Gen Ortho Term, Reax of MSK to disorder Flashcards
Orthoped Patho Goal
Prev. + corr of disorders of MSK sys + assoc str
Bone patho examples
Frac, inflam dis, gen+disem disor, neoplasm, epip discord, congen abn
Jt+soft tis patho ex
Deg, inflam disor, trauma, neoplasm
Muscle path ex
Motor unit, Mm. injury, dystrophy, neoplasm
Bone funct (nm. SPPHT)
Support (attch pt) of soft tis, Prot org., movement, Ca/P tank,
Hemopoesis, triglyceride in adipose (yellow marrow)
Bone c. type
Osteoprogenitor -> diff into below types
Osteoblasts -> bone-building matrix (collagen)
Osteocytes -> mature bone c.
Osteoclast (WBC lineage) -> remodel + resorp bone ECM (extra cell matrix), cause bone to rel Ca.
Volksmann canal
Nutrient foramen
Periosteal a.+ v., through diaphysis
Nutrient a.+v., center of diaph
4 scenarios of osteogen (bone form)
Embro + fetal dev
Growth before adult
Remodeling
Fracture healing
Ossification 2 Forms
Intramembranous: CT mem replaced by flat bone (e.g. skull)
Osteoblast - ECM, mesenchyme (stem c.) surrounding
Ca salts depo around osteocytes in lacuna, ECM Ca’s
ECM dev. Trabeculae -> fuse into spongy bone
Periosteum - esenchyme @ periphery dev. Into periostem.
Endochondral: cartilage repl w/ bone in dev. Embryo
Mesemchyme dev into chondroblasts to form cartilage model
Model growth via chondryocte c. div
Prim ossification centre - bone repl. cartilage
Medullary cav. Dev via osteoclast resorp
2ndry ossification centre @ epiphysis
Artic. Cartil. + epiphyseal plate -> hyaline cartilage
Bone growth/form
Periosteum ridges - groove for priosteal b.v.
Ridges fuse = endosteum-lined tunnel (Volksmann canal)
Osteoblast in endosteum -> new concentric lamellae inwards to tunnel
Osteoblast in periosteum build circumferential lamellae
Bone react
Alt’d deposit: ^| osteopetrosis (def resorb-?), acromegaly (excessive intramem oss from periosteum)
v| osteoporosis (v| osteoblastic activity, ^| resorp), rickets/osteomalacia (hypocalc, vit D def),
reabsorb, combo of alt depos + reabsorb (osteolytic neoplm
Epiphyseal plate
reax
^| growth: Generalized {Arachnodactyly, pituitary gigantism (gwth hmr)
Local { chronic inflamm
v| growth: Generalized {Achondroplasia=dwarfism, rickets, staphyloccocus
Local {disuse retardation, trauma or ischemia to plate
Torsional (growth twists)
6 Factors det ROM
Struct + shape of artc surf: complementary?
Str + tension of ligaments: position of jt
Arrg + tension of muscle: hamstr |v ext of leg when thigh flx’d
Contact of soft part
Hormns: Relaxin - ligamt + fibroct
Disease
Arti Cartl Reax
Destruction: Ex Irreparable lesion - RA (pannus), ankylosing spondylitis
Infections (staph, TBC), prolonged immobil, cont compress, intra-artic injec of corti
Degen: Prem aging (wear and tear), Prev destr -> degen of remaining cart, irregular artic surfc
Peripheral prolif: After degen of central jt area, peripheral tissue prolif ossifying “ring”
Syn Mem Reax
Excs flu pdn (eff): serous, inflam, hemmorrhagic
Hypertrophy
Adhesions - prolog’d lim mvm
Jt cap + lig Reax
Joint lax (overstr - gene, inj, infec) Jt contractures (tight) (congen, infec, chron arth, Mm contrax)
SkelMm Reax
Disuse atrophy
Hypertrophy
Ischemic necrosis (trauam vasc spasm, thromb, embol)
Contract (prolong imm, abn contrx)
Msk infec etiology
Temp/perm implant (heart valv, dent implant, morphine pump)
Pyogen
Granulomatous (TB)
Common Msk infec disease
Osteomyelitis
Diskitis
Infectious Arthritis
TBC
Osteomylitis
Bone marrow ,
Infection due to: Bacteria (common), fungi, parasite, virus Key factors: Virulence of organism Immune health Location/vasculariz of bone
Acute - children/seniors: exogen or endog (common in IV -> septicemia/chronic) Chronic- Adults 2ndary to bone/surround tiss (relapse, undiag infec, drug resist bact, impant) Acute Hematogenous (most common) - more in children/boys
Acute
Osteomyelitis
Cause: Staphcocc Aureus (SA) 90% (upper respit tract - nose/throat infect, binds to cartilage. Protect glcocalyx + endotox → resist antibiot)
Pathog:
Pus accum ^| oressyre-> in-situ thromb/ischem-> bone necrosis
Osteomyeltis Clinical signs
pain near end of long bone, malaise, anorexia, fever, local soft t. Swel
Erthrocyte Sedimentation Rate (ESR elev), leukocytosis (^|)
Osteomyelitis Tx
Prognosis
Complications
Antibacterial (penicilin), bed rest + analgesics, IV fluid, split/traction, surgical decomp if no improv >24 hrs of ICU
Time (30 mins earlier Tx), effect, dos, durx of drug
Early: Septicemia (blood posion), abcess form -> sept arth (abcess drain into jtmed emerg)
Late: chronic osteomyelitis, patho frac, jt contr, local gwth dist
Diskitis
Cause
Prognosis
IV disk most common site
SA, TB, unknown microorg
(P) for mths, complic: vc collapse, kyphosis, ankylosis
Diskitis in Children
Cause
Clinical sign
Children: hematogenous (URI, UTI after cath)
Fever + spinal (P)
Abd (P), diff bend, complic w/ vertebral osteomylitis
Diskitis in Adults
Clin sig
Adult: postop diskectomy
Symtom after surgery
Sev spinal (P)
Radi to LE
Rest doesn’t help
Skel TB
Pathogen
Tx + Prog
10-15% of TB is extrapul, 10% is skel
Only 25% w/ Skel TB have history of pul TB
Small # of bac cause dmg to bone (via blood in immuno-comp)
2-3 yr post-infect (P)/stiff
Low thorx 25% + lumb 20% involved (Pott’s)
Drugs simlar to pulm TB, decomp surgery
Latent TB
Extrapul TB
prev antibiotx eradicates the disease
TB not in lung, diff to access + diag CNS Meningitis Pleura - TBC Pleurisy Disseminated - Miliary TBC Spinal bone + jt - Pott’s
Septic(Infect=bacterial) Arthritis Etiology
S. Aureus + Neisseria gonorrhea (inoculation, extension- periarticular osteomyelit, continguous soft t. inf, hematogenous)
Bact (Gonnococcal, lyme, syphilis, TB)
Fungal (Candida)
Viral (Epstein-Barr, Hepatitis, Mumps)
Reactive (chlamydial, acute fever)
Bact Arth Pathogen
Introduct: Penetrat inj - human bite, frac, arthrocentesis (syringe biopsy), arthroscopy (microsp in body), arthroplasty (replacement)
Bact mult -> micrab-> phagocytosis of bact -> lysomo -> toxins intravasc -> syn Mem prolif = pannus
Bacteria Arthritis Causes
Underlying jt disease or abdn jt 47% of cases.
Child+older adult ^| risk of non-gonoccocal infectious arthritis
Predisposing: system corticosteriod, Radiation tx, preexisting arthiri, arthrocentesis, HIV, DM, Alcohol/drug ab, trauma, other infectious dis, idiopathic
Sept Arthritis Clinic Manife
All age groups, acute onset of jt (P) - P
Local swell+ tender (ROM restriction) - A, S
Fever, chills/signs of infection - H
Pus - R
Children: refuse to bear weight in affected, v. tender to palp, v. quick jt destruction (faster metabolism), longer term deformities
Adults:
Monoarticular if due to SA
Usually hip/knee affected, prosthetic usually sites of infection
Gonococcus affects women (urethra length to uterus location - internal secretion difficult to detect vs. pus from male urethra)
Septic Arthritis Tx
Any jt infect = med emerg
IV antibiotics 2-3 wk
Splint, tract, casting to drain, v| bump
Sept Ar Prog
Good if Tx w/i 5-7 days
Mortality higher in >65 yr, overall 25% or less
Pt jt disability 25-50%, knee better outcome than hip
Infectious Buritsitis + Tenosynovitis
Uncommon, SA 80% of infect
Superficial more susceptible (Hand, elbow, knee), diabetics more vulnerable (v| in blood flow bug goes undetected)
Trauma > human bites 25% > animal 10%
Myositis
Infection induced
Drug induced
Possible 1st sign of malignancy. DM: Threefold ^| risk, PM: 40% increase risk
S.A., Parasites
Trichinella (parasite), from undercooked pork, beef, game, 4% of popN.
Tapeworm larvae (tania solium): eggs in infected pork feces contaminate soil + ingest w/ raw vege.
Satins (red flag) - prescribed for high cholesterol, have they mentioned to dr of side effects, mention having muscle (P) get them to eval.
Statin -induced rhabdomyolysis
3 Forms of Myosites
Dermatomyositis(DM): Child+ older adult
Polymyositis (PM)
Inclusion Body Myositis: most common acq muscle disease >50, progressive/debilit, not responsive, appears autoimmune
Myositis
Clinical Mani
Tx
Non-specific: malaise/lethargy, fever, (P) + swell, weakness
Atrophy and necrosis
Necessary for aggressive early Tx
Anti-parasite Tx
Immunosuppressive Tx
