Exam 1- Musculoskeletal Pathologies Flashcards
____ may induce a fracture in musculoskeletal pathologies.
Trauma
Age, Genetics and Lifestyle choices are more likely to have an influence on the development of a condition like ________
Osteoporosis
Disorder of bony development resulting in defective ossification of the skeletal system
Develops due to irregular mesenchymal cell migration, during embryogenesis
Dysostosis
Examples of Dysostoses
Cleidocranial Dysostosis
Klippel-Feil Syndrome
Polydactyly/Syndactyly
Aplasia
Musculoskeletal pathology
Interferes with body’s ability to perform normal growth or regulate normal musculoskeletal homeostasis
Primarily abnormal bone formation (isolated/widespread)
Dysplasia
Examples of Dysplasias
Type 1 Spondylolisthesis
Osteogenesis Imperfecta
Osteoporosis
Achondroplasia
Stunted Growth
Individuals does not achieve a mature height of at least 4 ft. 11 in.
Dwarfism
Pathologies resulting in Dwarfism
Turner Syndrome Achondroplasia Osteogenesis Imperfecta Hypopituitarism Severe Malnutrition
Form skeletal dysostosis that involves congenital abnormalities of the bones and teeth
Cleiodocranial Dysostosis (Cleidocranial Dysplasia)
Characteristically, the ______ are either underdeveloped (hypoplastic) or absent and allows affected individuals to ______ their shoulders to an extreme degree
Clavicles
Adduct
Enlarged fontanelles (“soft spots”)
Normal intelligence
Mutation in the RUNX2 gene
Autosomal Dominant
Cleidocranial Dysostosis
Form of skeletal dysostosis Presence of 2+ cervical vertebrae w/ abnormal fusion Shortened neck height Low-appearing hairline Limited ROM in cervical spine
Klippel-Feil Syndrome
Conditions associated with Klippel-Feil Syndrome
Renal Abnormalities
Cardiac Abnormalities
Hearing Problems
Skeletal abnormality of the scapula
Failure of the scapula to descend during early embryogenesis
Characteristically associated with Klippel-Feil Syndrome
Sprengel’s Deformitiy
MC form of skeletal dysplasia and develops following a single gene mutation that affects many different areas of the musculoskeletal system
Autosomal dominant
MC Sporadic Mutations
Achondroplasia
What is the gene responsible for Achondroplasia?
FGFR3
What part of the body is most affected in achondroplasia with growth suppression?
Long bone elongation of the extremity bones
Sporadic mutations of Achondroplasia involve mutations in the FGFR3 gene within the
Father’s sperm
Advanced ______ age increases the risk of father’s sperm developing these spontaneous FGFR3 mutations
Paternal
Characteristics of Achondroplasia
Short Extremity Bones Trident Hand Appearance Frontal Bossing Stenosis of Foramen Magnum Midface Hypoplasia Lumbar Spinal Stenosis Bullet Vertebrae Lower Extremity Radiculopathy Normal Intelligence
Most common form of lethal dwarfism
Thanatophoric Dwarfism (Thanatophoric Dysplasia)
Severely diminished chondrocyte activity resulting in severely inhibited endochondral ossification
Thanatophoric Dwarfism (Thanatophoric Dysplasia)
FGFR3 gene mutation that traditionally causes achondroplasia with potentially lethal tissue distortions
Thanatophoric Dwarfism (Thanatophoric Dysplasia)
Lethal in utero or shortly after birth
1 in 20,000 pregnancies
Thanatophoric Dwarfism (Thanatophoric Dysplasia)
Greek for “death bearing”
Thanatophoric
Severely underdeveloped _____ does not provide enough space for normal heart and lung development
Thorax
Most common cause of death among individuals affected with thanatophoric dwarfism
Respiratory Failure
Also known as brittle bone disease or Type I Collagen Disease
Osteogenesis Imperfecta (OI)
Autosomal dominant mutation in the genes that code for the formation of α1 - or α2- chains of type I collagen, which causes premature breakdown of bone due to irregular formation
Osteogenesis Imperfecta (OI)
T/F. Only bones, teeth, eyes, skin and joints are affected by Osteogenesis Imperfecta.
False (all tissues throughout body containing Type I Collagen are impacted)
What tissues are prominently impacted by Osteogenesis Imperfecta?
Bones, teeth, eyes, skin and joints
What’s the most characteristic feature of Osteogenesis Imperfecta?
Severely under-mineralized bony tissue (which are very prone to fracture)
The presence of “blue sclerae” is very specific to
Osteogenesis Imperfecta (OI)
What causes the blue shade in the sclerae with an individual with Osteogenesis Imperfecta?
Sclerae is most translucent due to irregular Type I collagen, this allows the vascular choroid layer of eye to show blue
Hearing loss occurs due to middle ear bones irregularly forming
Teeth are likely to be small and misshapen due to an inability to produce normal dentin
Osteogenesis Imperfecta (OI)
What type of Osteogenesis Imperfecta is compatible with life, MC recognized during childhood, bowing of lower extremity bones, dwarfism or scoliosis
Type I Osteogenesis Imperfecta
What type of Osteogenesis Imperfecta is a contraindication to high-velocity, low-amplitude (HVLA) adjusting?
Type I Osteogenesis Imperfecta
What type of Osteogenesis Imperfecta is incompatible with postnatal life due to extreme skeletal fragility, suffer multiple fractures in utero or during birthing process resulting in lethal intracranial hemorrhage?
Type II Osteogenesis Imperfecta
AKA Marble Bone Disease
Osteopetrosis
Reduced osteoclast formation or activity resulting in widespread skeletal sclerosis
Osteopetrosis
Abnormal hardening of a body tissue
Sclerosis
Increased skeletal density, via Osteopetrosis, causes bones to be more prone to ______
Fracture
What is the condition that is occuring if an individual suffers from a “chalk stick fracture”?
Osteopetrosis
Bone marrow of individuals with _____ will fill with mineralized bone, which displaces functional red bone marrow and causes reduced hematopoiesis
Osteopetrosis
Erlenmeyer flask deformity associated with long bone distortion
Various cranial nerve defects due to foraminal stenosis
Osteopetrosis
Serve reduction in bone mineral density
Osteoporosis
At least ____ standard deviations from normal mineralization
-2.5
What is the primary complication of osteporosis?
Fracture
With Osteoporosis, fractures are most common in areas that have abundant ______ bone.
Trabecular
When diagnosing for Osteoporosis, bone mineral density is best evaluated with a
DEXA Scanner
Determines how many SD the patient’s bone mineralization is away from normal (average bone mineral density of a 25 y.o. of the same sex), with a T Score
DEXA Scanner
T/F. Plain film radiography is not sensitive enough to be used as a diagnostic test.
True
Bone mineralization is below normal, but not yet reaching a severity to be considered osteoporosis
Osteopenia
Osteopenia is considered to have a SD of bone mineralization of ___ and ___ SD’s below normal
1 and 2.5
Bone mineralization peaks during young adulthood, around the ages of
25-30
About _____ of individuals bone mineralization is lost with each of the following years.
0.5-0.7%
Factors that influence bone mineral density include:
Lifestyle choices Diet Physical Activity Muscle Strength Age Hormonal Factors
Osteo____ activity decreases with age
-blast
Age-related loss in bone mineralization
Senile Osteoporosis
____ have accelerated rates of osteoclast activity, due to estrogen levels.
Women
Screening for osteoporosis is recommended for all women over age ____
65
Asymptomatic until the development of a fracture
Osteopenia
Osteoporosis
Most common locations for osteoporosis-related fractures are the
Femoral Neck
Vertebral Bodies
Vertebral body osteoporosis-related fracture that is most likely to cause compression fractures within the ______ spine
Thoracolumbar
Loss of overall height and what other feature are observable features of advanced osteoporosis
Dowager’s Hump
Complications from osteoporosis-related fractures include:
Immobility
Spinal Deformation
Pneumonia
Pulmonary Embolism
_______ are a group of medications that decrease osteoclast activity
Bisphosphonates
Metabolic bone diseases that develop following a deficiency in Vitamin D
Rickets and Osteomalacia
Develop in children Deficient in Vitamin D Reduced bones deposition at the epiphyseal region Stunted growth Bowing of lower extremities Increased risk of fractures Abnormal spinal curvatures
Rickets
Adults "adult counterpart of rickets" Skeletally mature Bone is left under-mineralized Less severe than rickets Limited to increased fracture risk Mimics Osteoporosis
Osteomalacia
Evaluating serum vitamin D levels is needed to establish diagnosis of
Osteomalacia
Elevated parathyroid hormones (PTH) levels
Hyperparathyroidism
Parathyroid hormone levels regulate blood calcium levels by stimulating _______ activity, which releases calcium into the serum
Osteoclast
Parathyroid glands overproducing PTH Adenoma of the parathyroid gland. Women ~50 Removal of the Parathyroid adenoma Asymptomatic
Primary Hyperparathyroidism
Cause the parathyroid glands to increase production of PTH
Chronic Kidney Disease –> causes Hypocalcemia
Parathyroid gland responds by elevating PTH production
Secondary Hyperparathyroidism
Less commonly, Secondary Hyperparathyroidism is caused by
Vitamin D deficiency
What is the most common symptom of Primary Hyperparathyroidism?
Symptomatic kidney stones
What is the most common sign of Primary Hyperparathyroidism?
Hypercalcemia
T/F. Hyperparathyroidism will not affect many areas of the body
False (it is an endocrine disorder- it affects many areas of the body)
Skeletal changes associated with hyperparathyroidism involve resorption of ______ and _____ bone throughout the entire skeleton
Cortical
Trabecular
Hyperparathyroidism most characteristically affects the
Phalange Vertebral Body Calvaria Femur Tibia
Rugger Jersey Spine is present with an individual suffering from Hyperparathyroidism would have problems at what location?
Vertebral Bodiers
Resorption of the cortex, primarily on the radial side of the middle and distal phalanges is present with an individual suffering from Hyperparathyroidism would have problems at what location?
Phalanges
Salt and Pepper Skull is present with an individual suffering from Hyperparathyroidism would have problems at what location?
Calvaria
Osteitis Fibrosa Cystica is present with an individual suffering from Hyperparathyroidism would have problems at what location?
Long bones of the lower extremities
_____ ____ develop following localized osteolysis whereas the bone weakens, hemorrhage occurs, macrophages accumulate within the area, and fibrotic tissue fills the area
Brown Tumors
Localized areas of osteolysis may give rise to areas of “cystic degeneration” and produce what is known as
Osteitis Fibrosa Cystica
Three stages of Paget Disease are known as:
Osteolysis –> Mixed Osteoclastic-Osteoblastic Stage –> Osteosclerotic stage
Results in increased, but structurally weak, bone mass
Paget Disease of Bone
Caucasian males 70 y.o.
MC in North America, Australia and New Zealand
1% of general adult population affected
10% adults older than 80 y.o.
Paget Disease of Bone
T/F. Most patients with Paget disease are symptomatic
False (most (80%) are asymptomatic)
A sign of Paget disease involves elevated serum levels of _____ _____, which represents elevated osteoblastic activity
Alkaline Phosphatase
Symptoms of Paget Disease:
Back/Neck Paine Bony Deformation Increased fracture risk Headache Cranial Nerve Compression
_____ disease may cause an “ivory vertebra sign”, discovered upon radiological examination.
Paget
Paget disease on x-ray’s is usually referred to as a ______ appearance while histological exams of a site of the disease will manifest with an irregular _____ or jigsaw puzzle pattern
Shaggy
Mosaic
Paget disease is most likely to develop within the ____ ______ and the proximal _____
Axial Skeleton
Femurs
T/F. A large percentage (about 75% or less) of all cases of Paget disease will transition into an aggressive bone cancer known as Osteosarcoma
False (A small percentage [1% or less])
Osteosarcoma is associated with a very high _____ rate
Mortality
What is the cause of Paget disease?
Idiopathic
Complete or partial loss of bone integrity
Bone Fracture
T/F. Just as much force is needed to break a pathological bony tissue versus a normal bony tissue
False (smaller amount of force)
Fracture at the site of a bone-weakening pathology
Pathological Fracture
Completely separates what was previously a single bone
Separation of bone’s cortex
MC site of a pathological fracture
Occurs in an adult or older adult
Complete Fracture
Fracture that does not separate the fragments of the fractured bone
MC occur in long bones
Occur in pediatric individuals
Incomplete Fracture
Skin overlying the fracture remains intact
Reduces the risk that this fracture site will become infected
Closed (Simple) Fracture
Fracture is in communication with overlying skin
Exposes the fracture site to the external environment
Increases risk of infection at site
Compound (Open) Fracture
Fracture is splintered into multiple fragments.
High-velocity forces cause the fracture
Comminuted Fracture
Ends of the bones at the fracture site are not in alignment
Displaced Fracture
Slowly-developing fracture
Increased physical activity and repetitive loading
Stress Fracture
Fractures are typically painful because the fracture disrupts the sensitive ______
Periosteum
The fracture of a bone will induce an __1.__ inflammatory response that initiates the ___2.___ process while also inducing a painful response via ____3.___ and ____4._ ____ production
- Acute
- Reparative
- Prostaglandin
- Substance P
Normal fracture healing begins immediately after the fracture occurs with the development of a ______
Hematoma
The hematoma developed to initiate healing of a fracture will also prompt formation of a fibrin-rich clot and fibroblasts will form a ____ ___ by the end of the 1st week of healing.
Soft Callus
By the end of the 2nd week of healing, a ___ ____ will have formed and woven bone will rise to endochondral ossification
Bony Callus
Woven bone will forming through endochondral ossification will result in mature _____ bone at the end of the healing process.
Lamellar
How long does bone take to heal after a normal fracture?
6-8 weeks
What aspect of the healing process of a fractured bone will be remodeled over that persons lifetime?
Bony Callus
T/F. Bony callus’ will become more noticeable as that individual ages.
False (less noticeable over time)
What may delay fracture healing?
Fracture…
- Fragments remain displaced
- Splintered
- Not immobilized
- Becomes infected
- Malnourished (Calcium, Vitamin D, Phosphorus or Magnesium)
- Occurs in an older adult
Place the healing process of bone fracture in order:
Bony Callus, Hematoma,
Soft Callus, Lamellar Bone, Woven Bone
1st. Hematoma
2. Soft Callus
3. Bony Callus
4. Woven Bone
5. Lamellar Bone
Fractures that involve the epiphyseal growth plate
Salter-Harris Fractures (SHF)
Salter-Harris Fractures (SHF) only apply to individuals who have open or active ____ ____.
Growth Plates
Salter-Harris Fractures (SHF) are limited to ____ who have not reached skeletal maturity
Pediatrics
Occur in about 15% of all pediatric long bone fractures
Salter-Harris Fractures (SHF)
Fracture that extends through the entire growth plate (physis)
5% of all SHF’s
Favorable Prognosis
Type I
Fracture extends from the growth plate into the metaphysis
75% of all SHF’s
Favorable Prognosis
Type II
Fracture extends from the growth plate into the epiphysis
10% of all SHF’s
Limited prognosis, due to joint involvement
Type III
Fracture extends through the growth plate, metaphysis and epiphysis
10% of all SHF’s
Poor Prognosis
Type IV
Compression fracture of the growth plate
<1% of all SHF’s
Poor Prognosis
Type V
Site of necrosis, due to reduced blood supply (ischemia).
Avascular Necrosis (AVN)
___ dislocations may also cause vascular damage that result in an AVN.
Joint
Other causes of AVN:
Autoimmune Vasculitis (Type III Hypersensitivity reaction)
Prolonged use of Corticosteroids
Ionizing Radiation
Blood Clots
Blood Disorders (that increase clotting risk i.e. Sickle Cell Disease)
Idiopathic (about 25% of all cases)
What is the healing process called for AVN’s?
Creeping Substitution
Is healing of AVN’s managed?
No
_____ AVN’s may collapse and cause acute pain and surface irregularities at the joint, accelerating osteoarthritis. This is known as
Secondary Osteoarthritis
Term given to an AVN that develops at the subchondral area of a joint.
Originates from an ischemic injury and causes pain
Due to death of osseous and cartilaginous tissues
Osteochondritis Dissecans
What are the most common locations for Osteochondritis Dissecans to develop?
Knee and Hip Joints
Most AVN cases occur around age
30-50
Site of bone marrow inflammation, due to an infection
Osteomyelitis
Osteomyelitis is more commonly a feature of a localized bacterial infection with ______ ____ or _____
Pyogenic Bacteria or Mycobacteria
The site of an infected bone will die and this is refereed to as the ______, which is surrounded by irregular bone known as the _____ and the pus draining location is the ______
Sequestrum
Involucurm
Draining Sinus
Involves a bone marrow infection that reaches the marrow via hematogenous spread
Extension from nearby infection
Direct Implantation from trauma or a compound fracture
Occur at any age
Long bones of extremities tend to be MC site
Pyogenic Osteomyelitis
What bacteria, of Pyogenic Osteomyelitis, is the microbial origin of up to 90% of all cases?
Staph. Aureus
May develop in patients with pulmonary TB (about 3% of all Pulm. TB cases)
Invades the local mediastinal lymph nodes and spreads to the blood
MC among individuals with a suppressed immune sytstem
Result of chronic infection
Less likely to manifest with acute features
Mycobacterial Osteomyelitis
Mycobacterial Osteomyelitis will cause ____ ____ to form at the area of infection and tends to involve the long bones of extremities and the ___ ____.
Caseous Granulomas
Vertebral Bodies
