Pathology 2 : Musculoskeletal System

Neuromuscular: the connection between the neruon & the muscle

Myofascial: disorders at the interface between muscle and fascial layers

Joint related: problems associated with the joint & its associated tissues

Bone pain: is often the only symptom of bone disease. Constant, worse @ night or when weight bearing

Localized tenderness & swelling

Malformations

• most common inherited form of dwarfism
• a decrease in the proliferation of chondrocytes in the growth plate

one sided of the epiphyseal growth plate grows faster than the other

• Genu valgum (knock knees)
• Genu varum (bowed legs)

cartilage thinner lateral

cartilage thinner medial

• congenital
• heel pointing downward
• forefront turning inward
• the Achilles tendon is tight drawing the heel up toward the leg
• more common in boys
• 1 in 1000 live births
• massage can help a ton

• the hind foot is in valgus
• the forefoot in inversion

hallux valgus deformity of the great toe

• abnormally dense bone
• complications include no bone marrow & nerve entrapment (nerve pinch)
• deficient osteoclastic activty
• bones are brittle & break like chalk
• with no bone marrow, there is a decrease in cell production
• bones grows much thicker

• thickening & disorganization of bone architecture
• most common metabolic disease
• "Matrix of Madness"

• inherited disorders of connective tissue that affect joints, ligaments, teeth, sclera and skin
• a problem with the synthesis of collagen
• aka "brittle bone disease"

massage could be too much, energy work better

• structural abnormality of bone caused by defective mineralization, you get too much collagen, not enough minerals
• Vitamin D deficiency
• reversible when vitamin D is replaced
• Rickets is a vitamin D deficiency
• soft bones

• Vitamin D defiency
• loss of teeth
• sunken eyes

a reduction in bone mass per unit volume while displaying a normal ratio of mineral to matrix

• frequency & distribution
• 8x common in women

• Age-related changes: osteoblasts slow down while osteoclasts continue their normal activity
• Physical activity: decreased physical activity leads to a decrease in bone mass
• Genetic Factors: the type of vitamin D, receptor the individual has inherited accounts for 75% of maximal peak bone mass achieved
• Nutritional state: reduced calcium intake during adolescence increases the risk of osteoporosis in females
• Hormonal influences: in the decade following menopause there is a loss of up to 2% of compact bone & 79% of spongy bone per year
• Environmental factors: cigarettes

Loss of spongy bone and a thin covering of compact bone lead to collapse/fracture

pathologic bone fractures

• inflammation of the bone
• pus forms under pressure in the bone and there is a loss of the bone's vascular supply

a powerful direct or angular force

A powerful direct impact can shatter a bone into several fragments

A sharp sudden twist may break a bone diagonally across the shaft

Strong force may cause long bones to bend and crack obliquely on only one side

• Extensive muscle necrosis (muscle death)
• Hemorrhage
• Tearing of tendinous insertions and ligaments
• Nerve damange

• Open: the fracture site communicates with the integument
• Closed: overlying tissue intact
• Displacement: fracture in which bone is displaced greater than the thickness of the bone
• Pathologic: result of the disease process that weakens the bone to the point of fracture

• repeating injuries
• movement
• age
• nutrition

Accumulation of stress induced micro-fratures which eventually result in a true fracture through the cortex

Occurs in bones in which the cortex has few osteons and forms only when stress is applied

• pain and swelling over affected bone
• a callus forms at the site of the stress fracture before the fracture occurs

• Inflamed muscle torn to bone
• usually develops in athletic adolescents and young adults following a traumatic injury
• painful
• do not massage - will do more damage

• Pain: joint pain without inflammation
• Swelling: joint swelling is the result of an increase in synovial fluid volume
• Joint mass lesions: a joint may increase in size due to a lesion that feels boggy
• Crepitus: is an abnormal sound and/or sensation of grafting that accompanies joint movement
• Abnormal joint mobility: most joint diseases result in restricted range of motion

effect muscle or tendon

• inflammation
• localized pain
• worse with movement
• moderate spasm
• swelling
• ecchymosis

• hemmorrhage
• tearing
• localized pain aggravated by movement, moderate spasms, ecchymosis, redness, swelling and impaired muscle function

• ruptured muscle or tendon with separation of muscle from muscle or tendon, or tendon from bone
• sever pain
• disability
• spasm
• swelling
• ecchymosis

• Ice 1st 24-48 hrs
• massage distal to injury, unaffected areas
• use cross-fiber friction for healing

ligament injury

• minor tearing
• little or no swelling
• hemorrhaging
• loss of function

• partial tearing
• moderate tenderness
• swelling with abnormal motion
• local hemorrhaging
• recurrence, persistent instability and traumatic arthritis are common outcomes

• complete tear
• loss of function
• abnormal motion
• tenderness
• swelling
• hemorrhaging
• possibility of deformity

A dislocation or displacement of bone (FULL)

an incomplete or partial dislocation

• most common cause of joint disability
• NON-INFLAMMATORY degeneration of articular cartilage

subcategory (of Osteoarthritis/osteoarthrosis) that affects the patellar cartiliage in young people causing pain & stiffness

• Affects the PIP and DIP joints of the upper lime, the hip, cervical and lumbar vertebrae
• pain stiffness and swelling of affected joints with no evidence of inflammation
• Creptius is a characteristic feature
• deep aching joint pain after activity that is relieved by rest is the hallmark of osteoarthritis/osteoarthrosis

• moist heat
• passive ROM
• friction around joints - when pain is minimal or after rest

slow, chronic, and progressive inflammatory disease

• unknown
• although genetic predisposition is suggested
• considered an autoimmune disease

• Symmetric polyarticular arthritis usually affecting the small joints of the hands and feet (PIP).
• The affected joins are swollen, painful, and stiff.
• Stiffness is worst in the morning after the joints have been inactive during the night.
• Severe flexion and extension deformities often result

• Stress Reduction helpful
• heat decrease pain (no heat in acute stage)
• no aggressive massage
• passive ROM
• cross-fiber friction

• increased serum uric acid level leading to deposition of urate crystals in joints and kidneys
• 10:1 ratio men to women

• Inflammation of the tendon
• hurts during active vs. passive
• massage muscle

Inflammation of the tendon sheath

• Inflammation of the bursa
• usually from trauma

• Typically seen in rapidly growing athletic adolescents
• The tibial tuberosity becomes tender and swollen
• bones growing faster than muscle
• massage: work quads & all muscle of thigh

• micro tears in the plantar fascia
• areas of the medial calcaneous or mid foot
• (plantar fascia is the thick band of tissue that covers the bones on the bottom of the foot)
• massage great! Stripping strokes, cross-fiber, ice: acute, heat: chronic, self-massage before getting out of bed

synovial cyst associated with fluid escaping posterior to the knee

Subchondral cyst within the fused epiphysis

• Myalgia: muscle pain
• Inflammation: extra blood
• Atrophy: decreases
• Hypertrophy: enlarges
• Spasm: contracting - involuntary
• Weakness

• muscle being destroyed
• a chronic, active, non-inflammatory myopathic process leading to spontaneous, progressive degeneration of skeletal muscle fibers
• sensation there
• muscle protein missing
• a lot of weakness

severe progressive, X-linked, inherited condition affecting 1 out of 3500 males

relentless degeneration of muscle

common form of adult muscular dystrophy

• an aquired autoimmune disease characterized by abnormal fatigability
• more common in women typically beginning in young adults
• muscle fatigues easily

• Pain
• Spinal deformity

A lateral curvature of the spine

Excessive posterior curve of the thoracic spine

An exaggerated cervical or lumbar curve

• A humpback
• Collection of tissue @ C7 - extra stress in body (head forward causes collection of tissue)

Aneurysms or peripheral vascular disease may give rise to symptoms similar to sciatica

Tension, irritation, and/or compression of lumbar nerves may cause pain radiating down both legs

Disorders of the retroperitoneal organs may affect the spine

• Emotional overtones may cloud the clinical picture
• Stress / emotional issues

• Disc degeneration may occur anywhere along the spine producing pain.
• Disc degeneration may lead to nerve root irritation or compression.
• 90% of back pain

The forward displacement of one vertebra over another, usually L5 over S1

• degenerative joint disease
• predominantly affects young men (3:1) with the peak incidence between 15 and 30 years
• the sacrioiliac joint is the most commonly affected joint
• low back pain and stiffness are often the presenting symtoms
• massage can be beneficial @ relieving px