module 9 disorders of skeletal muscles, peds, aging Flashcards
contracture
muscle fiber shortening without an action potential
- cause by failure of the sarcoplasmic reticulum (calcium pump) even with available ATP; lack of use
stress induced muscle tension
neck stiffness back pain clenching teeth hand grip headache -associated with chronic anxiety - work demands
fibromyalgia
muscle pain target points - occiput - trapezius - suprasinatus - gluteal - greater trochanter - anterior neck - second rib - lateral epicondyle - knee fatigue sleep disturbance increased stimulus to touch
disuse atrophy
reduction in normal size of muscle cells due to prolonged inactivity
- bed rest
- trauma
- casting
- nerve damage
disuse atrophy tx
isometric movement ans passive lengthening exercises
diseases of energy metabolism
McArdle disease - myophysphorylase dificiency Acid Maltase deficiency - Pompe disease Myoadenylate deaminase deficiency (MDD) Lipid Deficiencies
Inflammatory muscle disease (dermatomyositis, polymyositis)
Focal or extensive degeneration fo muscle fibers attributable to inflammation infiltrates of lymphocytes, macrophages
- inflammatory cytokines, autoantibodies, cytotoxic
-> necrosis of muscle fibers -> fatty replacement -> weakness
collectively: myositis
viral, bacterial, and parasitic myositis
- staphylococcus aureus
- trichinosis
- toxoplasmosis
inflammatory muscle disease (myositis) s/s
weakness in proximal limb muscles
esophageal dysmotility can be seen
dermatomyositis
gottron papules: flat top over dorsal surface of hand joints
scaly patches over joints
rashes
Duchenne Muscular Dystrophy
most common muscular dystrophy
X-linked recessive inheritance: Mostly males affected
- deletion of segment of DNA on short arm of the X
Duchene muscular dystrophy gene
- encodes for dystrophin protein (deficient)
– mediates the anchorage of the actin cytoskeleton of the skeletal muscle fiber to the basement membrane -> wasting of skeletal muscle
Duchenne muscular dystrophy s/s
shoulders and arms held back when walking
sway back
weak butt muscles
knees bend to take wt
thick lower leg muscles (mostly fat, not strong)
tight heel cord -> toe walking
weak muscles in front of leg -> foot drop
belly sticks out due to weak abd. muscles
thin weak thighs
poor balance -> falls often, clumsy
decreased dystrophin -> weakened cell membrane -> extracellular fluid leaks into cell -> muscle fiber necrosis
Dechenne muscular dystrophy tx
education
preservation of physical function as long as possible
prevent contractures
genu varum
bowleg
peaks at 2.5 years
occurs in all newborns due to intrauterine stress
pathogenic past 2.5 years
genu valgum
knock-knees
peaks at 5-6 years
pathologic past 5-6 years
congenital defects
syndactyly: webbing or fusion of fingers vestigial tabs: extra digits deformities of foot: - metatarsus adductus (forefoot adduction ) - equinovarus deformity (club foot)
developmental dysplasia of the hip
abnormality of the proximal femur, acetabulum, or both
risk factors (head of femur in pelvis)
- female, metatarsus addutus, torticollis, oligohydramnios, 1st pregnancy, breech
osteogenesis imperfecta
brittle bone disease defect in collagen production - bone and vessel collagen results in osteoporosis, bowed and deformed limbs, short stature, spine curvature, and bluish sclera can be evident in utero; fractures
Juvenile Rheumatoid arthritis
3 forms of onset - pauciarticular: < 3 joints - polyarthritis: > 5 joints - systemic disease: most common Predominantly large joints subluxation and ankylosis of spine joint pain not as severe as adult chronic uveitis lab tests: detect inc. ANA, seldom detect rheumatoid factor *RA nodes not limited to subcutaneous- can be found in the heart, lungs, eyes, and other organs
Ricketts
osteomalacia of peds
softening of bones due to defective mineralization
cartilage in growing epiphysis fails to calcify
- not replaced by bone and continue to enlarge -> widening and irregularities
- delayed eruption of teeth
- decreased muscle tone
Osteochondrosis
Legg-Calve-Perthes disease
Osgood-Schlatter disease
Legg-Calve-Perthes disease
interrupted blood supply to the femoral head
self-limiting disease
deformation due to ischemia is permanent
Osgood-Schlatter diesase
tendinitis of the anterior patellar tendon and osteochondrosis of the tubercle of the tibia
- tendon does not grow as quickly as bone does
osteoarthritis (degenerative joint disease)
progressive loss of articular cartilage and formation of thick subchondral bone and new bone at joint margins
- seen more with increased age: >70
- related to wear and tear
- breakdown of proteoglycan and collagen -> decrease hydration of cartilage -> increased wear damage
osteoarthritis s/s
enlarged joints crepitus am stiffness for 30 minutes pain with function localized deformity unilateral
rheumatoid arthritis
type III hypersensitivity inflammatory joint disease systemic autoimmune damage to connective tissue, primarily in joints (synovial membrane) Women > men peak 40's-50's > risk with family hx
rheumatoid arthritis s/s
bilateral, symetrical malaise fatigue diffuse pain \+ for RF red and warm
ankylosing spondylitis
inflammatory joint disease of the spine or sacroiliac joints causing stiffening and fusion of the joints
systemic, immune inflammatory disease
Primary site: enthesis
- where ligament, tendons, and the joint capsule are inserted into bone
cause unknown but associated with HLA-B27 antigen (genetic component)
ankylosing apondylitis s/s
low back pain: improves with exercise, not relieved with rest
morning stiffness
loss of lumbar lordosis
- hips and knees compensate -> lower joint degradation/deformity
- restricted postural position -> decreased chest expansion
Gout
metabolic disorder that disrupts the body’s control of uric acid production or excretion
- high levels of uric acid
uric acid levels high enough to crystallize
- crystals deposit in connective tissues throughout the body.
gout risk factors
increase with age diet (increased purine) chronic kidney disease family Hx soda/ carbination increased ETOH
gout s/s
recurrent episodes accumulation of tophi (crystals) impaired renal system inflammation, pain attacks subside in 1-2 days but may last 1-2 weeks
4 phases of gout
- asymptomatic hyperuricemia
- acute gouty arthritis
- intercritical gout (betwen attacks)
- chronic tophaceous gout ( after 10 or so years tophi appear)
Primary and secondary skin lesions
primary: original appearance
secondary: appearance modified by normal progress over time
skin lesion features
size
symmetry of color and shape
distribution
skin lesion patterns
symetric sun-exposed genital intertriginous (warm, moist skin) acral (extremities, ears, nose)
primary lesions
macule papule nodule tumor plaque wheal vesicle bulla pustule
secondary lesions
erosion ulcer fissure atrophy excoriation crust scale lichenification scar keloid
childhood skin disorders
lacerations burn head lice scarlet fever tinea capitis impentigo rubella, roseola, rubeola (measles) chicken pox
Teen skin disorders
acne
exacerbated chronic skin disorders
geriatric skin disorders
keratoses skin cancer fungal infections dematitis asteatoses (scaling) nevi (moles) lentigines (liver spots) pigmentary disorders psoriasis urticaria comedones (black heads) cherry angiomas skin tags senile purpura
