:
Congenital ill-development.
Trauma –e.g. fractures, surgery, meniscal injury, obesity.
Osteoarthritis: Signs and Symptoms
- Onset is gradual, pain increasing (months –years).
- Joint pain and stiffness.
- Not associated with systemic symptoms.
Osteoarthritis: Pathophysiology
- Articular cartilage wears away; underlying bone is exposed.
- Subchondral bone becomes hard and glossy (‘eburnation’).
- Remodelling of underlying bone (i.e. thickening) occurs.
- Compensatory bone overgrowth in an attempt to stabilise joint = Osteophytes(spurs).
Rheumatoid Arthritis
Autoimmune inflammation of the synovium, potentially affecting ALL organs except the brain (systemic inflammation).
• Affects 1% of people worldwide, ↑ in women.
• Peak occurrence between 30–50 years of age
Rheumatoid Arthritis: Causes
- Geneticmarkers (HLA-DR4 & DR1).
- Infectious agents e.g. EBV, rubella.
- Abnormal intestinal permeability, Small Intestinal Bacterial Overgrowth (SIBO), smoking.
Rheumatoid Arthritis: Signs and Symptoms
- Symmetrical/bilateral arthritis of small joints (hands and feet mostly).
- Gradually spreads through more proximal structures.
- Progressive morning stiffness (>1 hour).
- Deformity of jointse.g. swan neck, ulnar deviation.
- General malaise and fatigue.
- Subcutaneous nodules (around fingers and elbows).
- C1/2 subluxation & compression of the spinal cord leading to paralysis neurological complications.
- Kidney problems.
Rheumatoid Arthritis: Treatment
- Anti-inflammatories and immunosuppressants
* Surgery.
Ankylosing Spondylitis (AS)
• AS is a systemic autoimmune disease associated with chronic inflammation of the spine & sacroilliacjoints, often leading to spinal fusion (‘ankylosis’) & stiffness.
Ankylosing Spondylitis (AS): Causes
- Age of onset is typically between 15-30 years of age, more commonly affecting males.
- Strong genetic association with HLA-B27 (present in 95% of AS patients).
- Links with inflammatory bowel diseases (& leaky gut), as well as uro-genital or intestinal infectionssuch as Salmonella & Shigella cross-reacting with HLA-B27.
Ankylosing Spondylitis (AS): Signs and Symptoms
• Typically begins with sacroiliac and low lumbar
spine pain, before progressing up the spine. Associated with worsening morning stiffness.
• Lower back symptoms often improve with activity.
• The lumber lordosis flattens & patients often
become kyphotic.
• Hip and heel (Achilles) pain are common.
• 20% suffer acute iritis –(HLA-B27diseases)
• Systemic symptoms: fever, fatigue & malaise.
Ankylosing Spondylitis (AS): Diagnosis
• Elevated blood inflammatory markers
(ESR/CRP), HLA-B27 positive.
• X-Ray/MRI – identifies characteristic
‘bamboo spine’.
Ankylosing Spondylitis (AS): Treatment
Surgery, anti-inflammatories (including non-steroidal and steroids).
Gout
Gout is a type of monoarthritis, characterised by uric acid crystal deposition in synovial joints.
• One of the most common forms of arthritis in men (10:1 women), over 40 years of age.
• Excess uric acid forms solid crystals (monosodium urate) on cartilage surfaces.
• This causes white blood cells to infiltrate activating an acute inflammatory response.
• ‘Hyperuricaemia’= elevated blood uric acid levels due to overproduction or underexcretion.
• Uric acid is derived from the breakdown of ‘purines’.
Gout: Causes
• Increased intake of purine rich foods (red
meat, organ meats, shellfish etc).
• Dehydration, kidney disease, obesity, excessive alcohol consumption (competes with uric acid for elimination by the kidney & accelerates purine breakdown), hypertension, type II diabetes.
Gout: Diagnosis
- Blood serum for uric acid (not definitive fluctuates) but can be useful to monitor treatment.
- Analysis of synovial fluid (needle aspiration).
Gout: Signs and Symptoms
- Most often affects the big toe. Can affect the mid-feet, ankles, knees, elbows, hands.
- Usually monoarticular (one joint).
- Sudden onset of intensely painful, red, hot & swollen joints, often lasting 12-24 hours. Shiny skin over joint.
- Urate crystals can deposit under the skin and produce ‘tophi’.
Gout: Treatment
- ‘Allopurinol’ to prevent episodes (hepatotoxic).
- Corticosteroid injection(Side effects:Indigestion, rapid heartbeat, nausea, insomnia, mood changes, diabetes, glaucoma, mood changes).
Disc Herniation
- The nucleus pulposus of the intervertebral disc leaks out through the annulus fibrosis.
- This tends to affect discs with the highest fluid content (30-40 yearsof age). Most commonly lumbar spine (L5/S1), then cervical spine.
- The classic injury mechanism is combined lumbar spine flexion (bending) and rotation.
- A herniated disc cancompress spinal nerves.
Disc Herniation - Treatment
Manual therapy & exercise
Steroid injection
Surgery
Bursitis
Inflammation of the bursae
Bursitis: Causes
Repetitive use (overhead painting) Sudden trauma, infection, wear and tear
