Musculoskeletal Pathologies

Question 1

What is Muscular Dystrophy, what causes it and which muscle groups does it affect?

3 marks

Answer 1

A group of genetic muscle diseases that lead to degeneration & the wasting away of muscle tissue.

The muscle cells can’t make a protein called dystrophin - this helps convert nutrients to energy (cells atrophy & die causing weakness).

It usually affects skeletal muscles but can affect breathing & cardiac muscles.

Question 2

What are spasms & cramps?

1 mark

Answer 2

Spasms are involuntary contractions of voluntary muscles.

Cramps are acute, strong, painful short lived spasms

Question 3

Explain how ischaemia can cause spasms & cramps.

4 marks

Answer 3

Reduced blood flow to a muscle deprives it of O2 & causes it to tighten gradually or suddenly. Blood flow can be reduced due to chronic contraction eg postural muscles holding up back & neck, making it harder for blood flow to enter muscles.
Lack of O2 = anaerobic working which releases by-products like lactic acid which irritate muscle & cause pain. A vicious cycle is set up, reinforcing muscle spasm & cramps.

Question 4

What are strains and what causes them?

1 mark

Answer 4

Injuries to muscles causing tearing of myofibrils & production of scar tissue.
Either trauma or chronic accumulative overuse.

Question 5

What pathological process is involved in strains and what are the consequences?

4 marks

Answer 5

Inflammation!
When muscle fibres are torn their contents leak and start the inflammatory process - leading to laying down of collagen fibres as scar tissue.
Collagen doesn’t contract - so puts extra load on remaining muscle fibres which may be damaged making situation worse.
Also collagen may be laid down haphazardly so that adhesions occur between layers of tissue - limiting mobility & increasing possibility of further injury.

Question 6

What are signs and symptoms of a strain?

1 mark

Answer 6

Mild or intense local pain, stiffness & pain on resisted movement & passive stretching

Question 7

Once a muscle strain has been accurately diagnosed, what broad approaches might be used?

1 mark

Answer 7

Control inflammation with RICE
Rehabilitate gradually with incremental load/stretch to align scar tissue.
Prevent further injury with advice, taping etc.

Question 8

What is osteosarcoma?
How might it present in a patient?

4 marks

Answer 8

A rare form of cancer that forms in bone tissue, usually in the young.
It is different from cancer that forms in other tissues & then spreads to bone.

Usually a younger person - pain on activity (putting load on the bone), progressing to pain at rest and then at night. There may be a lump on the bone.

Question 9

What is osteoporosis?

2 marks

Answer 9

A loss of bone mass & density brought about by endocrine imbalances, poor metabolism of calcium, nutritional & other influences.

Question 10

How might osteoporosis present in a client?

2 marks

Answer 10

Spontaneous fractures of ribs, vertebrae or hips.

Hyper kyphosis - ‘widow’s hump’ (thoracic spine bent forward) by compression fractures in the thoracic vertebrae.

Question 11

Is it possible to reverse osteoporosis? What might you do to help prevent it?

3 marks

Answer 11

Can’t reverse it but can help slow it down or halt it.

Dietary calcium from absorbable sources - beans & greens, leafy veg.
Supplements of calcium carbonate, calcium citrate, calcium phosphate.
Vitamin D
Weight bearing exercise
Avoiding excess salt, alcohol, caffeine, animal proteins, tobacco & sugar which all pull calcium off bones as the body needs it to process them.

Question 12

What is fibromyalgia, what causes it and what has it been linked to?

2 marks

Answer 12

A common syndrome where a person has long term, body-wide pain and tenderness in joints, muscles, tendons & other soft tissues.
Causes are unknown.
It has been linked to fatigue, sleep problems, headaches, depression & anxiety

Question 13

What are the main features that might make you think a patient has fibromyalgia?

5 marks

Answer 13

Pain is the main symptom can be mild to severe.
Painful areas are called tender points - found on soft tissue of back of neck, shoulders, chest, lower back, hips, knees, elbows & shins. Pain spreads out from these areas.
Pain can be a deep ache to a sharp shooting or burning pain. Joints are not affected.
Those with fibromyalgia wake up w/ body aches - some improve during the day & worsen at night, some have pain all day.
Pain can worsen w/ damp cold weather, w/ activity, anxiety & stress.
Fatigue, depressed mood & sleep problems are seen in almost all patients. Feel as tired when they wake up as when went to bed. Struggle to get to sleep & maintain sleep.

Question 14

What is Ankylosing Spondylitis?

1 mark

Answer 14

Spinal inflammation (spondylitis) leading to stiff joint (ankylosis).
Ultimately joints between & around vertebrae can become permanently fused.

Question 15

Describe the atieology of ankylosing spondylitis

4 marks

Answer 15

It starts with chronic inflammation of SI joint(s) - usually where tendon or ligaments attach to bone.
The cartilage vertebral discs turn to bone (ossify).
The lumber curve (lordosis) flattens & the thoracic curve (kyphosis) becomes exaggerated so the person is bent forward.
Fusions at ribs may cause breathing problems.

Question 16

What signs and symptoms might you expect in a patient with ankylosing spondylitis?

4 marks

Answer 16

Chronic low back pain, possibly down to heels.
Stiff spine and hips.
Unlike most back pain - worse in morning or after rest, better on movement - as inflammatory materials build up at rest and are dispersed on movement.
There may be a slight fever, eyes might be dry and red.

Question 17

What is RA and how does it develop?

5 marks

Answer 17

Rheumatoid arthritis is an autoimmune disease where the immune system attacks the synovial membranes of certain joints and some other tissues - heart, lungs, eyes, skin, liver.

Inflammation causes heat, pain, redness, swelling & loss of function & causes the synovial membrane to thicken & swell.
Synovial fluid and inflammatory materials cause fluid to accumulate inside the synovial capsule, causing pressure & pain.
Inflamed tissue releases enzymes that erode cartilage & bone & sometimes ligaments & tendons.

Question 18

RA typically affects synovial membranes, but it may also attack other tissues - which?

3 marks

Answer 18

Sclera - whites of eyes
Eyes & mouth - dry
Pleura of lungs - pleuritis
Heart - carditis/pericarditis
Liver - hepatitis
Blood vessels - vasculitis
Bursae - bursitis
Blood - anaemia

Question 19

What signs and symptoms would you expect in a patient with RA?

5 marks

Answer 19

Symptoms vary widely.
Early on - general feeling of illness - lack of energy, appetite, fever & muscle pain which becomes joint pain.
Small painless bumps around fingers, elbows & other pressure bearing areas.
Later - affected joints red, hot, painful & stiff but improve with heat, movement & stretching.
Usually affects knuckles in hands, toes, ankles, wrists ( non-weight bearing). Less common in knees compared with OA.
Usually affects both sides of body (OA often 1 side)
Often periods of flare followed by periods of remission.

Question 20

Explain how Osteoarthritis arises

5 marks

Answer 20

OA is a process of degeneration of the cartilage of synovial joints, progressing to the synovium & bone.
The hyaline cartilage has a small number of chondrocytes - cartilage producing cells. they are active throughout life replacing & building cartilage.
But! they don’t multiply, don’t move to damaged areas to repair cartilage & they become less active with age.
When cartilage degenerates from wear & tear there are fewer chondrocytes & so less cartilage can be produced in total so the structure degrades further.
Inflammation occurs & the inflammatory molecules inhibit chondrocyte activity further.
Synovial lining becomes inflamed & produces molecules that damage cartilage.
Breakdown of cartilage stimulates osteocytes to lay down more bone - so bone in joint becomes enlarged.

Question 21

Compare & contrast OA & RA

Prevalence
Demographics
Pain patterns
Other symptoms
Implications for massage

6 marks

Answer 21

Prevalence: OA - 33-90% bony deformation in >65s, RA - 1.5% population

Demographics: OA - mostly >40s, men = women, RA - Women 2-3x > men, men get more systemic symptoms, may also affect children

Pain patterns: OA - mostly spine, knees, hips (weight bearing) & base of thumb, RA - Hands, wrists, feet, ankles, joints may be distorted/misshapen, pain.

Other symptoms: OA - None, RA - Fever, malaise, poor appetite, muscle pain.

Implications for massage: OA - can maintain range of motion & relieve pain in muscles if inflammations not acute, RA - Can be useful to maintain joint function during periods of remission - Don’t massage joint in flare!

Question 22

How does a fractured bone heal? Identify some complications that may arise.

3 marks

Answer 22

If bone is stabilised in a cast, osteocytes - bone-producing cells lay down a thickened area of new growth over the break, leading to a structure that is denser than before it was broken.

Complications can arise if: the break affects a growth plate in children, or if healing process is slowed down due to age, nutrition, stress or other factors.

Question 23

How does Gout arise?

4 marks

Answer 23

Uric acid is a normal by product of digestion. Usually it is extracted from the blood by the kidneys, but if the kidneys are not working properly or the diet is high in purines or alcohol then uric acid forms sharp needle-like crystals.
These accumulate in and around the joint capsule, grinding on & irritating synovial membranes, bursae, tendons & other tissues.
Crystals attract WBCs which set up an inflammatory response. It usually occurs at joint where big toe attaches to foot.
Later deposits of sodium urate, called tophi may form in & around the joint, eroding it & leading to complete loss of function.

Question 24

What signs & symptoms would lead you to suspect a case of gout?

1 mark

Answer 24

Sudden onset in feet, especially big toe, of all signs of inflammation - hot, red, swollen, shiny, painful.
May also be moderate fever & chills.