Skeletal Pathophysiology Flashcards
What is arthritis?
Arthritis is a general term meaning “joint inflammation”
What are the two most common types of arthritis?
Osteoarthritis and rheumatoid arthritis
What is another name for osteoarthritis?
Degenerative Joint Disease
Where does osteoarthritis typically affect people?
It primarily affects the weight bearing joints of the hips and knees
What happens during osteoarthritis?
The bones and cartilage between the bones begins to breakdown
What are the causes of osteoarthritis
?
Research points to inflammatory processes or metabolic disorders
What are the signs and symptoms of arthritis?
Joint stiffness
Aching and pain with weather changes
Fluid around joints
Grating noises with joint movements (caused by bone on bone contact)
What diagnostic exams and tests can one undergo to diagnose osteoarthritis?
X-rays of the affected joint are used to determine if osteoarthritis is present.
Blood tests are used to determine if rheumatoid arthritis is present
What is the treatment for osteoarthritis?
-Anti-inflammatory drugs like aspirin
-Nonsteroidal anti-inflammatory drugs (NSAIDs) naproxen and feldene
-Intra-articular steroid injections may be tried for severe cases
-Sometimes hyaluronic acid containing medications are injected when other treatments do not work.
-Transplanting harvested cartilage cells from a patients healthy knee cartilage which are grown in a lab and then injected into the affected joint
-Surgical scraping of the diseased joint to remove deteriorated bone fragments
-Partial or Full joint replacement prostheses eg the
Birmingham hip resurfacing prosthesis
Why are hyaluronic acid injections used in osteoarthritis treatment?
They are used to replace joint fluid
What substances are surgical prostheses made out for osteoarthritis?
Metal, plastic or a combination of both
Briefly describe the Birmingham Hip Resurfacing prostheses
The head of the femur is replaced by an all metal prosthesis
What is an advantage of partial
Joint replacement?
It conserves more bone than conventional total joint replacement
Why is conserving bone during osteoarthritis replacement surgery important?
If additional surgery is needed in the future, the surgeon will have more natural bone to work with if a revision or new prosthesis is required.
What is rheumatoid arthritis
?
It is the second most common form of arthritis. It is a chronic, systematic inflammatory disease.
In which segment of the population is rheumatoid arthritis most commonly found?
It is typically found in females, it is three times as common in women than in men.
How does rheumatoid arthritis typically present?
It usually starts in the smaller joints of the hands and feet. As the disease progresses inflammation of the larger joints occurs.
How does rheumatoid arthritis show itself through your a person’s life?
There are flares or attacks of pain and inflammation followed by periods of remission.
What are the causes of rheumatoid arthritis?
It is an autoimmune disease, the body’s immune system attacks the synovial membranes of the joints triggering the inflammation.
What are the signs and symptoms of rheumatoid arthritis?
The immune response causes
-Edema(swelling)
-Tenderness
-Warmth in and around joints
-Tissue becomes granular and thick eventually destroying the articular capsules and bones
-Formation of scar tissue
-Atrophied bones
-Visible deformities due to bone malalignment and immobility
-Moderate to severe pain in affected joints
What are the diagnostic exams and tests for rheumatoid arthritis?
-Magnetic Resonance Imaging (MRI)
-X-rays
-Blood tests
What are the treatment options for rheumatoid arthritis?
-Anti- inflammatory drugs
-Exercise
-Heat or cold treatments
-cortisone injections
-low impact aerobic exercise
-warm water
What is bursitis?
Inflammation of the bursa, the fluid filled sac that cushions tendons
Where does bursitis mainly occur?
-Elbow
-Knee
-Shoulder
-Hip
What are the causes of bursitis?
-Overuse of joints
-Trauma to the joints
-Bacterial infection to the joints
What are the signs and symptoms of bursitis?
-Joint pain
-Swelling
-Tenderness in the structures surrounding the joint
How is bursitis diagnosed?
-Physical exam
-Patient history
-X-rays
-MRI
-Lab tests on fluid withdrawn from the bursa
What are the treatment options for bursitis?
-Bed rest
-Pain medication
-Steroid injections
-Aspiration of excess fluid from the bursa
-Antibiotics
What is a fracture?
Fractures are cracks, breaks, or splintering of a bone.
What is a complete fracture?
Complete fractures are fractures that go across the entire bone breaking it in two
What is an incomplete fracture?
An incomplete fracture only goes through part of the bone, it is not split in two
What is a comminuted fracture?
A comminuted fracture is a fracture in which the bone has broken into several different fractures.
What is a greenstick fracture?
A greenstick fracture is one in which the bone is bent, but only one side is fractured.
When do greenstick fractures occur most often?
They occur most often in childhood because the bones are still soft and pliable
What is an open fracture?
An open fracture is one in which the bone breaks through the skin
What is a dislocation?
A dislocation is the displacement of a bone end from the joint.
What are the causes for fractures and dislocations?
They are most often caused by falls, automobile accidents, and sports injuries. Fractures also may occur in people with bone disorders like:
-Tumors
-Osteoporosis
-Paget’s disease
What are the signs and symptoms of fractures and dislocations?
-After accident or fall
-Intense pain
-Localized swelling
-Bruising
-Bleeding
-a limb or joint displaced or deformed or out of place
-Numbness
-Loss of use of the limb
What is the diagnostic procedure for fractures and dislocations?
X-ray images and physical examination are used to diagnose fractures
What are the treatment methods for fractures and dislocations?
-Fractures and dislocations must be realigned and immobilized by casting or splinting
-Surgical placement of plates, screws, or pins.
What is Ewing Sarcoma Family of Tumors(ESFT)?
Ewing Sarcoma Family of Tumors is a group of tumors that affect different tissues. They primarily affect bone
What demographic is mostly affected by Ewing Sarcoma Family of Tumors?
It mostly affects caucasians between the ages of 10 and 20
What are the causes of Ewing Sarcoma Family of Tumors?
The causes of Ewing Sarcoma Family of Tumors are unclear.
Where do the tumors in the Ewing Sarcoma Family of tumors typically occur in the body?
Usually located in the lower extremities but they also occur in the pelvis, chest wall, upper limbs, vertebral column, and skull.
What are the signs and symptoms of Ewing Sarcoma Family of Tumors?
Fever
Pain in the tumor location
Fractures
Bruises in the tumor location
What is the diagnostic procedure for Ewing Sarcoma Family of Tumors?
-X-rays
-MRIs
-CT Scan
-Blood Test
-Biopsy
What are the treatment options for Ewing Sarcoma Family of Tumors?
-Surgery
-Chemotherapy
-Radiation therapy
-Bone marrow transplant
-Stem cell transplant
What is Hyperkyphosis?
An exaggerated kyphotic curvature of the vertebral column, most often of the thoracic (chest) level.
What is another term for Hyperkyphosis?
Humpback
What are the causes of adolescent Hyperkyphosis?
-Adolescent Hyperkyphosis may result from growth retardation or improper development of the epiphyses as a result of rapid growth.
What are the causes of adult Hyperkyphosis?
The adult form of Hyperkyphosis is caused by aging and degenerative disc disease of the intervertebral discs and vertebral fracture from underlying osteoporosis
What are the signs and symptoms of adolescent Hyperkyphosis?
-No symptoms other than visible back curvature
-mild pain
-tiredness
-tenderness
-stiffness of the thoracic spine
What are the signs and symptoms of adult Hyperkyphosis?
The upper back is rounded and there may be pain, back weakness, and fatigue
What is the diagnostic procedure for Hyperkyphosis?
-Physical Exam
-x-ray
MRI
CT scans
What are the treatment options for childhood Hyperkyphosis?
-Exercise
-A firm mattress
-a back brace
-Harrington rods
-Spinal fusion or grafting in cases of neurological damage or disabling pain
What is hyperlordosis ?
It is an exaggerated lordotic curvature of the lumbar region of the vertebral column.
What is another term for hyperlordosis?
Swayback
What are the causes of hyperlordosis?
-wearing high heels frequently as the elevated heel causes an inward positioning of the back as a counterbalance measure
What are the signs and symptoms of hyperlordosis?
-The main sign is visual inward curvature of the lower back.
-mild pain with exaggerated curvature
What is the diagnostic procedure for hyperlordosis?
-Physical exam
-X-ray
-CT Scan
-MRI
What are the treatment options for hyperlordosis?
-Avoiding excessive heel height
- exercise
Appropriate footwear
What is gout?
Gout is a type of arthritis that usually occurs more frequently with age.
What is another term for gout?
Gouty Arthritis
What are the causes of gout?
Gout is caused by deposits of uric acid crystals in the joints. People with gout cannot properly break down uric acid and remove it from the bloodstream.
What are the signs and symptoms of gout?
-Sudden or chronic joint pain
-Pain commonly in the big toe
-Joint swelling and stiffness
-Fever
What are the diagnostic criteria for gout?
-A specimen of joint fluid is aspirated from the affected joint and tested for uric acid crystals.
-Blood tests for high levels of uric acid and creatinine may also be performed
What are the treatment options for gout?
-Pain medication
-Changes to a patient diet
-Elimination of foods that cause the formation of uric acid(meat, fish, beer and wine)
-Medication that increases uric acid elimination by the kidneys
-Medication that decreases uric acid production
What are the Medication that increases uric acid elimination by the kidneys?
Uricosuric agents
What are Medication that decreases uric acid production?
Xanthine oxidase inhibitors
What is Osteogenesis Imperfecta?
It is a decrease in the amount of collagen in the bones which leads to brittle bones
What is another name for Osteogenesis Imperfecta?
Brittle Bone Disease
What are the 8 types of Osteogenesis Imperfecta?
Type I to Type VIII
What is Type I Osteogenesis Imperfecta?
It is the mildest form which occurs more often than other types of
What is Type II Osteogenesis Imperfecta?
It is the most severe form normally fatal within a few weeks of birth
What is Type III Osteogenesis Imperfecta?
It is a severe form however infants live longer than those with type II
What is type IV Osteogenesis Imperfecta?
It is a moderate form that is usually diagnosed later in childhood
What is type V Osteogenesis Imperfecta?
It is similar to type VI except large callouses form around bone fractures. It accounts for only 5% of OI cases
What is Type VI Osteogenesis Imperfecta?
It is an extremely rare, moderate form of OI. It is characterized by a defect in the mineralization of the bones.
What is Type VII Osteogenesis Imperfecta?
A moderate form caused by inheritance of a recessive gene mutation. Similar to Type IV. Moderately abnormal bone growth occurs in this type.
What is Type VIII Osteogenesis Imperfecta?
It is similar to type II and III, growth deficiencies are severe however, sclera are white in type VIII
What are the causes of Osteogenesis Imperfecta?
It is hereditary
What are the signs and symptoms of Osteogenesis Imperfecta?
-Fractures(All Types)
-Blue Sclera(Types I, II, III and IV)
-Dental Problems(Types III and IV)
-Hearing Loss(Type I)
-A triangular face(Type III)
-Abnormal Spinal Curves(Types I, III, IV, V and VI)
-Very small Stature(Types II, III, IV, VII and VIII)
-A small chest(Types II and III)
-Fractures at birth (Types II and III)
-Loose joints (Type IV)
-Muscle Weakness(Types I, III, and IV)
-Respiratory difficulties (Types I, II, III, and IV)
What are the diagnostic criteria for Osteogenesis Imperfecta?
-Genetic tests to determine if there is mutations in genes associated with OI
What are the treatment options for Osteogenesis Imperfecta?
-fracture repair
-surgery to strengthen bone by inserting metal rods
-dental procedures
-physical therapy
-braces to prevent bone deformity
-wheelchairs
-supportive aids and medications
-surgery for heart, lungs,
What is Osteoporosis?
It is a condition in which bones become thin( more porous) over time.
What demographics are most affected by Osteoporosis?
-Caucasians
-Women more than men
Why does Osteoporosis occur?
It occurs because of hypocalcemia in which bone is broken down to release calcium and is not replaced in sufficient quantities leading to bone density decreases
What are the causes of osteoporosis?
-Hormone deficiencies (estrogen in women testosterone in men)
-sedentary lifestyle
-lack of calcium and vitamin d in diet
-bone cancer
-corticosteroids excess (due to endocrine conditions)
-smoking
-excess alcohol consumption
-steroids use
What are the signs and symptoms of osteoporosis?
-usually no symptoms in early stages of disease
-in later stages, patients may experience fractures (usually of spine, wrists, hips)
-back and neck pain
-loss of height over time
-abnormal curving of spine (Hyperkyphosis)
What are the diagnostic criteria for osteoporosis?
-high risk patients with family history should get bone densitometry studies to catch disease before symptoms begin
What are the treatment options for osteoporosis?
The most common treatments include:
-medications to prevent bone loss and relieve bone pain
-hormone replacement therapy
-lifestyle changes to prevent bone loss (exercise and supplements that contain calcium, vit d and phosphorus)
-cessation of smoking and low alcohol consumption
What is osteosarcoma?
It is a type of bone cancer usually affecting bone of the lower limb that originates from osteoblasts the cells that make bone tissue
What are the demographics most affected by osteosarcoma?
-children, teens, and young adults
-males more often than females
What are the causes of osteosarcoma?
The etiology of this cancer is unclear
What are the causes of osteosarcoma?
The etiology of this cancer is unclear
What are the signs and symptoms of osteosarcoma?
-Pain in affected bones
-swelling around affected bones
-increase in pain with movement of the affected bones
What is the diagnostic criteria for osteosarcoma?
-CT scan
-MRI
-X-rays
-bone scans
-biopsy
What are the treatment options for osteosarcoma?
-Surgery
-Chemotherapy
-Radiation therapy
-Amputation followed by a prosthesis fitting to prevent metastasis
What is Paget’s disease?
A disease that causes bones to become enlarged, deformed and weak.
What are the demographics most affected by Paget’s disease?
People over 40
What are the causes of Paget’s disease?
A virus or various hereditary factors
What are the signs and symptoms of Paget’s disease?
-Bone pain
-Deformed bones
-fractures
-headaches and hearing loss of the bone affects skull bones
What is the diagnostic criteria for Paget’s disease?
-X-rays
-Bone scans to visualize bone deformities
What are the treatment options for Paget’s disease?
-Surgery to remodel bones
-Hip replacement
-Medications to prevent bone weakening
-Physical Therapy
What is Scoliosis?
Scoliosis is an abnormal, C or S shaped, lateral curvature of the thoracic and or lumbar regions of the vertebral column
What are the cause of scoliosis?
-It develops prenatally when vertebrae do not fuse together
-it also develops from diseases that cause weakness of the muscles that hold vertebrae together
-Other causes are unknown but they may be genetic
What are the signs and symptoms of scoliosis?
-Vertebral column that looks bent to one side with one shoulder or hip appearing to be higher than the other
-back pain
What are the diagnostic criteria for scoliosis?
Physical exam and spinal x-rays
What are the treatment options for scoliosis?
-Back brace
-Surgery to correct lateral curvature
-physical therapy to strengthen muscles of the back and abdomen
