Musculoskeletal pathophysiology Flashcards
What is the main characteristic of degenerative joint disease?
degeneration of articular cartilage with hypertrophy of subchondral bone and joint capsule
What are some common medications used to help with DJD pain?
corticosteroids
Glucocorticoid injections
NSAID’s
Acetaminophen
What is ankylosing spondylitis?
Progressive inflammatory disorder of unknown etiology that initially affects the axial skeleton
Who does ankylosing spondylitis usually affect?
men 3x greater than women
What are the first symptoms of ankylosing spondylitis?
mid and low back pain, morning stiffness, and sacroilitis
What is gout?
A genetic disorder of purine metabolism, characterized by elevated serum uric acid (hyperuricemia
What is the pathophysiology of gout?
Excess uric acid changes into crystals and deposits into peripheral joints and other tissues (kidneys).
What is Rheumatoid arthritis?
Chronic systemic disorder of unknown etiology, usually involving a symmetrical pattern of dysfunction in synovial tissues and articular cartilage of joints of hands, wrists, elbows, shoulders, knees, ankles and feet (so most of the appendicular skeleton.)
What is pannus formation?
Characteristic inflammatory granulation tissue that covers joint surfaces in pts with RA
What are common anatomical deviations in the hand with RA?
ulnar drift and volar subluxation of MCP joints Ulnar drift at PIP's in severe RA swan neck deformity boutonniere deformities Bouchards nodes
What is a swan neck deformity?
contracture of intrinsic muscles with dorsal subluxation of lateral extensor tendons
flexion of MCP and DIP with extension of PIP
What is a boutonniere deformity?
Rupture of central tendinous slip of extensor hood
Extension of MCP and DIP with flexion of the PIP
Who is affected with RA to a greater degree?
Women 3x greater than men
What is osteoporosis?
Metabolic disease that depletes bone mineral density/mass, predisposing individual to fracture. Affecting women 10x more than men
What is osteomalacia?
decalcification of bones due to vitamin D deficiency
what are some symptoms of osteomalaica?
severe pain, fractures, weakness, and deformities
What is osteomyelitis?
An inflammatory response within bone caused by an infection (usually staphylococcus aureus)
Who most commonly is affected with osteomyelitis?
More common in children and immunosuppressed adults.
More common in males than females
What is arthrogryposis multiplex ocngenita?
Congenital deformity of skeleton and sot tissues, characterized by limitation in joint motion and a “sausage-like” appearance of limbs.
Is intelligence affected in aryhtogryposis multiplex congenita?
no intelligence develops normally
What is osteogenesis imperfecta?
Inherited autosomal dominant disorder characterized by abnormal collagen synthesis leading to an imbalance between bone deposition and resorption. This leads to bone becoming very thin, leading to fractures and deformity of weight bearing bones
What is osteochondritis dissecans?
A separation of articular cartilage from underlying bone (osteochondral fracture)
Where do you usually see osteochondritis dissecans?
usually involves the medial femoral condyle near the intercondylar notch
observed less frequently at the femoral head and talar dome. may also affect the humeral capitellum
What is a “trigger point”?
focal point of irritability found within a muscle. Trigger points can be identified as a taut, palpable band within a muscle.
What are the two different types of trigger points?
Active trigger points and latent trigger points
Active-tender to palpation and have a characteristic referral pain patter when provoked
latent-palpaple taut bands that are not tender but can be converted to active trigger points.
What is bursitis?
inflammation of a bursa secondary to overuse, trauma, git or infection
What are the symptoms of bursitis?
pain with rest
PROM/AROM limited but not in capsular pattern
What is myositis ossificans?
Painful condition of abnormal calcification within a muscle belly
How is myositis ossificans usually caused?
direct trauma that results in hematoma and calcification of the muscle.
Can also be induced by early mobilization and stretching, with aggressive physical therapy following trauma to muscle.
Where are the most frequent locations for myositis ossificans?
quadriceps, brachialis and biceps brachii
When is surgical care warranted in pts with myositis ossificans?
only after maturation of lesion (6-24 months) and IF lesion mechanically interferes with joint movement or impinges on a nerve
What is CRPS?
results in dysfunction of sympathetic nervous system to include pain, circulation and vasomotor disturbances. Etiology largely unknown but thought to be related to trauma.
What is CRPS I?
frequently triggered by tissue injury; term describes all patients with pain, circulation and vasomotor disturbances but no known nerve damage
What is CRPS II?
Experience same symptoms as CRPS I buy are clearly associated with a nerve injury.
What is Paget’s disease?
Osteitis deformans. Metabolic bone disease involving abnormal osteoclastic and osteoblastic activity with unknown etiology.
How does Paget’s disease present?
Spinal stenosis, facet arthropathy and possible spinal fracture.
What are the two types of scoliosis?
Structural-irreversible lateral curvature of spine with a rotational component.
nonstructural-reversable lateral curvature of spine without a rotational component
When is surgery indicated for structural scoliosis?
> 45 degree cobb angle
When is a spinal orthosis indicated for idiopathic scoliosis?
25-45 degree cobb angle
What is torticolis?
Spasm or tightness of sternocleidomastoid muscle with varied etiology
What is the dysfunction seen with torticolis?
side bending toward and rotation away from affected SCM.
