Skeletal Pathologies Flashcards
Ankylosing Spondylitis (AD)
Chronic inflammation of the spine and sacroiliac joints, often leading to spinal fusion (‘ankylosis’) and stiffness
Causes:
• Age of onset is typically 15-30 years, more common in males
• Strong genetic association with HLA-B27 (present in 95%)
• Links with inflammatory bowel diseases (& leaky gut), as well as urogenital or intestinal infections such as salmonella and shigella, cross-reacting with HLA-B27
Signs and symptoms:
• Sacroiliac & lower lumbar spine pain, progresses up spine. Worsening morning stiffness
• Lower back symptoms improved with activity
• The lumbar lordosis flattens - become kyphotic
• Hip and heel (Archilles) pain
• 20% suffer acute iritis – (HLA-B27 diseases)
• Systemic symptoms: Fever, fatigue and malaise
Diagnostic:
• Elevated blood inflammatory markers (ESR / CRP), HLA-B27 +
• X-ray / MRI – identifies characteristic ‘bamboo spine’
Allopathic treatment;
• Surgery
• Anti-inflammatories (including non-steroidal & steroids)
Bursitis
Inflammation of the bursa
Causes:
• Repetitive use (for example: sub-acromial bursitis following lots of overhead work
• Sudden trauma, infection, wear and tear
Bursae are located around many joints in the body. Commonly affects the shoulder (‘sub-acromial’) and hip (‘trochanteric’)
Disc Herniation
The nucleus pulposus of the intervertebral disc leaks out through the annulus fibrosus
Causes:
• Tends to affect discs with highest fluid content, often lumbar spine (L5 / S1), then cervical spine.
• (Age 30-40 years)
• The classic injury mechanism is combined: Lumbar spine flexion (bending) & rotation
• A herniated disc can compress spinal nerves
Dislocation and Subluxation
Dislocation: Complete separation of two bones at a joint
Subluxation; Incomplete or partial joint dislocation
• Dislocation leads to reduced strength and compromised joint function (movement). Associated with a high risk of reoccurrence unless sufficiently strengthened.
• Commonly occurs in the shoulder and knee (patella). May be accompanied by damage to soft tissues, nerves and blood vessels.
Fracture
A fracture describes any break in a bone
Fracture classification:
• Complete; Bone is broken in two or more fragments. Can be either open (perforated skin) or closed (soft tissues not compromised)
• Incomplete; Bone is fractured but not into fragments
• Fractures can be linear (along the bone length) or transverse (dissect across the bone)
• Avulsion fracture occurs when a tendon or ligament pulls of a piece of bone
Causes:
• Trauma (mostly)
• Low bone density (associated w/ osteoporosis)
• Vitamin D deficiency
Complications
• Can damage blood vessels that supply bone and surrounding nerves
Gout
Type of monoarthritis, characterized by uric acid crystal deposition in synovial joints
Causes:
• Purine-rich foods (red meat, organ meats, shellfish, etc).
• Dehydration, kidney disease, medications, obesity, excessive alcohol consumption (competes with uric acid for elimination by the kidneys & accelerates purine breakdown)
• Hypertension
• Type 2 diabetes
Signs and symptoms:
• Often affects big toe. Can affect mid-feet, ankles, knees, elbows, hands
• Usually monoarticular (one joint)
• Sudden onset of intensely painful, red, hot, swollen joints, often lasting 12-24 hours. Shiny skin over joint. Urate crystals can deposit under the skin and produce ‘tophi’
Diagnostic:
• Blood serum for uric acid (not definitive – fluctuates) but can be useful to monitor treatment
• Analysis of synovial fluid (needle aspiration)
Allopathic treatment;
• ‘Allopurinol’ to prevent episodes (hepatotoxic)
• Corticosteroid injections
Pathophysiology:
• Excess uric acid forms solid crystals (monosodium urate) on cartilage surfaces
• This causes white blood cells to infiltrate activating an acute inflammatory response
• ‘Hyperuricaemia’ = elevated blood uric acid levels due to overproduction or underexcretion
• Uric acid is derived from the breakdown of ‘purines’
Hyper-kyphosis
Excessive curvature of the thoracic spine
Causes:
• Poor posture (occupation, stress, body language)
• Secondary disease (osteoporosis spinal fractures)
Signs and symptoms:
• Muscular fatigue - scapula/shoulder blade)
• Irritation of the rib joints
• Can interfere with breathing
Lordosis
Increased concavity in the lumbar and cervical spine
Causes:
• May be a genetic / ethnic cause (e.g. Afro-Caribbean women) or secondary to other musculoskeletal changes
• More common in obese individuals
• Normal adaptation for pregnancy
Signs and symptoms:
• Muscular fatigue
• Encourage the vertebral joints to move closer, causing inflammation
Osteoarthritis
A degenerative wear and tear arthritis of the angular cartilage typically affecting weight-bearing (larger) joints in individuals typically over 50 years of age
Pathophysiology:
1. Articular cartilage wears away; bone exposed
2. Bone becomes hard & glossy (‘eburnation’)
3. Remodeling of underlying bone (i.e. thickening) occurs
4. Compensatory bone overgrowth in attempt to stabalise joint = osteophytes (spurs)
Causes:
• Primary: associated with aging, 80% of 65-year olds have radiological signs of OA
• Secondary: associated with predisposing factors;
1. Congenital ill-development
2. Trauma – e.g. fractures, surgery, meniscal injury, obesity
Signs and symptoms:
• Onset is gradual, pain increasing (months / years)
• Joint pain and stiffness
• Not associated with systemic symptoms
. Pain in larger weight bearing joints
Diagnostic:
• X-ray – revealing joint space narrowing, osteophyte 9bone spur) formation, squaring of rounded joint surfaces.
Osteomalacia (Rickets)
Inadequate mineralisation of the bone matrix in spongy and compact bone
• Rickets; prior to epophyseal plate closure (<18 years)
• Osteomalacia; as an adolescent or adult
Causes:
• Vit D deficiency, possibly due to;
1. Insufficient sunlight
2. Insufficient dietary vit D
3. Secondary deficiency; malabsorption disorders
4. Reduced receptor sites for Vit D in tissues
Signs and symptoms:
• Deformed bones (bowed legs & fractures)
• Severe backpain & muscle weakness
• In Rickets; delayed closure of fontanelles & skull softening
Complications:
• Decalcification & softening of bone, esp in spine, pelvis & legs
Osteomyelitis
A bacterial infection of the bone marrow, resulting in necrosis and hence bone weakness
Causes:
• Bacterial infection (staphyloccus aureus) through the blood supply or post fracture
• Immunosuppression
• Diabetes
• IV drug users
Signs and symptoms:
• Presents as severe bone pain (often worse at night) with swelling, redness and warmth
Diagnostic:
• Bloods; Elevated inflammatory markers (ESR / CRP) & WBCs
• X-ray
• MRI
Osteoporosis
Chronic progressive thinning of the bone; ‘porous bone / brittle bone disease’
Causes:
• Age – + 30 years, ability to retain calcium lowers
• Female & post-menopausal – oestrogen suppress osteoclast activity
• Poor diet – high acid forming diet (high sugars/ proteins), low minerals, malnourished, + sodium, caffeine, fizzy drinks
• Drugs – long term corticosteroid therapy
• GIT disease – liver disease, malabsorption syndromes, low stomach acidity (gastric acid is needed to ionize calcium and assist absorption)
• Genetics – family history
• Sedentary – lack of osteoblast stimulation
• Endocrine pathologies –Cushing’s syndrome, hyperparathyroidism, hyperthyroidism, inability to produce oestrogen
• Low body weight
• High alcohol consumption and smoking
• Toxins (heavy metals)
Signs and symptoms:
• Asymptomatic until the bone has reached critical thinness = fractures occur spontaneously with minor trauma. Affects spine & hips
• Focal pain & kyphotic posture with loss of height (vertebrae collapse into each other)
• Pain is aggravated by prolonged sitting, standing or bending. It is relieved by lying on side with hips and knees flexed
Diagnostic:
• ‘Dual X-ray absorptiometry’ (a DXA scan). On this test a ‘T-Score’ lower than -2.5 indicates oesteoporosis
Allopathic treatment:
• Bisphosphonates (alendronic acid) (suppress osteoclast activity)
• HRT
Complications:• Decreased bone mineral density (BMD) leads to bone fragility & risk of fracture
• Can get fractures from mineral trauma (pathological fractures)
Rheumatoid Arthritis
Autoimmune inflammation of the synovium, potentially affecting ALL organs except the brain (systemic inflammation)
Causes:
• Genetic markers (HLA-DR4 and DR1)
• Infectious agents e.g. EBV, rubella
• Abnormal intestinal permeability, small intestinal bacterial overgrowth (SIBO)
. Smoking
Signs and symptoms:
• Symmetrical / bilateral arthritis of small joints (hands & feet mostly)
• Gradually spreads through more proximal structures
• Progressive morning stiffness (>one hour)
• Deformity of joints, e.g. swan neck, ulnar deviation
• General malaise & fatigue
• Subcutaneous nodules (fingers & elbows)
• C1/C2 subluxation & compression of the spinal cord leading to paralysis & neurological complications
• Kidney problems
Allopathic treatment;
• Anti-inflammation & immunosuppressants (significant implications of immune suppression)
• Surgery
Scoliosis
A lateral ‘S’ shaped curve in the spine
Causes:
• Can be born with scoliosis or develop it throughout their life (often adolescent onset)
• Can result from everyday imbalances (carrying a rucksack on one shoulder)
• Also common with leg length discrepancies
Signs and symptoms:
• Often asymptomatic
• Severe scoliosis can cause spinal nerve compression
Sprain
A joint being forced beyond its normal range
Allopathic treatment;
• First aid – RICE (Rest, Ice, Compression, Elevate)
Complications:
• Often leads to joint instability
