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Biomedicine > 2. Skeletal System - Pathologies > Flashcards

2. Skeletal System - Pathologies Flashcards

1
Q

Fractures

A

Any break in a bone

Causes include trauma, low bone density (osteoporosis), vitamin D deficiency

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2
Q

Fracture types

A

Complete - bone is broken in two of more fragments. Can be either open (perforated skin) OR closed (soft tissues not compromised)

Incomplete - not in fragments

Avulsion - tendon or ligament pulls off a piece of bone

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3
Q

Fracture repair

A
  1. Haematoma (and inflammation):
    Blood vessels at fracture line are broken and blood leaks into site. Causes death of local cells and swelling.
  2. Fibrocartilaginous callus information:
    Phagocytes clean up the debris. Fibroblasts invade and lay down collagen forming a ‘soft callus’ (2-3 weeks)
  3. Bony callus formation:
    Osteoblasts replace soft callus with new bone (three months)
  4. Bone remodelling:
    The callus is mineralised and compact bone laid down. Then osteoclasts reshape the new bone. Remodelling occurs over three months to years.
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4
Q

Fracture treatment

A

Address potential causes of fracture (i.e. underlying nutritional deficiencies, osteoporosis, etc). Improve circulation and nutrients to the bone to aid repair

Nutrients: Calcium, Vitamin D, Vitamin C

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5
Q

Sprains

A

Involves a trauma that forces a joint beyond its normal range, over-straining / tearing ligaments

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6
Q

Sprain treatment

A

RICE: Rest, Ice, Compression, Elevation

Nutrients: Glucosamine, Vit C, Zinc, Vit E

Manual therapy & rehab / exercise is critical to ensure it repeat

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7
Q

Subluxation

A

Incomplete or partial joint dislocation

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8
Q

Dislocation

A

Complete separation of the two bones at a joint

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9
Q

Kyphosis

A

Rounding of the upper back

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10
Q

Lordosis

A

Increased concavity in the lumbar and cervical spine

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11
Q

Scoliosis

A

A lateral S-shaped curve in the spine

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12
Q

Osteoporosis

A

Osteoporosis describes chronic, progressive thinning of the bone (porous bone)

Characterised by decreased bone mineral density (BMD), leading to bone fragility & increased risk of fracture

Diagnosed by ‘dual x-ray absorptiometry’ (a DXA scan). T-Score lower than -2.5 indicates osteoporosis

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13
Q

Osteoporosis: Risk Factors

A 
Increasing age -> over 30
Female and post-menopausal
Poor diet
Drugs -> long term corticosteroid therapy
GIT diseases
Genetics
Sedentary lifestyle
Endocrine pathologies (Cushings, hyperparathyroidism)
Low body weight
High alcohol consumption and smoking
Toxins (heavy metals)
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14
Q

Osteoporosis: Signs & Symptoms

A

Asymptomatic until the bone has reached critical thinness

Fractures with minor trauma
Focal pain and kyphotic posture with loss of height

Pain is aggravated by prolonged sitting, standing or bending, relieved by lying on side with hips & knees flexed

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15
Q

Osteoporosis: Treatment

A

Bisphosphonates (Alendronic Acid)

HRT

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16
Q

Osteomalacia and Rickets

A

Inadequate mineralisation of the bone matrix in spongy and compact bone

Decalcification & softening of bone (spine, pelvis & legs)

Rickets - prior to epiphyseal plate closure (< 18yrs)
Osteomalacia - adult or adolescent

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17
Q

Osteomalacia and Rickets: Causes

A

Vitamin D deficiency, possibly due to:

Insufficient sunlight
Insufficient dietary vitamin D
Secondary deficiency: malabsorption disorders
Reduced receptor sites for vitamin D in tissues

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18
Q

Osteomalacia and Rickets: Signs and Symptoms

A 
Deformed bones (bowed legs) & possible fractures
Severe back pain & muscle weakness

In Rickets: Delayed closure of fontanelles and skull softening

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19
Q

Osteomyelitis

A

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.

20
Q

Osteomyelitis: Signs and Symptoms

A

Presents as severe bone pain (often worse at night), with swelling, redness and warmth.

21
Q

Osteomyelitis: Causes

A

Bacterial infection (staphylococcus aureus) through the blood supply or post-fracture

Immunosuppression, diabetes, IV drug users

22
Q

Osteoarthritis

A

A degenerative wear & tear arthritis of the articular cartilage, typically affecting weight bearing (larger) joints in individuals typically over 50 years of age

23
Q

Osteoarthritis: Signs and Symptoms

A

Onset is gradual, pain increasing (months –years).
Joint pain and stiffness

Not associated with systemic symptoms

24
Q

Osteoarthritis: Causes

A

Primary: associated with ageing 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.
25
Q

Osteoarthritis: Diagnosis

A

X-ray - revealing joint space narrowing, osteophyte (bone spur) formation, squaring of rounded joint surfaces

26
Q

Osteoarthritis: Pathophysiology

A
  1. Articular cartilage wears away; underlying bone is exposed
  2. Subchondral bone becomes hard and glossy (‘eburnation’)
  3. Remodelling of underlying bone (i.e. thickening) occurs
  4. Compensatory bone overgrowth in an attempt to stabilise joint = Osteophytes (spurs)
27
Q

Osteoarthritis: Treatment

A

NSAIDs, joint replacement

28
Q

Rheumatoid Arthritis

A

Autoimmune inflammation of the synovium, potentially affecting ALL organs except the brain (systemic inflammation)

  • Affects 1% of people worldwide, higher in women.
  • Peak occurrence between 30–50 years of age
29
Q

Rheumatoid Arthritis: Causes

A 
Genetic markers (HLA-DR4 & DR1).
Infectious agents e.g. EBV, rubella.

Abnormal intestinal permeability, Small Intestinal Bacterial Overgrowth (SIBO), smoking.

30
Q

Rheumatoid Arthritis: Signs and Symptoms

A
  • Symmetrical/bilateral arthritis of small joints (hands and feet mostly)
  • Gradually spreads through more proximal structures
  • Progressive morning stiffness (>1 hour)
  • Deformity of joints e.g. swan neck, ulnar deviation
  • General malaise and fatigue
  • Subcutaneous nodules (around fingers and elbows)
  • C1/C2 subluxation & compression of the spinal cord leading to paralysis neurological complications
  • Kidney problems
31
Q

Rheumatoid Arthritis: Treatment

A

Anti-inflammatories and immunosuppressants (significant implications)

Surgery

32
Q

Ankylosing Spondylitis (AS)

A

AS is a systemic autoimmune disease associated with chronic inflammation of the spine & sacroiliac joints, often leading to spinal fusion (‘ankylosis’) & stiffness

33
Q

Ankylosing Spondylitis (AS): Causes

A

Age of onset is typically between 15-30 years (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 urogenital or intestinal infections such as Salmonella & Shigella cross-reacting with HLA-B27

34
Q

Ankylosing Spondylitis (AS): Signs and Symptoms

A

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

35
Q

Ankylosing Spondylitis (AS): Diagnosis

A

Elevated blood inflammatory markers (ESR/CRP), HLA-B27 positive.

X-Ray/MRI – identifies characteristic ‘bamboo spine’.

36
Q

Ankylosing Spondylitis (AS): Treatment

A

Surgery

Anti-inflammatories (including non-steroidal and steroids).

37
Q

Gout

A

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’.
38
Q

Gout: Causes

A

Increased intake of purine rich foods (red meat, organ meats, shellfish etc)

Dehydration, kidney disease, medications, obesity, excessive alcohol consumption (competes with uric acid for elimination by the kidneys & accelerates purine breakdown), hypertension, type II diabetes

39
Q

Gout: Diagnosis

A

Blood serum for uric acid (not definitive/fluctuates) but can be useful to monitor treatment

Analysis of synovial fluid (needle aspiration).

40
Q

Gout: Signs and Symptoms

A

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’.

41
Q

Gout: Treatment

A

‘Allopurinol’ to prevent episodes (hepatotoxic)

Corticosteroid injection(side effects: indigestion, rapid heartbeat, nausea, insomnia, mood changes, diabetes, glaucoma, mood changes)

42
Q

Disc Herniation

A

The nucleus pulposus of the intervertebral disc leaks out through the annulus fibrosis

This tends to affect discs with the highest fluid content, most commonly lumbar spine (L5/S1), then cervical spine. (30-40 years)

The classic injury mechanism is combined lumbar spine flexion (bending) and rotation

A herniated disc can compress spinal nerves

43
Q

Disc Herniation - Treatment

A

Manual therapy & exercise

Acupuncture

44
Q

Bursitis

A

Inflammation of the bursae

Bursae are located around many joints in the body. Commonly affects the shoulder ‘sub-acromial’ & hip ‘trochanteric’

45
Q

Bursitis: Causes

A 
Repetitive use (overhead work)
Sudden trauma, infection, wear and tear

Biomedicine (9 decks)

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