Skeletal System Pathologies Flashcards
What is a fracture?
Any break in a bone
What can cause a pathological fracture (a fracture that wouldn’t happen without an underlying problem)?
Osteoporosis, Vitamin D deficiency
Which vitamin helps to mineralise bones?
Vitamin D3
There are 2 main classifications of fractures. Name them.
- Complete fracture - bone is broken into 2 or more parts
2. Incomplete fracture - bone is fractured but not in to separate fragments.
There are 2 types of complete fracture. What are they?
- Open fracture (skin is perforated)
2. Closed fracture (soft tissue not compromised)
Fractures can be linear or transverse. What is the difference?
Linear = along the bone length Transverse = across the bone width
What is an avulsion fracture?
Where a tendon or ligament pulls off a piece/fragment of bone. This is most common in the feet.
What are the 4 stages of fracture repair?
- Haematoma (bone bleeding and inflammation)
- Phagocytes clean up the fracture site debris.
- Soft callus formation, via fibroblasts (collagen)
- Bony callus formation, via osteoblasts
- Bone remodelling, via osteoclasts
What is a ‘callus’?
A mass of tissue
Suggest a homeopathic remedy to support the healing of fractures
Arnica. Ruta, calc phos.
What are ligaments and what is their purpose?
Tough bands of connective tissue that attach bone to bone.
They keep joints stable.
What is a sprain?
A sprain involves a trauma that forces a joint beyond its normal range, over-straining and tearing ligaments. This often leads to joint instability.
Exercise and rehab are critical to prevent reoccurrence.
Which joint is susceptible to sprains?
The ankle
What is the difference between subluxation and dislocation?
Subluxation = incomplete or partial joint dislocation
Dislocation = complete separation of 2 bones at a joint
Why is it that blood clots can be detected by Xray?
Due to the accumulation of RBC’s (and hence iron)
What is one of the problems with X-rays?
They are a mutagenic agent, and can introduce mutations in DNA.
A healthy spine will include a natural slight kyphosis. Why is this important?
Because it can help to distribute forces through the spine.
Describe kyphosis
A rounding / arching of the thoracic spine
List some of the side effects of a kyphotic posture
- Difficulty breathing
- Irritation of rib joints
- Muscular fatigue around the shoulder blade
What is lordosis?
An increased concavity in the cervical and lumbar spine
List 3 causes of lordosis
- Pregnancy
- Muscular weakness
- Genetic/ethnic cause (afro-caribbean women)
What is a scoliosis?
A lateral ‘S’ shaped curve in the spine.
Often asymptomatic
Often adolescent onset
Can cause spinal nerve compression if severe
What can cause a scoliosis?
- Born with it
- Everyday imbalances (i.e, carrying a rucksack on one shoulder)
- Leg length discrepancy
Define osteoporosis
A chronic, progressive thinning of the bone.
Also called ‘brittle bone disease’.
What is osteoporosis characterised by?
Decreased bone mineral density, leading to bone fragility and increased risk of fracture
How is osteoporosis conventionally diagnosed?
Via a DXA scan
On a DXA scan, what T-score indicates osteoporosis?
A T-score of less than -2.5
List some risk factors for osteoporosis
- Increasing age (over 30)
- Female & post-menopausal
- Poor diet (acidic)
- Malnourished, low in minerals
- Caffeine
- Drugs (i.e, long term corticosteroids)
- GIT diseases, malabsorption
- Low stomach acid (gastric acid is needed to ionise calcium and assist absorption)
- Genetics, family history
- Sedentary lifestyle
- Hormonal issues, such as Cushings
- Alcohol consumption
- Heavy metal toxicity
Why is osteoporosis more common in post-menopausal women?
Oestrogen would normally suppress osteoclast activity. Post menopause, women have less oestrogen.
Is osteoporosis always symptomatic?
No. It is usually asymptomatic until the bone has reached critical thinness whereby fractures occur spontaneously with minor trauma.
How is osteoporotic pain aggravated and relieved?
Aggravated by prolonged sitting, standing or bending.
Relieved by lying on side with hips and knees flexed
Bisphosphonates and HRT are usually used allopathically to treat osteoporosis, but what are the problem with these?
Lots of side effects
How would you treat osteoporosis nutritionally?
Alkaline, plant based diet Limit animal products No dairy Supplement vitamin D3 and K2 No caffeine or alcohol
What causes osteomalacia and/or Rickets?
Inadequate mineralisation of bone matrix. Caused by a VITAMIN D DEFICIENCY.
‘Soft’ bone, caused by decalcification.
What is the difference between osteomalacia and rickets?
Rickets = happens prior to epiphyseal plate closure (< 18 yrs) Osteomalacia = happens as an adolescent or adult.
What are the main signs and symptoms of Osteomalacia and Rickets?
Deformed bones (i.e, bowed legs)
Possible fractures
Severe back pain and muscle weakness
What is Osteomyelitis?
A bacterial infection of the bone marrow.
An infection within the bone itself.
How does osteomyelitis present?
With severe bone pain (often worse at night)
Redness, warmth, swelling
List 3 causes of osteomyelitis
- Bacterial infection (often travelled from a fracture site)
- Immunosuppression
- Intravenous drug use
What does a blood test for osteomyelitis look for?
Inflammatory markers (ESR & CRP) Elevated WBC's
Xray and MRI scans can also be useful in diagnosing osteomyelitis.
In blood tests, what does CRP stand for?
C-Reactive Protein (an inflammatory marker)
In blood tests, what does ESR stand for?
Erythrocyte Sedimentation Rate (an inflammatory marker)
Define osteoarthritis (OA)
A degenerative wear & tear arthritis of the articular cartilage in synovial joints.
Typically affects the large, weight bearing joints (i.e, knees, hips, spine)
Which age group is typically affected by osteoarthritis?
Over 50’s
What are the signs and symptoms of osteoarthritis?
- Gradual onset over months/years
- Often asymptomatic in most people
- Gradually increasing joint pain and stiffness
- NOT associated with systemic symptoms
List the primary and secondary causes of osteoarthritis.
Primary = Ageing. Secondary = Trauma (ie, fractures, surgery), congenital ill-development, obesity
What are osteophytes (think in relation to osteoarthritis)?
Bone spurs
Describe the 4 stages of the disease process in osteoarthritis.
- Articular cartilage wears away. Bone is exposed.
- Subchondral bone becomes hard and glossy (‘eburnation’).
- Remodelling of underlying bone (thickening) occurs
- Compensatory bone overgrowth in an attempt to stabilise the joint = osteophytes (bone spurs)
What is ‘eburnation’?
When subchondral bone becomes hard and glossy. Part of the disease process in osteoarthritis (OA)
