Musculoskeletal Disease c602...
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Transcript of Musculoskeletal Disease c602...
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Musculoskeletal DiseaseMusculoskeletal Disease
Long Bone FormationLong Bone Formation Long Bone FormationLong Bone Formation
Membranous BoneMembranous Bone Articular Joint FormationArticular Joint Formation
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Articular Joint FormationArticular Joint Formation
Lamellar Bone vs. WovenLamellar Bone vs. Woven
Lamellar BoneLamellar Bone Bone StructureBone Structure
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Bone MetabolismBone Metabolism
Congenital ProblemsCongenital Problems
Matrix problemsMatrix problems Premature Premature
epiphyses closureepiphyses closure PituitaryPituitary MalabsorptionMalabsorption
Osteogensis ImperfectaOsteogensis Imperfecta
Brittle Bones Dis.Brittle Bones Dis. Multiple SubtypesMultiple Subtypes
Auto DominantAuto Dominant Auto RecessiveAuto Recessive
Collagen defectCollagen defect Bad bone matrixBad bone matrix
Blue scleraBlue sclera
Osteogenesis ImperfectaOsteogenesis Imperfecta OsteopetrosisOsteopetrosis
RockRock--like boneslike bones Actually ‘Chalk’Actually ‘Chalk’ Osteoclast defectOsteoclast defect Can’t resorbCan’t resorb Many FrxsMany Frxs
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Lamellar Bone vs. WovenLamellar Bone vs. Woven AchondroplasiaAchondroplasia
Premature Premature closure of closure of epiphysesepiphyses
Auto dominantAuto dominant Homozygous is Homozygous is
lethallethal
EnchondromaEnchondroma
Small rest of Small rest of hyaline cartilagehyaline cartilage
DevelopmentalDevelopmentalBony defectBony defect Bony defectBony defect
FracturesFractures Syndrome of Syndrome of
multiple multiple enchondromasenchondromas
Very disfiguringVery disfiguring
Multiple EnchondromasMultiple Enchondromas
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Nonossifying FibromaNonossifying Fibroma
Very commonVery common DevelopmentalDevelopmental Fibrous cortical Fibrous cortical
defectdefectdefectdefect Size determines Size determines
what we call what we call them.them. 55--6 cm6 cm
OsteoporosisOsteoporosis
Loss of bone Loss of bone massmass
Not problem of Not problem of calciumcalciumcalcium calcium metabolismmetabolism
Peak bone massPeak bone mass WomenWomen FracturesFractures HRTHRT
OsteoporosisOsteoporosis
OsteoporosisOsteoporosis
Collapse of vertebral Collapse of vertebral bodiesbodies
KyphosisKyphosis Loss of heightLoss of height Hip fracturesHip fractures Peak bone massPeak bone mass Physical activityPhysical activity GeneticsGenetics
RANK & OPGRANK & OPG
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Vitamin D DeficiencyVitamin D Deficiency
RicketsRickets Developing boneDeveloping bone Can’t convert cartilage Can’t convert cartilage
d l t bd l t bmodel to bonemodel to bone Permanent deformityPermanent deformity
OsteomalaciaOsteomalacia AdultsAdults Can’t remodelCan’t remodel Softening of boneSoftening of bone
HyperparathyroidismHyperparathyroidism
HyperparathyroidismHyperparathyroidism Renal OsteodystrophyRenal Osteodystrophy
Paget’s DiseasePaget’s Disease
Viral infectionViral infection Destructive and Destructive and
proliferativeproliferativeS l i fS l i f Sclerosis of marrow Sclerosis of marrow spacespace
Skull and pelvisSkull and pelvis Increased incidence Increased incidence
of primary bone of primary bone tumortumor
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Paget’s DiseasePaget’s Disease ClubbingClubbing
Hypertrophic Hypertrophic osteoarthropathyosteoarthropathy
Soft tissue and Soft tissue and periosteal boneperiosteal bone
COPDCOPD Pure emphysema, rarePure emphysema, rare
Lung cancerLung cancer Heart defectsHeart defects
OsteomyelitisOsteomyelitis
Direct infection of Direct infection of bone.bone.
Bacterial most oftenBacterial most oftenSt h lSt h l StaphylococcusStaphylococcus
SalmonellaSalmonella Sickle Cell DiseaseSickle Cell Disease
TuberculosisTuberculosis Spine firstSpine first
SyphilisSyphilis PeriosteumPeriosteum
Avascular Necrosis, Avascular Necrosis, Legg-Perthes
Weight bearing jts.Weight bearing jts. Developmental?Developmental? Physically active.Physically active.
Compression andCompression and Compression and Compression and necrosis of bone and necrosis of bone and articular cartilage.articular cartilage.
Legg-Perthes FracturesFractures
AnthropologyAnthropology ForensicsForensics
IdentificationIdentification Pattern in child Pattern in child
abuseabuse Bumper heightBumper height PathologicalPathological
TumorTumor GummaGumma Developmental Developmental
defectdefect
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Greenstick FractureGreenstick Fracture PseudoarthrosisPseudoarthrosis
Bone TumorsBone Tumors
Benign vs. MalignantBenign vs. Malignant Primary vs. MetastaticPrimary vs. Metastatic
SymptomsSymptoms SymptomsSymptoms PainPain EnlargementEnlargement Fracture at site of tumorFracture at site of tumor
OsteochondromaOsteochondroma
Mechanical injury to growth line.Mechanical injury to growth line. Continues to grow as a unit for years.Continues to grow as a unit for years. Problem of diagnosis.Problem of diagnosis.
Fibrous DysplasiaFibrous Dysplasia
DevelopmentalDevelopmental MonostoticMonostotic PolyostoticPolyostotic BonesBones
Ribs, femur, jaw, Ribs, femur, jaw, , , j ,, , j ,humerus….humerus….
McCuneMcCune--AlbrightAlbright PolyostoticPolyostotic CaféCafé--auau--lait spotslait spots Sexual precocitySexual precocity HyperthyroidismHyperthyroidism Pituitary adenomasPituitary adenomas
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McCuneMcCune--AlbrightAlbright Bone CystsBone Cysts
Fairly commonFairly common BenignBenign RibsRibs Weakened area tends Weakened area tends
to fractureto fracture
Osteoid OsteomaOsteoid Osteoma
TibiaTibia Injury?Injury? CorticalCortical
V i f lV i f l Very painfulVery painful AspirinAspirin
Malignant tumors, metastaticMalignant tumors, metastatic
From practically any From practically any cancercancer BreastBreast ProstateProstate LungLung
To any boneTo any bone VertebraeVertebrae Long bonesLong bones
Osteosarcoma, Primary MalignancyOsteosarcoma, Primary Malignancy
Weight bearingWeight bearing Long bonesLong bones Young peopleYoung people Osteoblast is malignant Osteoblast is malignant
cellcellcellcell Genetics of tumor being Genetics of tumor being
unraveledunraveled Rb geneRb gene P53P53 MDM2MDM2 St. Bernards and Great St. Bernards and Great
DanesDanes
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Osteosarcoma, Primary MalignancyOsteosarcoma, Primary Malignancy Codman’s TriangleCodman’s Triangle
XX--Ray findingRay finding Lifting of periostium Lifting of periostium
by tumorby tumor
ChondrosarcomaChondrosarcomaEwing SarcomaEwing Sarcoma
‘Small blue tumor’‘Small blue tumor’ Primitive neuroectodermal Primitive neuroectodermal
tumor (PNET)tumor (PNET)Children and young adultsChildren and young adults Children and young adults.Children and young adults.
Oseous and extraOseous and extra--oseousoseous ‘Fusion genes’‘Fusion genes’ t(11;22)(q24;q12)t(11;22)(q24;q12)
Giant Cell TumorGiant Cell Tumor
OsteoclastsOsteoclasts BenignBenign Locally destructiveLocally destructive EpiphysesEpiphyses
AdolescentsAdolescents
MetaphysesMetaphyses KneeKnee SolitarySolitary
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ArthritisArthritis Inflammation of the jointsInflammation of the joints
Articular surface and/or joint capsule.Articular surface and/or joint capsule. InfectiousInfectious
GCGCL & thL & th Lyme & othersLyme & others
Immune mediated, rheumatic feverImmune mediated, rheumatic fever Streptococcal triggerStreptococcal trigger
Autoimmune, rheumatoid arthritisAutoimmune, rheumatoid arthritis Wear and Tear, osteoarthritisWear and Tear, osteoarthritis Crystal arthritis, goutCrystal arthritis, gout
Rheumatic Heart DiseaseRheumatic Heart Disease
Rheumatoid Arthritis Rheumatoid Arthritis –– Systemic DiseaseSystemic Disease
Genetically Genetically susceptiblesusceptible
TriggerTrigger Virus? EBVirus? EB
AutoimmuneAutoimmune Autoimmune Autoimmune destructiondestruction Rheumatoid factorRheumatoid factor
Loss of articular Loss of articular cartilagecartilage
Joint fusionJoint fusion
Rheumatoid ArthritisRheumatoid Arthritis Rheumatoid FactorsRheumatoid Factors Present in about 80% of casesPresent in about 80% of cases Some healthy people and other CT diseasesSome healthy people and other CT diseases RA need titer (Don’t screen with this)RA need titer (Don’t screen with this) IgMIgM generated against persons generated against persons IgGIgG
Rarely Rarely IgGIgG or or IgAIgAT d iT d i FF i f ib di f ib d Targeted against Targeted against FcFc portion of antibodyportion of antibody
SelfSelf--associate to form immune complexesassociate to form immune complexes Activate complement, causing cartilage destructionActivate complement, causing cartilage destruction These circulating immune complexes bring about These circulating immune complexes bring about
many of the extramany of the extra--arthritic symptomsarthritic symptoms TNF, ILTNF, IL--1, IL1, IL--6, IL6, IL--1515 CCP antibodies (cyclic CCP antibodies (cyclic citrullinatedcitrullinated proteins)proteins)
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Rheumatoid FactorRheumatoid Factor
CitrullineCitrulline generationgeneration Cyclic Cyclic citrullinatedcitrullinated proteins antibodies proteins antibodies
PanusPanus FormationFormation Rheumatoid ArthritisRheumatoid Arthritis
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Rheumatoid ArthritisRheumatoid ArthritisRheumatoid NodulesRheumatoid Nodules
Rheumatoid NoduleRheumatoid NoduleJuvenile Idiopathic ArthritisJuvenile Idiopathic Arthritis
Number of subtypesNumber of subtypes Some RF Some RF ––
Some RFSome RF ++ Some RF Some RF ++ ANA +ANA + All are systemicAll are systemic <16 years old<16 years old
Ankylosing SpondylitisAnkylosing Spondylitis Reiter’s SyndromeReiter’s Syndrome
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OsteoarthritisOsteoarthritis
Wear and tear on Wear and tear on joint cartilagejoint cartilage
Normally there is very Normally there is very little friction.little friction.
Minimal damage leads Minimal damage leads to cartilage fractures.to cartilage fractures.
Synovial fluid into Synovial fluid into underlying bone.underlying bone.
Microcysts and bone Microcysts and bone necrosis.necrosis.
OsteoarthritisOsteoarthritis
Weight bearing Weight bearing jointsjoints
Injury to Injury to cartilagecartilage
ProgressiveProgressive MiddleMiddle--age and age and
olderolder
OsteoarthritisOsteoarthritis
The The Boston Molasses DisasterBoston Molasses Disaster, also known as the , also known as the Great Molasses FloodGreat Molasses Flood or or The Great Boston Molasses The Great Boston Molasses TragedyTragedy, or the "Molasses Spill" occurred on January 15, 1919, in the North End neighborhood of Boston, , or the "Molasses Spill" occurred on January 15, 1919, in the North End neighborhood of Boston, Massachusetts in the United States. A large molasses tank burst and a wave of molasses rushed through the Massachusetts in the United States. A large molasses tank burst and a wave of molasses rushed through the streets at an estimated 35streets at an estimated 35 mph (56mph (56 km/h), killing 21 and injuring 150. The event has entered local folklore, and km/h), killing 21 and injuring 150. The event has entered local folklore, and residents claim that on hot summer days the area still smells of molasses.residents claim that on hot summer days the area still smells of molasses.
MolassesMolasses or or treacletreacle is a thick syrup byis a thick syrup by--product from the processing of the sugarcane or sugar beet into sugarproduct from the processing of the sugarcane or sugar beet into sugar
Crystal ArthritisCrystal Arthritis
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GoutGout Crystal ArthritisCrystal Arthritis
GoutGout Uric acid crystalsUric acid crystals Genetics and dietGenetics and diet Crystals in joint space Crystals in joint space
and soft tissuesand soft tissues Tophi in soft tissueTophi in soft tissue
Intense inflammatory Intense inflammatory reaction in jointreaction in joint
Very PainfulVery Painful
GoutGout GoutGout
GoutGout GoutGout
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PseudogoutPseudogout
Similar symptomsSimilar symptoms Calcium pyrophosphateCalcium pyrophosphate SmallerSmaller
Gout or Pseudogout?Gout or Pseudogout?
Tumors of Soft TissueTumors of Soft Tissue
Nodular FasciitisNodular Fasciitis FasciitisFasciitis
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Myositis OsificansMyositis Osificans
LegsLegs PalmsPalms
Auto mechanicsAuto mechanics
Hematoma that becomesHematoma that becomes Hematoma that becomes Hematoma that becomes calcifiedcalcified
Overt bone formationOvert bone formation Even bone marrowEven bone marrow
DesmoidDesmoid
LiposarcomaLiposarcoma RhabdomyosarcomaRhabdomyosarcoma
FibrosarcomaFibrosarcoma Malignant Fibrous HistiocytomaMalignant Fibrous Histiocytoma