Musculoskeletal Pathologies Flashcards
Dysostosis
Developmental anomaly of bone or cartilage
Syndactyly frequency
1 in 2,500 births
Sprengel’s deformity
Undescended scapula
Sprengel’s deformity can cause
Renal and cardiac malformations
Dysplasia
Mutations interfere with growth
Height to be considered a dwarf
<4’10”
MC form of dwarfism
Achondroplasia
Mutated gene in achondroplasia
FGFR3
Achondroplasia
___ are spontaneous
___ are autosomal dominant
90%
10%
Spontaneous achondroplasia MC from
Sperm (high paternal age)
Freq of achondroplasia
1 in 10,000
____ is inhibited in achondroplasia
Growth plates
Symptoms of achondroplasia
Short/bowed long bones
Frontal bossing
Midface hypoplasia
Trident hand
Frontal bossing
Excessive curvature of frontal bone
Bullet vertebrae in achondroplasia an cause
Hyperlordosis
Kyphosis
Scoliosis
Spinal abnormalities in achondroplasia
Bullet vertebrae
Spinal stenosis
Spinal stenosis can occur in
Foramen magnum
Spinal canal
Achondroplasia treatment growth hormone
Somatotropin
Thanatophoric dwarfism
Extremely small thorax and short long bones
Thanatophoric dwarfism is __ and ___
Rare
Fatal
Osteogenesis imperfecta aka
Brittle bone disease
Type 1 collagen disease
Thanatophoric means
Death loving
Type 1 osteogenesis imperfecta
Normal lifespan
Type 2 osteogenesis imperfecta
Lethal in utero
Osteogenesis imperfecta is autosomal ___
Dominant
Osteogenesis imperfecta results in
Mutated type 1 collagen
Alpha 1 or 2 chains
Childhood osteogenesis imperfecta can result in
Fractures Bowing Scoliosis Hearing loss Dwarfism
Cleidocranial dysostosis
Absent clavicle
Klippel-feil syndrome
Congenital fusion of >2 cervical vertebrae
“Blue sclera” can be observed in this condition
Osteogenesis imperfecta
Adjusting is ___ in osteogenesis imperfecta
Contraindicated
Zebra stripe sign
Bisphosphonates cyclically given to treat osteogenesis imperfecta in children
Osteopetrosis aka
Marble bone disease
Osteopetrosis has low ___ activity
Osteoclasts
Treatment for osteopetrosis
Low calcium intake
Stem cell transplant
Skeletal sclerosis
Hardening
Bony stenosis in osteopetrosis can cause
CN palsies
Osteopetrosis can cause abnormal
Hematopoiesis
Abnormal hematopoiesis can cause
Fatigue (low RBC)
Infections (low WBC)
X-ray features of osteopetrosis
No medullary canal
Erlenmeyer flask deformity
Osteoporosis
Severe bone mineral density reduction at least -2.5 SD from normal
Osteoporosis is evaluated with a ___ scan
DEXA
Osteoporosis fractures are common in
Trabecular bone
MC places for fracture with osteoporosis
Vertebral bodies
Femur
Calcaneus
Osteopenia
Bone mineralization below normal but not severe
Between 1 and 2.5 SD below normal
Bone mineralization peaks between
25-30 yo
Osteoblasts activity ____ with age
Decreases
Senile osteoporosis
Age related loss in bone mineralization
Activity decreases with age, which ___ bone loss
Accelerates
Menopause causes ___ osteoclast Activity
Accelerated
Osteoclast activity in menopause is stimulated by
Low estrogen
Compression fractures on vertebral bodies can cause ___ (MC in women with osteoporosis)
Dowager’s hump
Complications of osteoporosis
Immobility
Spinal deformity
Pulmonary embolism
Pneumonia
Drug that can decrease osteoclast activity
Bisphosphonates
Vitamin D deficiency in kids
Rickets
Rickets can cause
Stunted growth
Bowing of lower extremities
Increased fracture risk
Vit D deficiency in adults
Osteomalacia
____ less severe than rickets and mimics osteoporosis
Osteomalacia
Hyperparathyroidism
Elevated PTH levels
PTH regulates
Blood calcium levels
PTH stimulates ___ activity
Osteoclast
Primary hyperparathyroidism
Parathyroid glands overproduce PTH
Primary cause of primary hyperparathyroidism
Adenoma of parathyroid gland
Primary hyperparathyroidism MC in
Women age 50
Secondary hyperparathyroidism primary cause
Chronic kidney disease
Chronic kidney disease can cause ____, which results in elevated ___
Hypocalcemia
PTH
Other cause of secondary hyperparathyroidism
Vit D deficiency
Symptoms of hyperparathyroidism
Hypercalcemia
Kidney stones
Brown tumor
Brown tumor
Non-neoplastic
Develops following localized osteolysis
Steps of developing brown tumor
- Bone weakens
- Hemorrhage occurs
- Macrophages accumulate
- Fibrotic tissue fills area
Skeletal changes due to hyperparathyroidism
Resorption of trabecular and cortical bone
Osteitis fibrosa cystica
Hyperparathyroidism:
Radiological appearance of vertebral bodies
Rugger jersey spine
Hyperparathyroidism:
Radiological appearance phalanges
Resorption of cortex
Primarily on radial side of middle and distal phalanges
Hyperparathyroidism:
Radiological appearance calvaria
Salt and pepper skull
Hyperparathyroidism:
Radiological appearance long bones of lower extremity
Osteitis fibrosa cystica
Paget Disease of bone aka
Osteitis deformans
Paget Disease involves both ___ and ___ activity
Osteoclasts
Osteoblasts
Paget Disease results in
Sclerotic phase
Weak bone with “shaggy” appearance
Paget Disease
“Jigsaw puzzle” mosaic pattern
Paget Disease
Paget disease is mostly ____
Idiopathic
Most paget Disease is
Asymptomatic
Paget disease: if symptomatic, MC pain present in
Neck and back
Largest risk factor for paget disease
Increasing age
Ivory vertebrae sign can indicate
Paget disease
Metastatic cancer (prostate)
Lymphoma
Treatment for paget disease
Bisphosphonates
MC diagnosed with paget disease at age
70
Classifications of fractures
Complete vs incomplete Closed Compound Comminuted Displaced
Closed fracture
Intact overlying tissue
Compound fracture
Skin ruptured
Comminuted fracture
Fragmented/splintered
Displaced fracture
Distal segment misaligned
Pathological fracture
Site of any pathology
Stress fracture
Microfractures
Stress fractures MC
Lower leg/foot
Sex MC for paget Disease
Men
Incomplete fractures are more common in
Children
Aka green stick fracture
Type 1 SHF
Fracture that goes straight through growth plate
Type 1 SHF cannot occur in
Adults
Growth plates fused
Type 1 SHF has a ___ prognosis
Favorable
Type 2 SHF occurs
When fracture goes through growth plate and metaphysis
MC form of SHF
Type 2 SHF
Type 2 SHF has ___ prognosis
Favorable
Type 3 SHF
Fracture goes through growth plate and epiphysis
Type 3 SHF has an epiphyseal fragment without
Associated metaphysical fracture
SHF stands for
Salter-Harris fracture
Worst prognosis SHF
Type V
Least common SHF
Type V
SHF types that occur with articular fracture
Type III, IV
Type IV has ____ due to severity
Poor prognosis
Delayed fracture healing can be due to
Nonunion Comminution Inadequate immobilization Infection Nutrition deficiency Advanced age
MC cause of AVN
Fracture
Osteonecrosis is painful if present with
Joint surface
Other causes of AVN
Corticosteroids
Vasculitis
Embolism
Irradiation
10% hip dislocations cause
AVN
Osteomyelitis
Bone marrow inflammation from infection
Types of osteomyelitis
Pyogenic
Mycobacterial
Osteochondritis dissecans
Osteonecrosis at knee joint
Large AVN can cause
Osteoarthritis
Corticosteroids use can cause AVN at
Hip
Involucrum
Woven bone to wall off infection in osteomyelitis
MC cause of osteomyelitis
Hematogenous infection
Pyogenic osteomyelitis MC from
Staph Aureus
Pyogenic osteomyelitis in neonates from
E. coli
Group B Strep
Pyogenic osteomyelitis sickle cell disease
Salmonella
Sequestrum
Entrapped necrotic bone
Draining sinus
Pus drains into surrounding soft tissues
Mycobacterial osteomyelitis occurs from
TB infection
TB osteomyelitis spreads via
Hematogenous (MC) or lymphatic
TB can cause
Caseous granulomas
TB in vertebral bodies
Pott Disease