Skeletal System Pathologies Flashcards by Gracie Costello

Caused by diminished proliferation of cartilage in the growth plate

Individuals have short limbs, which contrast with an average length of trunk (axial skeleton)

Achondroplasia (dwarfism)

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Occurs at junction of spine segments
Congenital disorder
Usually occurs in lumbar/sacral junction
*can occur at any junction - c/t, t/l

Transitional vertebrae

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-Posterior defect of the spinal canal, resulting from failure of the posterior elements to fuse properly
-large defects are associated with spinal cord abnormalities, may lead to a variety of muscular abnormalities and lack of bladder/bowl control

Spina Bifida
*in many cases, slight dimpling of the skin or a tuft of hair over the vertebral defect indicates the site of lesion

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Spina Bifida

Germination of the meninges caused by large defects in lumbar or cervical spine

Meningocele

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What are some other associated malformations of Spina Bifida meningocele?

Clubfoot, gait disturbances, bladder inconsistence

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Spina Bifida

Germination of the meninges and a portion of the spinal cord or nerve roots

Myelomeningocele

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What is an associated symptom of myelomeningocele Spina Bifida?

Associated neurological deficits at and below the site of protrusion

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Spina Bifida

Mild insignificant form
Splitting of the bony neural canal at the L5 or S1 level
Failure of the posterior elements to fuse

Spina Bifida Occulta

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A genetic disorder characterized by fragile, easily breakable bones
AKA - OI, brittle bone disease, fragile bone disease

Osteogenesis Imperfecta
Other symptoms include:
-muscle weakness
-hearing loss
-joint hyperlaxity
-chronic bone pain
-curved bones
-respiratory complications
-scoliosis
-brittle teeth (dentinogenesis imperfecta)
Blue sclera (eyes)

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A rare hereditary bone dysplasia in which failure of the restorative mechanism of calcified cartilage interferes with the normal replacement by mature bone

Prevents bone marrow from forming so that the bones become very brittle and stress fractures can occur

Osteopetrosis
“Marble bones”
*may cause anemia as a result of lack of blood producing bone marrow

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Acetabulum is too shallow and the femur may partially or totally dislocate, tendons and ligaments responsible for proper alignment are affected

Affects pediatric patients

Developmental dysplasia of the hip
DDH
AKA congenital hip dysplasia

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A twisting of the spine;curvature in the lateral perspective, somewhat like an S curve

Scoliosis

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What are the 4 types of scoliosis?

Idiopathic - cause unknown

Functional - caused by problem outside the spine

Neuromuscular - occurs when the vertebra fails to form completely or fails to separate appropriately

Degenerative - adult type scoliosis, caused by arthritis

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Auto immune disease, non infectious
Crippling deformity of joints

Begins as inflammation of synovial membrane of joints
-excessive amounts of exudate are excreted into the synovial fluid (thickened fluid)

Rheumatoid arthritis RA

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Chronic inflammatory rheumatic disease
Causes the vertebrae to fuse together (bamboo spine)

Can also cause excess growth of vertebral projections called bony protuberances causing pain and limited mobility

Ankylosing Spondylitis (AS)

Ankylosing = fusion
Spondylitis = spine and inflammation

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What other parts f the body can be affected by Ankylosing Spondylitis?

Inflammation and stiffness in:
-hip, shoulder, knees
-ribs
-heels
-hand/feet joints

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A generalized disorder characterized by loss of joint cartilage and reactive new bone formation
Normal part of aging
*commonly affects weight bearing joints

Osteoarthritis (OA)
AKA - DJD

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An inflammation of the bone and bone marrow that can be caused by various organisms, predominantly bacteria
Most commonly caused by staphylococci and streptococci bacteria

Osteomyelitis

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Where might the infection spread to the bone from in osteomyelitis?

In osteomyelitis, infection may spread to the bone from:
-nearby infected structures
-penetrating trauma or surgery
-bloodstream
Weakens parts of the bone are more susceptible

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What are some common risk factors for osteomyelitis?

-injury or trauma
-uncontrolled infections elsewhere in the body
-post surgery
-immune system conditions
-IV drug use
-circulation disorders
-diabetes

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Commonly seen in the femoral head
Caused by loss of blood supply
(Can result from thrombosis, vasculitis, disease of surrounding bone, single or repeated episodes of trauma)
*bone is starting to die

Ischemic Necrosis

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A hormonal disorder that develops when your pituitary gland produces excessive growth hormone is on skeletal mature patients
*most commonly from a pituitary adenoma (benign tumor of pituitary gland)

Acromegaly
(Gigantism)

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What are common manifestations of acromegaly?

Enlargement of hands, feet’s, nose, tongue, lips, ears

General thickening of the skin

Internal organs overgrowth

Vocal cords, resulting in a characteristic thick, deep voice and slowing speech (overgrowth)

Excessive hair growth and sweating

Vertebral fractures

A deficiency of bone matrix in which mass of bone per unit volume is decreased in amount but normal in composition (bone density)

Osteoporosis
*bond is constantly changing and normally exists between the amount of old bone being removed (an osteoclastic process) and the amount of new bone replacement (an osteoblastic process)

T/F Osteoporosis is a major cause of hip, spine, wrist fractures

True

T/F Osteoporosis is difficult to diagnose without diagnostic imaging

True Other manifestations might be, back pain from damaged vertebrae, bone tissue fractures easily

Lower than normal bone mass, skeletal demineralization Can be generalized or regional *defined as a BMD T-score lower than -1.0 but higher than -2.5

Osteopenia See slide 61

A metabolic disorder where purine (a nucleic acid) is not metabolized This increases uric acid in the blood and deposits uric acid crystal in the joints, cartilage and kidneys

Gout

Destruction of bone followed by a repetitive process, results in weakened, deformed, and thickened bony structures that tend to fracture easily Affects particularly the pelvis, femurs, skull, tibias, clavicles and ribs

Paget’s disease (osteitis deformans)

What are the two different phases of Paget’s disease?

Destructive - predominates initially, more frequently a combination of destruction and repair in the pelvis and weight bearing bones Repetitive - may begin early and may be prominent feature often invoking multiple bobes

Bone softening due to inadequate intake of, or failure of absorption of calcium, phosphorus and vitamin D

Osteomalcia “Rickets” in children

What patients may osteomalacia occur most commonly in?

-Those who live in climates with little sunlight exposure -work or stay inside during daylight hours -lactose intolerant -vegetarians

What is the most widely accepted method of determining skeletal bone age?

Radiographic atlas of Greulich and Pyle

What areas are most commonly affected by advanced or delayed bone age?

Hand, wrist, knee

What are the key points for bone tumor classification?

Site of lesion, border of lesion, periosteal reaction Smaller = nodule Larger = mass

Also called “unicameral” bone cyst Benign, fluid filled cyst surrounded by a fibrous tissue wall Asymptomatic

Simple bone cyst Usually found in prox humerus/femur

What are the Radiographic signs of a cyst?

Darker area of bone Circular, uniform

Benign bone cyst, like simple bone cyst Rather than being a true neoplasm or cyst, consists of numerous blood filled arteriovenous communications thought to be caused by trauma

Aneurysmal bone cyst

An overgrowth of cartilage and bone that happens near the growth plate Most often affects long bones in leg, pelvis, scapula

Osteochondroma Pediatric pathology

What is the most common non cancerous bone growth?

Osteochondroma

Highly malignant tumors that arise from connective tissue, spread rapidly Generally occur in the end of long bone (metaphysis) Commonly occurs in patients 10-25 years old

Osteosarcoms

What are common causes and symptoms of osteosarcoma?

Causes: -oncogenes - turned on -tumor suppressor genes - turned off -inherited gene mutations of acquired gene mutations Symptoms: -pain, swelling, fever, lump, mass, bone fracture with no injury

What pathology is the sunburst pattern and Codmans triangle seen in?

Osteosarcoma

A primary malignant tumor arising in the bone marrow of long bones, children/young adults are affected

Ewings Sarcoma -local pain -malaise -sick -fever

Widespread malignancy of plasma cells that may be associated with bone destruction, bone marrow failure, hypercalcimia, renal failure, recurrent infections Primary bone tumor attacks the intramedullary canal of the diaphysis

Multiple myeloma (Punched out lesions)

A joint condition where bond underneath cartilage of a joint dies due to lack of blood flow The bone and cartilage of the joint break loose, causing pain and possibly hindering joint motion

Osteochondritis Dissecans *common in children/adolescents *most common in knees, but can occur in elbows, ankles…

Degeneration of the spine Can occur in C, T, or L vertebrae Often used to describe OA of the spine

Spondylosis

Stress fracture in the lumbar vertebrae (most commonly L5 or L4) Fractured in the pars interarticularis without displacement

Spondylolysis *caused by activities that include repeated back bending, weight bearing, rotation

A progression of spondylolysis When stress fracture weakens the bone, it can cause the vertebrae to slip anterior over the vertebrae below **fracture of the pars interarticularis with displacement

Spondylolisthesis

A twisted neck where the head is tipped to one side, and the chin to the other Usually results from the unilateral fibrosis and shortening of the sternocleidomastoid muscle *can be acquired of congenital

Torticollis

Anterior concave in the curvature of the thoracic spine, sacrum, coccyx, as viewed from the side Caused by: -fractures -osteoporosis -disk degeneration -birth defects -scoliosis -cancer/cancer treatment

Kyphosis

Anterior convex in the curvature of the lumbar and cervical spine as viewed from the side Caused by: -acondroplasia -discitis -kyphosis -obesity -osteoporosis -spondylolisthesis

Lordosis

Refers to physically induced injuries in young children caused by parents or guardians

Non accidental trauma

A disease that affects children between 4-10 4x more common in males than females Idiopathic avascular necrosis of the femoral head Involves the destruction of the femoral head and sometimes acetabulum

Legg-Calve-Perthes disease

Common cause of knee pain in growing adolescents Inflammation of tibial tuberosity

Osgood Schlatter disease