PowerPoint Presentation · BIOS222 Pathology and Clinical Science 2 & 3 Session 10 Disorders of...
Transcript of PowerPoint Presentation · BIOS222 Pathology and Clinical Science 2 & 3 Session 10 Disorders of...
BIOS222
Pathology and Clinical Science 2 & 3
www.endeavour.edu.au
Session 10
Disorders of Musculoskeletal
System 1
Bioscience Department
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Session Learning Outcomes
At the end of the session, you should be able to:
o Revise and review anatomy and physiology of Musculoskeletal system.
o Identify a general clinical examination and investigations of the musculoskeletal system and relate the clinical findings to the underlying pathology.
o Describe the major musculoskeletal manifestations, and identify their underlying causes and diagnostic measures.
o Describe the causes, diagnostic measures and management for back pain.
o Describe the general principles of management of musculoskeletal disorders including the pharmacological and non-pharmacological interventions.
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Session Plan
o Overview of the musculoskeletal system
o Examination and investigation of the
musculoskeletal system
o Presenting problems in musculoskeletal
disease
• Acute monoarthritis
• Polyarthritis
• Fracture
• Generalised musculoskeletal pain
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Session Plan
• Back pain
• Regional musculoskeletal pain
• Muscle pain and weakness
o Principles of management of musculoskeletal
disorders
• Non pharmacological
• Pharmacological
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Overview of the Musculoskeletal
System
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Musculoskeletal System
o Function of The musculoskeletal system:
• Movement of the body
• Provides a structural framework to protect internal organs
• Acts as a reservoir for storage of calcium and phosphate in the
regulation of mineral homeostasis
o Components of the musculoskeletal system:
• Bones
• Joints
• Skeletal muscles
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Bones
o Types of bones:
• Short bones
• Irregular bones
• Flat bones
• Long bones
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Bones
o Cells of bone:
• Osteoclasts
• Osteoblasts
• Osteocytes
o Bone matrix and
mineral
o Bone remodelling
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Jointso Classification of joints:
• Fibrous joints
• Fibrocartilaginous joints
• Synovial joints
Walker, BR, Colledge, NR, Ralston, SH, & Penman, ID (eds) 2014, Davidson’s principles and practice of
medicine, 22nd edn, Churchill Livingstone Elsevier, Edinburgh
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Joints
o Structure of synovial joint
• Articular cartilage
• Synovial fluid
• Intra articular discs
• Joint capsule
• Synovial membrane
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Skeletal muscleso Skeletal muscles: consists of bundles of myocytes
embedded in fine connective tissue containing nerves
and blood vessels.
o Functions of skeletal
muscle tissues
– Producing motions
– Stabilizing body
positions
– Storing and moving
substances within the
body
– Thermogenesis
http://training.seer.cancer.gov/anatomy/muscular/structure.html
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Examination and investigation of
the Musculoskeletal System
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Examination of Musculoskeletal
System
o Inspection at rest
• Skin changes
• Swelling
• Wasting of muscle
• Attitude
• Deformity
o Inspection during
movement
• Restriction
• Increased range
• Pain on usage
o Palpation with
movement
• Tenderness
• Increased warmth
• Swelling
• Crepitus
• Stability
• Resisted active
movements
• Stress tests
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Investigation of Musculoskeletal
SystemInvestigation Conditions detected
Synovial fluid analysis Acute monoarthritis, suspected septic arthritis,
crystal arthritis or intra-articular bleeding.
Plain radiography Rheumatoid arthritis, Osteoporosis, Paget’s
disease, Spondyloarthritis, Osteoarthritis
Radionuclide bone scan Metastatic bone disease, Paget’s disease, stress
fracture
Magnetic resonance
imaging (MRI)
Intervertebral disc disease, Nerve root
entrapment, Spinal cord compression, Spinal
stenosis, Malignancy, Fractures
Ultrasonography Small joint synovitis and erosion, periarticular
lesions
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Investigation of Musculoskeletal
SystemInvestigation Conditions detected
Computed tomography
(CT)
When MRI is contraindicated, for evaluation of
articular regions in which an adjacent joint
replacement creates image artefacts on MRI
Bone mineral density Osteoporosis
Haematology Inflammatory rheumatic diseases
Routine biochemistry metabolic bone disease, Paget’s disease, renal
bone disease and osteomalacia, muscle
diseases and gout
Serum uric acid Gout
C-reactive protein (CRP) Infection and inflammation
Serum creatine kinase
(CK)
Myopathy, inflammatory myositis, Muscular
dystrophy, Motor neuron disease
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Investigation of Musculoskeletal
SystemInvestigation Conditions detected
Synovial biopsy Mycobacterial infections
Muscle biopsy Myopathy, Inflammatory myositis
Bone biopsy infiltrative disorders, Osteomalacia, Chronic
infections and Malignancy
Electromyography Myopathy, Inflammatory myositis
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Investigation of Musculoskeletal
SystemAutoantibodies Conditions associated with positive
Autoantibodies
Rheumatoid factor (RF) Rheumatoid arthritis, Mixed essential
cryoglobulinaemia, Primary biliary cirrhosis,
Infective endocarditis, Systemic lupus
erythematosus, Tuberculosis
Anti-citrullinated peptide
antibodies (ACPA)
Rheumatoid arthritis
Antinuclear antibodies
(ANA)
Systemic lupus erythematosus, Systemic
sclerosis, Dermatomyositis or polymyositis,
Mixed connective tissue disease, Autoimmune
hepatitis
Anti-DNA antibodies Systemic lupus erythematosus
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Presenting Problems in
Musculoskeletal Disease
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Presenting Problems in
Musculoskeletal Disease
o Acute monoarthritis
o Polyarthritis
o Fracture
o Generalised
musculoskeletal pain
o Back pain
o Regional musculoskeletal
pain
• Neck pain
• Shoulder pain
• Elbow pain
• Hand and wrist pain
• Hip pain
• Knee pain
• Ankle and foot pain
o Muscle pain and weakness
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Acute Monoarthritis o Definition: Sudden pain and swelling in a single joint.
o Diagnosis:
• Clinical assessment
– Clinical history
– Pattern of joint
involvement
– Speed of onset
– Age and gender of
the patient
• Synovial fluid
analysis
• Blood tests
Walker, BR, Colledge, NR, Ralston, SH, & Penman, ID (eds) 2014, Davidson’s principles and practice of
medicine, 22nd edn, Churchill Livingstone Elsevier, Edinburgh
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Polyarthritis
Walker, BR, Colledge, NR, Ralston, SH, & Penman, ID (eds) 2014, Davidson’s principles and practice of
medicine, 22nd edn, Churchill Livingstone Elsevier, Edinburgh
o Diagnosis:
• Clinical presentation
– Pattern of joint
involvement
– Extra-articular
features
• Blood tests
• Ultrasound
examination
• MRI
o Definition: Pain and swelling affecting five or more joints
or joint groups.
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Polyarthritis
Walker, BR, Colledge, NR, Ralston, SH, & Penman, ID (eds) 2014, Davidson’s principles and practice of
medicine, 22nd edn, Churchill Livingstone Elsevier, Edinburgh
o Patterns of joint involvement in different forms of
polyarthritis:
Rheumatoid arthritis Psoriatic arthritis Ankylosing spondylitis Osteoarthritis
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Fractureo Definition: Discontinuity or breech in the bone tissue,
breaking of bone
o Diagnosis:
• Clinical presentation
– bone pain,
worsened by
movement of the
affected part
– history of trauma
• Radiographs
• MRI
Walker, BR, Colledge, NR, Ralston, SH, & Penman, ID (eds) 2014, Davidson’s principles and practice of
medicine, 22nd edn, Churchill Livingstone Elsevier, Edinburgh
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Generalised Musculoskeletal
Paino Definition: pain that affects the muscles, ligaments and
tendons, and bones.
o Diagnosis:
• Clinical history and
examination
• Radiological skeletal
survey
• Radionuclide bone
scanning
• Routine
biochemistry
Walker, BR, Colledge, NR, Ralston, SH, & Penman, ID (eds) 2014, Davidson’s principles and practice of
medicine, 22nd edn, Churchill Livingstone Elsevier, Edinburgh
Causes of generalised pain
Metastatic bone
disease
Osteomalacia
Fibromyalgia Osteoarthritis
Joint
hypermobility
Polymyalgia
rheumatica
Paget’s disease Myositis
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Back Pain
o Diagnosis:
• Clinical assessment
• MRI
• Plain radiographs
• Radionuclide bone
scan
• Routine biochemistry
and haematology
Walker, BR, Colledge, NR, Ralston, SH, & Penman, ID (eds) 2014, Davidson’s principles and practice of
medicine, 22nd edn, Churchill Livingstone Elsevier, Edinburgh
© Endeavour College of Natural Health www.endeavour.edu.au 27
Back Pain
Walker, BR, Colledge, NR, Ralston, SH, & Penman, ID (eds) 2014, Davidson’s principles and practice of
medicine, 22nd edn, Churchill Livingstone Elsevier, Edinburgh
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Neck Pain
Walker, BR, Colledge, NR, Ralston, SH, & Penman, ID (eds) 2014, Davidson’s principles and practice of
medicine, 22nd edn, Churchill Livingstone Elsevier, Edinburgh
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Shoulder Pain
Walker, BR, Colledge, NR, Ralston, SH, & Penman, ID (eds) 2014, Davidson’s principles and practice of
medicine, 22nd edn, Churchill Livingstone Elsevier, Edinburgh
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Elbow Pain
Walker, BR, Colledge, NR, Ralston, SH, & Penman, ID (eds) 2014, Davidson’s principles and practice of
medicine, 22nd edn, Churchill Livingstone Elsevier, Edinburgh
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Other Regional Pain
Walker, BR, Colledge, NR, Ralston, SH, & Penman, ID (eds) 2014, Davidson’s principles and practice of
medicine, 22nd edn, Churchill Livingstone Elsevier, Edinburgh
Region Causes
Hand and wrist
pain
Osteoarthritis, De Quervain’s tenosynovitis, Raynaud’s
phenomenon, C8/T1 radiculopathy, Reflex sympathetic
dystrophy
Hip pain Trochanteric Bursitis, Gluteal enthesopathy, Adductor
tendinitis
Knee pain Osteoarthritis, Bursitis, Popliteal cyst
Ankle and foot
pain
Osteoarthritis, Plantar fasciitis, Subcalcaneal bursitis,
Achilles tendinitis/bursitis
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Muscle Pain and Weakness
Walker, BR, Colledge, NR, Ralston, SH, & Penman, ID (eds) 2014, Davidson’s principles and practice of
medicine, 22nd edn, Churchill Livingstone Elsevier, Edinburgh
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Principles of Management of
Musculoskeletal Disorders
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General Aims of Management
o Educate the patient
o Control pain
o Optimise function
o Modify the disease process where this is possible
o Identify and treat related comorbidity
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Education and Lifestyle
Interventionso Patient education:
• Nature of the condition and its investigation, treatment and
prognosis
o Exercise:
• Aerobic fitness training
• Local strengthening exercise
o Joint protection:
• Shock-absorbing footwear
• A walking stick
o Weight loss:
• Strategies for weight loss and maintenance
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Pharmacological Treatment
o Analgesics:
• Paracetamol
o Non-steroidal anti-inflammatory drugs (NSAIDs):
• Traditional NSAIDs
• COX-2 selective NSAIDs
o Topical agents:
• Topical NSAID creams and gels
• Capsaicin
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Non-pharmacological
Interventionso Physical and occupational therapy:
• Local heat, ice packs, wax baths
• Hydrotherapy
• Various manipulative techniques
• Splints
• Orthoses
• Aids and appliances
o Surgery
o Self-help and coping strategies
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Reading and Resourceso Crowley LV, 2012, An Introduction to Human Diseases – Pathology and
Pathophysiology Correlations, 9th edn, Jones and Bartlett Learning
o Grossman SC & Porth CM 2014, Porth’s Pathophysiology- Concepts of
Altered Health States, 9th edn. Wolters Kluwer Health - Lippincott, Williams
& Wilkins
o Hinson, J, Raven, P & Chew, S 2010, The endocrine system: basic science
and clinical conditions, 2nd edn, Churchill Livingstone Elsevier, Edinburgh
o Jamison, JR 2006, Differential diagnosis for primary care: a handbook for
health care practitioners, 2nd edn, Churchill Livingstone Elsevier,
Edinburgh.
o Jarvis, C, 2012 Physical Examination & Health Assessment, 6th ed.,
Elsevier Saunders, Philadelphia.
o Kumar, P & Clark, M 2012, Kumar and Clark’s clinical medicine, 8th edn,
Saunders Elsevier, Edinburgh.
o Kumar, V, Abbas, AK & Aster, JC 2015, Robbins & Cotran pathologic basis
of disease, 9th edn, Elsevier Saunders, Philadelphia.
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Reading and Resourceso Lee, G & Bishop, P 2009, Microbiology and infection control for health
professionals, 4th edn, Pearson Education, Frenchs Forest, NSW.
o McCance, KL, Heuther, SE, & Brashers, VL 2014, Pathophysiology: the
biologic basis for disease in adults and children, 7th edn, Elsevier.
o Michael-Titus, A, Revest, P & Shortland, P 2010, The nervous system: basic
science and clinical conditions, 2nd edn, Churchill Livingstone Elsevier,
Edinburgh
o Mosby’s dictionary of medicine, nursing and health professions 2013, 9th
edn, Elsevier, St. Louis, MO.
o Tortora, GJ & Derrickson, B 2014, Principles of anatomy and physiology,
14th edn, John Wiley & Sons, Hoboken, NJ.
o VanMeter, KC & Hubert, RJ 2014, Gould's pathophysiology for the health
professions, 5th edn, Elsevier, St Louis, MO.
o Walker, BR, Colledge, NR, Ralston, SH, & Penman, ID (eds) 2014,
Davidson’s principles and practice of medicine, 22nd edn, Churchill
Livingstone Elsevier, Edinburgh.
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