musculoskeletal - patho E4 Flashcards
osteoporosis
bone mineral density is 2.5 standard deviations below peak bone mass
measured w/ a dexa scan and reported in T scores
osteopenia
thinning of the trabecular matrix of the bone before osteoporosis
T score is between -1 and -2.5
osteoporosis characteristics
“porous bone”
-common but serious
-low bone density and structural deterioration of the bone (usually in the hips, vertebrae & wrists aka trabecular bone)
actual breaks in trabecular matrix occurs
osteoporosis risk factors : major
-aging
-female
-caucasian
-history fracture as adult
-family hx
-body wt <127 lbs
-smoking
-alcohol
-long term steroid use (inhibits osteoblasts)
-immunosuppressive drugs
osteoporosis risk factors : minor
-thin, small frame
-lack of weight bearing exercise
-lack of calcium and/or Vit D
-eating disorders
-gastric bypass surgery
-lack of estrogen / testosterone
-excessive caffeine
osteoporosis pathogenesis
increased bone resorption (osteoclast activity increased) -> decreased bone formations (osteoblasts)
osteoporosis problems
-failure to make new bone (osteoblasts)
-too much bone resorption (osteoclasts)
or both
osteoporosis clinical manifestations
early is asym
-factures
-pain
-loss of height
-stooped posture (kyphosis)
what is one of the biggest complications of osteoporosis
hip fractures
causes increased risk of mortality d/t sepsis, skin breakdown, immobility, pneumonia, blood clots
not from the break itself
hip fracture clinical presentation
-sudden onset of hip pain before or after a fall
-inability to walk
-severe groin pain
-tenderness
-the leg on the hip break side is externally rotated and shortened
what is our pharm goal for osteoporosis
reduce fractures by promoting bone formation or decreasing bone resorption
primary pharm therapy for osteoporosis
-calcium: 1200 to 2000 mg/d
-vit D: 800 to 1000 IU daily
what is a fragility fracture
when the bone is so fragile that it just breaks without a fall or something causing the break
fractures definition
any break in the continuity of bone that occurs when more stress is placed on the bone that is able to absorb
fracture causes
-traumatic (fall)
-fatigue (repeat, prolong stress like a running stress fracture)
-pathologic (weakened bones, spontaneous)
open fracture
compound
fractured bone penetrates skin
closed fracture
simple
does not break through the skin
transverse fracture orientations
straight line
90 degree angle to the length of the bone
most common w/ falls
spiral fracture orientations
a twisting injury
abuse
comminuted fracture orientation
more than 1 fracture line & more than 2 bone fragments
ex: people fall on their feet and its a compression fracture
greenstick fracture orientations
incomplete break where the bone bends
most common type of break in children
fracture clinical manifestations
pain, edema, and deformity (PED)
3 phases of bone healing
1) inflammatory -> hematoma
2) reparative -> fibrous cartilage, callous, ossification
3) remodeling
complications of fractures
delayed healing
bone growth impairment
compartment syndrome
fat embolism syndrome
fracture complication: delayed healing
-dx 3mo to a year after fracture
-pain and tenderness are increasing even tho bone should’ve healed by now
-slowed by infection, smoking, malnut & poor circulation
-can lead to malunion and non union
malunion
unequal stretch of muscle pull causing improper alignment
ex of cause: starting weight bearing too soon
non union
when fracture has not healed in 4-6months after d/t smoking, older age, severe anemia, uncontrolled diabetes, low vit D levels, hypothyroid, poor nutrition, infection
fracture complication: impaired bone growth
-peds
-fracture through epiphyseal plate which can delay future bone growth
fracture complication: compartment syndrome
-seen w/ crush injuries and casts that are too tight
-results from increased pressure within limited anatomic space causing decreased circulation
tourniquet effect -> edema puts intense pressure on the soft tissue causing tissue hypoxia of the muscles & nerves
compartment syndrome symptoms
edema
loss or weakened pulses
extreme pain
fat embolism
treatment for compartment syndrome
fasciotomy
fat embolism
fat molecules in the lung following long bone fracture & major trauma
leads to sudden respiratory distress
Sx: hypoxemia, altered LOC, & petechial rash
tx: self limiting but work to make sure pt remains stable
fracture complication: osteomyelitis
an acute or chronic pyogenic (pus producing) infection of the bone needs immediate treatment -> weeks of abx & wound vac
risk factors of osteomyelitis
recent trauma
diabetes
hemodialysis
IV drug use
splenectomy
route of contamination for osteomyelitis: direct
open wound
gunshot
puncture
surgery
route of contamination for osteomyelitis: indirect
from bloodstream (most common)
bacteremia
osteomyelitis clinical manifestations
local: tenderness, warmth, redness, wound drainage, restricted movement, spontaneous fracture
systemic: fever, positive blood culture, leukocytosis
arthropathy
a joint disorder -> when the disorder involves inflammation of one of more joints it is then called arthritis
osteoarthritis (OA)
-degeneration of joints caused by aging and stress localized
-most common cause of disability in US
-obesity and longer life expectancy is causing the incidence of OA to increase
common joints affected by OA
cervical spine
lumbosacral spine
hip
knee
hands
big toe
what joints are typically spared from OA
wrist, elbow and ankles
OA risk factors
aging
obesity
hx of participation in team sports
history of trauma or overuse of joints
heavy occupational work
misalignment of pelvis, hip, knee, ankle or foot
OA etiology
stresses applied to joint (wt bearing)
degeneration of cartilage: excessive loading of healthy joint, normal loading of previously injured joint
OA pathophysiology
pressure on joint wears away cartilage exposing the bone -> cyst development & destroys the cartilage -> localized inflammation leads to more degradation & chondrocytes synthesize fluid called proteoglycan to try and repair which causes swelling -> osteoblasts activation leads to bone spurs & synovial fluid thickening -> loss of cartilage narrows the joint space
what is a hallmark of OA
osteophytes -> bone spurs that are caused by osteoblasts
OA clinical manifestations
-deep, aching joint pain, esp w/ exertion & relived w/ rest
-pain worsens w/ cold weather
-stiffness in the morning
-crepitus of joint during motion
-joint swelling
-altered gait
-limited ROM
OA physical exam findings
-joint deformity
-joint tenderness
-decreased range of motion
-weird finger things (the nodes)
herbeden’s nodes
distal interphalangeal joint
bouchard’s nodes
proximal interphalageal joint
treatment for OA
-manage pain
-maintain mobility
-minimize disability
what are dietary supplements for OA
chondroitin sulfate and glucosamine
degenerative disc disease (DDD)
-most common cause of pain, motor weakness & neuropathy (most often occurs in lumbar or cervical spine)
-usually w/ lifting or twisting motions
-loose the bounce between discs so they lay on each other and compress the nerve
DDD sx: lumber
-worse when sitting, bending, lifting or twisting
-better when walking
-numbness, tingling or weakness in the legs
-foot drop
DDD sx: cervical
-chronic neck pain that radiates
-numbness or tingling in the arm or hand
-weakness of the arm or hand
DDD can lead to
herniated or ruptured discs
RA definition
-systemic autoimmune disease
-type III hypersensitivity
-inflammatory disease of synovium
type III hypersensitivity of RA
that body begins to attack the synovial tissue in the joints and immune complexes are deposited which further develops inflammatory processes and destroys the joint
RA risk factors
-age: 40-60s
-women
-tobacco use
-family hx
-genetics (+a trigger)
immune cells involved in RA
B cells
lymphocytes and macrophages -> secrete cytokines that further attract WBCs
-the immune cells produce rheumatoid factor (RF)
during phagocytosis tissues are damaged
rheumatoid factor
antibody against the body’s own antibodies (IgG)
formation of immune complex
RA progression
intensifying inflammatory response -> cartilage is destroyed by osteoclasts and scar tissue forms (pannus)
very hard on the tissues
pannus
inflammation and exuberant proliferation of synovium (hypertrophied synovium) -> leads to bone erosion, bone cysts, fissure development
clinical manifestations of RA
early: very little, maybe joint pain or discomfort + fatigue, anorexia, wt loss
late: pain, stiffness, motion limitation, inflammation
advanced: deformity and disability, joint subluxation
will be symmetrical
RA assessment
-systemic so check joints and everything else (esp <3 and eyes)
-can cause Sjorgrens syndrome and rheumatoid nodules
Sjorgrens syndrome
destruction of moisture producing glands (salviary and lacrimal)
dry itchy eyes
rheumatoid nodules
immune mediated granulomas, developed around inflamed joints, subcutaneous and firm, sometimes painful
