Chapter 4 Musculoskeletal Systems Diseases and Disorders – Sophia

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*For diseases we discuss:

a) Basic Risk Factors

b) Most Common signs and symptoms

c) Basic Pathology, with basic diagnostic tools (e.g. imaging, blood tests) and basic treatment

1. Musculoskeletal Trauma:
   1. Contusions
   2. Fractures
   4. Types of Fractures – oblique, simple, comminuted, open, pathologic, segmented, spiral, transverse, greenstick, impacted, Colles fracture, Pott’s fracture, compression fracture of vertebra, avulsion, stress (fatigue or insufficiency),

   5. 

   6. Risk factors for Fractures: occuption, lifestyle (certain sports e.g. mountain biking, snowboarding, skiing, horseback riding, impact sports), falls, workplace, automobiles, osteoporosis, bone cancer,
   7. 5 Stages of Fracture Healing
   8. 
      1. Hematoma Formation
      2. Organization of Hematoma
      3. Procallus (Cartilage Callus) formation
      4. Bony Callus formation
      5. Remodelling (from woven/immature to lamellar/mature bone which contains both cortical/compact and cancellous/spongy/trabecular bone)
   9. Treatments: reduction/realignment of fracture ends, casts, pins, wires, plates, sarcoplasty, bone grafts, intramedullary nail, electrical stimulation, ultrasound stimulation

   10. 

       Intramedullary Pin

   11. 

   12. Possible Complications affecting Bone Fracture Healing
       1. Osteonecrosis
       2. 
       3. Osteomyelitis

       4. 

       5. Muscle spasms
       6. Ischemia,
       7. Thrombi, emboli (fat or blood)

       8. 

       9. Fracture blisters

       10. 

       11. Non-union
       12. Mal-union

       13. 

       14. Delayed union
       15. Stunted growth (due to fracture in epiphyseal growth plate leading to premature ossification of growth plate).

       16. 

           

       17. Exuberant callus formation – typically temporary – will be remodelled to become a more typical bone shape

       18. 

       19. Osteoarthritis due to damage affecting ends of long bones – within joint space

       20. 

       21. Transchondral fractures leading to separation of articular cartilage and clicking/crepitus within join – may be limit range of motion in joint and be painful upon movement
       22. Compartment Syndrome – damage to tissue inside muscular comparment leads to inflammation and swelling, causes increases in compartment pressure, and local tamponade (as capillaries are pinched off), ischemia and hypoxia occurs causing muscle and capillary necrosis – causing more inflammation and more edema, compartment tamponade causes increased muscle and nerve ischemia leading to nerve dysfunction and muscle infarction (death due to lack of O2), nerves and other affected tissues within the compartment can also die.
       23. 
           1. Acute Compartment Syndrome – symptoms include 5 Ps (severe pain, paralysis, paresthesia, pallor, and pulselessness)
              1. Treatment – fasciotomy

              2. 

              3. Possible Complications: Can be fatal as:
                 1. Death and rupture of skeletal muscle cells leads to myoglobin entering the blood stream =Myogloninemia which leads to Rhabdomyolsis, myogloinuria and renal failure.  Ruptured skeletal muscle cells also release potassium causing hyperkalemia; lactic acid contributes to acidosis – electrolye and pH imbalance caus cardiac dysrhythmias (renal failure also contributes to acidosis)
                 2. ECF shift (excessive inflammation leads to increased capillary permeability and shift of fluid from inside blood vessel to interstitial spaces, causing hypovolemia and increased compartment pressure
                 3. Hypovolemia causes shock = not enough blood to tissues; signs of shock include: pallor, diaphoresis, hypotension, reflex tachycardia, nausea/vomiting
           2. Chronic Compartment Syndrome – from repeated training (e.g. gymnastics)
       24. Muscular/tendon damage – leading to scarring and shortening of tendon causing contractures (e.g. Volkmann contractures)

       25. 

       26. Neural damage – leading to temporary/permanent loss of various sensations (if sensory nerve damage) or muscle weakness (if motor neuron damage)
       27. Vascular damage – hemorrhaging
       28. Disseminated Intravascular Coagulation
       29. Dislocations, Subluxations
       30. Adhesive capsulitis
       31. Sprains (Grade 1, 2, 3, 4)
       32. Strains (1st, 2nd, 3rd degree)
       33. 
       34. Sprain and Strain Healing
       35. Tendinitis

       36. 

       37. Meniscus Tear
       38. Arthroscopy
       39. Bursitis
       40. Carpal Tunnel Syndrome
       41. Osteopenia
       42. Osteoporosis
       43. Ostemalacia
       44. Rickets
       45. Hip Fractures (femure fractures)
       46. Muscular Dystrophy
       47. Fibromyalgia
       48. Osteoarthritis
       49. Rheumatoid Arthritis
       50. Gouty Arthritis