year 2 semester 2

8/4/2019 Year 2 Semester 2

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THEME CONVENOR MRS. L.MATAITINI.

YEAR 2 – SEMESTER 2, 2011 08/08/11



This week, we will introduce you to thedisorders of the musculoskeletal system.

Musculoskeletal system includes the bones, joints and muscles of the body togetherwith the associated structures such as theligaments and tendons. These disorders

affects person of all age groups and allwalks of life, causing pain and disability.



At the end of this session the studentshould be able to:

Define the key terms

Discuss the different causes of musculoskeletal disorders.



Explain the clinical manifestations of eachdisorders.

Discuss the pathophysiological problems of each musculoskeletal system.

Discuss the different types of therapeutic

procedures available for each disorders.

Discuss the different drugs available to treat



Pathophysiological changes of themusculoskeletal.



Musculoskeletal disorders divides up intothree according to the structures:

(i) Tissue(ii) Joints(iii)Bones



Physical forces such as:

Blunt tissue trauma.

Disruptions of tendons and ligaments Fractures of the bony structures. Other causes: Motor vehicle accident Motorcycle accident

Falls



rugby athletes

other sports



SOFT TISSUE INJURY.

•Contusion

•Hematoma

•

Laceration



It is the injury to softtissue that results fromdirect trauma and isusually caused bystriking a body partagainst a hard object.



CLINICAL MANIFESTATIONS

ecchymosis-due to hemorrhagediscoloration gradually changes tobrown and yellow as the blood isreabsorbed.

Hematoma- blood accumulates and exertspressure on nerve endings.



CLINICAL MANIFESTATIONpain- increases with movement swelling

infection due to bacterial growth split skindue to increase pressures and producedrainage of the hematoma

TREATMENT:

apply cold compress during the 1st

24hrs of injury.



After the 1st 24hrs, heat or coldcompression to be doneintermittently for 20mins at a time.

Laceration:Injury in which the skin is torn or its

continuity is disrupted. The

seriousness of the lacerationdepends on the size and depth of the wound.



Punctured wounds from nails or rustedmaterial provide the setting for growth of

anaerobic bacteria such as those that causetetanus and gas gangrene.

TREATMENT:

Wound closure after cleaning the wound well

and apply sterile dressing antibiotics.



Strains

Sprains

Dislocation

Knee injuries

Meniscus injuries.



STRAINS:

A strain is a stretching injury to a muscle or amusculotendinous(joint)unit caused by amechanical overloading.

.

CAUSE : unusual muscle contraction.

excessive forcible stretch . overweight or excessive exercises.



Pain.

Stiffness.

Swelling.



Lower back Cervical region of the spine Elbow

Shoulder foot



TREATMENT:

Bed rest. traction. application of heat. massage. cold compression for the 1st 24hrs

to educe pain and swelling of the

affected area.

exercises, correct posture and goodbody mechanics.



SPRAINS:Involves the ligamentous structuressurrounding the joints, resemble astrain, but the pain and swelling

subsides slowly.CAUSE:abnormal and excessive movement

of the joint.

CLINICAL MANIFESTATIONS:

pain.



Rapid swelling.Heat.Disability.Discoloration Limitation of function

DIAGNOSTIC TESTS: history of the injury. x-ray.



Dislocations can be congenital, traumatic orpathologic.

Traumatic dislocations occur after falls,blows, or rotational injuries.

CAUSE: trauma .

motor vehicle accidents. fall. sports.



CLINICAL MANIFESTATIONS.

pain.limitation of movementswellingdeformity

DIAGONISTIC TESTS.history.physical examination

x-ray.TREATMENT.Bed rest.manipulation

surgical repair.



It is a common site of injury, particularly sport

related injuries in which the knee is subjectedto abnormal twisting and compression forces.

These forces can result in injury to themeniscus, patella sublaxation and

dislocation .

MENISCUS INJURY:

Meniscus injury commonly occurs as the

result of rotational injury from a sudden orsharp instrument or a direct blow to the knee,as in hockey, basketball or football.



CLINICAL MANIFESTATIONS.pain .

swelling DIAGNOSTIC TEST:

physical examinationx-ray.

arthroscopy TREATMENT:

conservative

rest



A break in the continuity of the bone. A fractureoccurs when the stress placed on the bone isgreater than the bone can absorb.

TYPES OF FRACTURE:open fracture –skin involve

closed fracture-skin not involve

complete fracture-involves the entire

cross section of the bonepathologic fracture-through an area of

diseased bone.



Greenstick-one side of the bone is broken

Transverse-straight across the bone. Oblique –at an angle across the bone. Spiral-twists around the shaft of the bone. Comminuted-bone splinted into more than

three fragments. Depressed-fragments indriven. Compression-bone collapses in on itself. Avulsion –fragment of bone pulled of by

ligament. Impacted-fragment of bone wedged into other

bone fragment.



Pain

Tenderness Swelling Loss of function Deformity of the affected side Angulations Shortening of the bones Rotation deformity

Crepitus or grating may be felt as the bonefragments rub each other.

Bleeding



PICS SUPPLEMENT



Hypovolemic shock due to bleeding.

◦ Numbness of the affected area.

DIAGNOSTIC AND THERAPEUTIC.

history

physical examination

x-ray examination



Reduction-to align the bones Immobilization-prevents movement of the

bones External fixation

COMPLICATIONS OF FRACTURES. fracture blisters Compartment syndrome Muscle wasting Fat embolism



Direct extension or contamination of

the open fracture.Wide variety of microorganisms

introduced during injury, operativeprocedures or from the blood

stream.Usually bacteria in origin; isolatedorganisms which include :

staphylococcusaureus

Escherichia coli



PATHOPHYSIOLOGY:

1. Site inoculated.

2.Inflammatory and immunologic response;pus formationedema.vascular congestion.

3. Vascular occlusion leads to ;

ischemiabone necrosis.

4. Infections spread through the bone viaVolkmann's and haversian canals,

causing further vascular occlusions



Ischemia allows necrotic bone to separatefrom the living bone, forming sequestra.

Sequestra enlarge, spreading toward andbreaching the cortex, forming asubperiosteal

abscess, further interfering with thevascular

supply. Vascular supply may remain sufficient to

maintain life of bone tissue.



Large pieces of dead bone cannot be

destroyed . Central residual remains a sequestrum

composed of cancellous New bone is laid down beneath the elevated

periosteum and tends to form anencasement

around the sequestrum. Pockets of infection are walled off in which

organisms can lie dormant long periods Chronic sinuses may form that eventually

reach the surface and drain



Drainage continues until infection quietsonce more. Channels become pluggedwith granulations and remain closed untilthe pressure of the pus builds up andcauses the sinuses to reopen or reachthe surface through new channels(chronicosteomyelitis)

Complete healing takes place only whenall the dead bone has destroyed,discharged or excised



COMPLICATIONS: Chronic osteomyelitis Pathological fracture

Joint destruction Skeletal deformities Limb length discrepancies Life threatening if untreated



CLINICAL MANIFESTATIONS Localised pain Swelling

Erythema Fever Malaise Irritability.



Development dysplasia of the hip:congenital dislocation of the hip.

CAUSE:

Unknown Hereditory-high risk with family history Increased ligamentous laxity secondary to

maternal hormones.

Breach presentation First born In-utero restrictions to fetal movement



Swaddling in the postnatal period, where thehips are in abduction and extension

PATHOPHYSIOLOGY:

Acetabelum tends to be shallow and oblique Head of the femur tends to smaller than

normal. Ossification centers are delayed in

appearance. Dysplasia-shallow acetabelum, roof slants

upward



Sublaxation –acetabular surface of thefemoral head is in contact with shallowdysplastic.

Dislocation-articular cartilage of completely displaced femoral head doesnot contact acetabular articular cartilage



COMPLICATION: Avascular necrosis of femoral head

Loss of range of movement. Leg length inequality. Early osteoarthritis

Recurrent dislocation or unstable hip.

CLINICAL MANIFESTATIONS: Asymmetry of high or gluteal folds Abnormal gait pattern Ortolani’s sign and positive Barlow’s test.



DIAGNOSTIC TEST: X-ray-cartilagenous femoral head is difficult

to visualise in the newborn Ultrasound examination Arthrogram- outline the cartilagenous

portions of the acetabulum and femoral head Physical examination



Congenital anomaly characterised by a threepart deformity of the foot, consisting of theheel(varus), adduction and supination of theforefoot, and ankle equinus.

CAUSE: Unknown. Suggested contributing factor;

.intrauterine position..primary arrest in fetal

development.



Familial tendency.

PATHOPHYSIOLOGY:

Foot is planter flexed at the ankle and thesubtalar joints. Hind foot is inverted. Midfoot and hind forefoot are adducted and

inverted. Contractures of the soft tissues maintain the

malalignments.



COMPLICATIONS:

Deformity becomes fixed if untreated. Disturbances in epiphyseal plates from

overaggressive manipulations Child bearing weight on lateral border of foot Gait is awkward

Recurrent deformity



CLINICAL MANIFESTATION:

Deformity is obvious at birth with varyingdegree rigidity and ability to correct position.

DIAGNOSTIC TEST: clinical presentation

Physical examination X-ray

TREATMENT: Manipulation-pop cast Corrective footwear Surgical intervention



Congenital scoliosis exact cause is unknown Neuromuscular scoliosis-child has a definite

neuromuscular condition that directlycontributes to the deformity.

PATHOPHYSIOLOGY: Vertebral column develops lateral curvature Vertebral rotate to the convex side of the

curve Vertebral become wedged shape Disk shape is altered



Deformity progress, changes in the thoraciccage worsened.

Changes in the thoracic cage, ribs andsternum lead to further characteristics

deformities such as “rib hump”. Neurological compromise-very rare.



CLINICAL MANIFESTATIONS:

Poor posture Uneven should height One hip appears more prominent Crooked neck Lump on the neck Rib hump Uneven waistline

Uneven breast size Visualization deformity Back pain



DIAGNOSTIC TEST: X-ray of the spine –upright position Myelogram Tomograms

C.T. Scan

TREATMENT: Medical management Exercise therapy Surgical intervention



OSTEOPOROSIS: DEFINITION:Condition in which the bone matrix is lost,

thereby weakening the bones and makingthem susceptible to fractures.

PATHOPHYSIOLOGY: The rate of bone resorption increases over

the rate of bone formation, causing loss of bone mass .Calcium and phosphate salts are lost-

creating brittle bones.Occurs most frequently in postmenopausal

women.



Age

Inactivity Chronic illness Medications such as corticosteroids

Calcium and vitamin D deficiency Family history Smoking Diet –caffeine is a risk factor

Race white and Asians have higher risk



Computed Tomography (CT Scan) Bone biopsy.

COMPLICATION Fracture



DEFINITION:

Degenerative joint disease is a chronic noninflammatory, slowly progressing disorderthat causes deterioration of articularcartilage

It affects weight- bearing joints( hips andknees) as well as joints of the distalinterphalanges and of the fingers.



PATHOPHYSIOLOGY:Changes in particular cartilage occurs firstSoft tissue changes may occur next.



Progressive wear and tear on cartilage leads

to thinning of joint surface Ulceration into bone Inflammation of the joint and increased

blood flow.. Hypertrophy of suprachondral bone . New cartilage and bone formation at joint

margin results in osteophytosis altering the

size and shape of bone



CAUSE: unknown Aging and obesity are contributing factors Previous trauma may cause secondary

osteoarthritis

DIAGNOSTIC TESTS: Physical examination X-ray of affected joints

Bone scan Analysis of synovial fluid differentiates

osteoarthritis and rheumatoid arthritis



DEFINITION:Musculoskeletal neoplasm include primary

sarcoma, metastic bone disease, andbenign tumors of the bone.



PATHOPHYSIOLOGY Benign bone tissue

Osteoid osteomaChondroma

Osteoclastoma

Malignant bone tumorsChondrosarcoma and osteosarcoma

are examples of primary malignantbone tumors



CLINICAL MANIFESTATIONS: Pain in the involved bone-worst at night. Swelling and limitations of motion and joint

effusions

Physical findings-palpable, tender fixedboney mass. Increase in skin temperatureover the mass. Superficial veins dilated andprominent.



TREATMENT:

Surgery Chemotherapy Radiotherapy

year 2 semester 2

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