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Disorders of the musculoskeletal system

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Amy Rampersad

on 25 November 2014

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Transcript of Disorders of the musculoskeletal system

Myasthenia Gravis

A fracture is a medical condition where the continuity of the bone is broken.

A crack, not only a break in the bone is also known as a fracture. It is abbreviated as FRX or Fx, Fx, or #. Fractures can range in severity from a crack; known as a hairline or greenstick fracture, to a complete break and separation of a bone that may protrude through the skin; known as an open or compound fracture.

Myasthenia Gravis
Myasthenia gravis is a chronic autoimmune neuromuscular disease characterized by varying degrees of weakness of the skeletal (voluntary) muscles of the body. (NINDS,2010)
A sprain is a stretching or tearing of ligaments where the tough bands of fibrous tissue connect one bone to another in the joints.

A strain is the stretching or tearing of a muscle or tendon . A tendon is a fibrous cord of tissue that connects muscles to bones. Strains often occur in the lower back and in the hamstring muscle in the back of the thigh.

Disorders of the musculoskeletal system
Risk Factors
Diagnostic Tests - Importance
Actual Diagnosis
Potential Diagnosis
Disease Characterized by reduced bone mass, deterioration of bone matrix, and diminished bone architectural strength. The rate of bone resorption is greater that the rate of bone formation. The bones become progressively porous, brittle and fragile, and they fracture easily.

Family history of osteoporosis, white race, increased age and female sex.
small stature, fair or pale skinned, thin build and low bone mineral density.
Hormonal and Metabolic
Early menopause (natural or surgical), Late menarche, Obesity.
Corticosteroids, Dilantin, Loop diuretics.
Low dietary calcium and vitamin D

Sedentary, smoker, alcohol consumption (excessive)
Illness and Trauma
Renal insufficiency, hypocalciuria, rheumatoid arthritis
Liver Disease

Marrow disease (myeloma, mastocytosis)

Deficient Knowledge related to unfamiliarity with prevention and treatment as evidenced by patient verbalization

Risk for Injury: fracture related to osteoporotic bone


Amy B. Rampersad

Candice Valley

Cristol Lewis

Lisa Wildman

Sheena Mudie

Sundardaye Rampersad

Risk Factors
Aim of Care
The immune system produces antibodies that block or destroy many of your muscles' receptor sites for a neurotransmitter called acetylcholine.

Antibodies may also block the function of a protein called a muscle-specific receptor tyrosine kinase

Thymus Gland
Triggers or maintains the production of the antibodies that block acetylcholine.

Antibody-negative Myasthenia Gravis

Genetic Factors
Neonatal myasthenia gravis.

Congenital myasthenic syndrome.
(Mayo Clinic, 2013)
Eye Muscles
- Droopy eyelids (ptosis)
- Double vision (diplopia)
Face and Throat Muscles
- Altered speaking
- Difficulty swallowing
- Problems chewing
- Limited facial expressions
Neck and Limb Muscles
- Stiffness of neck
- Waddling of legs
Talk to a doctor if there is difficulty in:
- Breathing
- Seeing
- Swallowing
- Chewing
- Walking
- Using your arms or hands
- Holding up your head
(Mayo Clinic, 2013)
Women are more likely
to develop MG between the ages of 20 to 30.

Men are more likely
to develop MG between the ages of 60 to 70.

People with certain genetic markers,
called HLA-B8, DR3, are more likely to develop MG.

Infants of mothers with MG
are more likely to develop a temporary form of the condition, called neonatal MG
(DeWitt, 2011)

Myasthenia Crisis

Thymus tumors

Autoimmune Disease
(Mayo Clinic, 2013)
Diagnostic Tests- Importance
Edrophonium test
Edrophonium chloride blocks an enzyme that breaks down acetylcholine, the chemical that transmits signals from your nerve endings to your muscle receptor sites.

Blood analysis
A blood test may reveal the presence of abnormal antibodies that disrupt the receptor sites where nerve impulses signal your muscles to move.

Imaging scans
Your doctor may order a CT scan or an MRI to check if there's a tumor or other abnormality in your thymus.

Actual Diagnosis

Fatigue, related to increased energy needs from muscular
involvement as evidenced by, patient verbalizing of increased weakness, bilateral ptosis, and mild dysphagia in the late afternoon or evenings.

Potential Diagnosis

Risk for aspiration , related to difficulty swallowing.

Aim of Care

To increase general muscle function and prevent secondary respiratory and nutritional problems since the swallowing and breathing muscles are affected by this condition.
In affected persons the tiny rigid plates forming the honeycombed matrixes within bone gradually become thinner and rod like, and the spaces between them grow larger. The bone thus becomes more porous and weaker. These lighter and more fragile bones tend to fracture from minor traumas and stresses that ordinarily would have no ill effects.

The gradual progression toward osteoporosis results from changes in the balance between the amount of new bone that is formed within the body and the amount of bone that is resorbed, or broken down and assimilated. Thus, the disease may arise from either decreased bone formation or increased bone resorption. Because there is less bone per unit volume, the decrease in bone density of osteoporosis is great. Measurements of bone density (bone densitometry) define osteoporosis by a T score of –2.5 (2.5 standard deviations below normal peak bone density based on sex and genetic background) or lower.

Most patients with osteoporosis have no symptoms, though some patients have back pain. As the thoracic vertebrae become compressed, the spine bends forward, producing the typical “dowager's hump,” with an accompanying loss of height. A compression fracture of a vertebra may be signaled by a sudden sharp pain in the affected area after minimal or no trauma or by a sudden loss of height. It is common, however, for the patient not to recall pain or trauma and for vertebral compression fractures to be detected.

Osteoporosis develops when the remodeling cycle ( coupling) bone resorption and bone formation is disrupted leading to an imbalance in the coupling process. Osteoclasts are differentiated cells that function to resorb bone. Importance is the Osteoclasts differentiation pathway that is dependent on processes including, proliferation, maturation, fusion and activation.
These processes, in turn, are dependent on the availability of stem cells to allow differentiation to occur and controlled by hormones, cytokines and paracrine stromal cell interactions. Thus the intracellular communication in bone is key and the molecular regulators are necessary for bone homeostatsis.
Dual x-ray absorptionmetry (DXA)
is the gold standard for detecting and monitoring osteoporosis.

Quantitative computed tomography (QCT)
- is an established technique for measuring bone mineral density (BMD) in the axial spine and peripheral skeleton (forearm, tibia). QCT can determine in three dimensions the true volumetric density (mg/cm 3) of trabecular or cortical bone at any skeletal site. However, because of the high responsiveness of spinal trabecular bone and its importance for vertebral strength.
QCT has been principally employed to determine trabecular BMD in the
vertebral body. QCT has been used for assessment of vertebral fracture risk,
measurement of age-related bone loss, and follow-up of osteoporosis and
other metabolic bone diseases. This article reviews the current capabilities of
QCT at different skeletal sites and the recent technical developments,
including volumetric acquisition.

Laboratory studies
(e.g. serum, calcium, serum phosphate, serum alkaline phosphate, urine calcium excretion, urinary hydroxyproline excretion, hematocrit, erythrocyte, sedimentation rate (ESR) are used to exclude other diagnosis

In most cases, osteoporosis can be prevented. The most effective measures for preventing osteoporosis include good nutrition and a liberal intake of calcium and vitamin D throughout life, particularly in the early postmenopausal years. Moderate, regular physical activity, especially weight-bearing exercise such as walking, running, and weightlifting, also protects against bone loss.

There are several therapeutic agents that play different roles in preventing bone loss, reducing fracture risk, and rebuilding bone. Estrogen replacement therapy (see hormone replacement therapy) may be used to prevent osteoporosis in postmenopausal women; however, it is typically used as a last resort when other medications prove ineffective. Raloxifene (an estrogen-like drug), bisphosphonate drugs (such as risedronate and alendronate), and calcitonin decrease bone resorption. Calcium and vitamin D supplements decrease bone resorption and stimulate bone formation. In addition, parathormone, when given intermittently, increases bone formation.


Sudden twisting of the ankle, such as:
Stepping on an uneven surface
or in a hole
- Taking an awkward step when
running, jumping, or stepping
up or down
- Having your ankle roll over
when playing sports or
exercising—called inversion of
the foot

Risk Factors
Factors that increase your chance of getting an ankle sprain include:

- Playing sports especially with the wrong type of
-Walking on uneven surfaces
- Weak ankles from a previous sprain

- Poor coordination
- Poor balance
- Poor muscle strength and tight ligaments
- Loose joints
- Footwear (Example high heels)

Pain around the affected joint.

Being unable to use the joint normally or being unable to put weight on it.




Diagnostic Tests- Importance
High force impact/ Trauma

Stress / Ouveruse

Certain medical conditions which cause weakening of the bones

Risk Factors
Young adventurous adults

The older population


People with underlying illnesses and conditions

Professional sports persons

Swelling and tenderness around the affected area
Discolored skin around the affected area
Angulation - the affected area may be bent at an unusual angle
The patient is unable to put weight on the injured area
The patient cannot move the affected area
The affected bone or joint may have a grating sensation
If it is an open fracture there may be bleeding
Muscle spasms

When a large bone is affected, such as the pelvis or femur..
The sufferer may look pale and clammy
Feelings of dizziness (faint)
Feelings of sickness and nausea.

When a bone is broken, the periosteum, blood vessels in the cortex, marrow, and surrounding soft tissues are disrupted. Bleeding occurs from the damaged ends of the bone and from the neighboring soft tissue.
A clot (hematoma) forms within the medullary canal, between the fractured ends of the bone and beneath the periosteum. Bone tissue immediately adjacent to the fracture dies.
This necrotic tissue along with any debris in the fracture area stimulates an intense inflammatory response characterized by vasodilation, exudation of plasma and leukocytes, and infiltration by inflammatory leukocytes and mast cells.
Within 48 hours after the injury, vascular tissue invades the fracture area from surrounding soft tissues, the marrow cavity, and blood flow to the entire bone is increased.
Bone-forming cells in the periosteum, endosteum, and marrow are activated to produce sub periosteal procallus along the outer surface of the shaft and over the broken ends of the bone.
Osteoblasts within the procallus synthesize collagen and matrix, which becomes mineralized to form callus (woven bone).
As the repair process continues, remodeling occurs, during which unnecessary callus is resorbed and trabeculae are formed along lines of stress.

Pathophysiology Cont'd
Diagnostic Tests - Importance
X- ray -
The main purpose of plain x-ray is to detect serious underlying structural and pathologic conditions. X-rays show whether a bone is intact or broken as they provide clear images of bone. They can also show the type of fracture and exactly where it is located within the bone.

Computed Tomograph (CT scan) -
CT imaging provides anatomic imaging of the osseous (bony) structures and is recommended when more detailed imaging of the bony architecture is important. CT imaging is best used in the face of suspected fracture and can be utilized in the detection of disc injury in patients who cannot undergo MRI scanning.

MRI (magnetic resonance imaging) -
An MRI (magnetic resonance imaging) is useful in determining exact levels of pathology for a selective nerve root block when physical examination and electro diagnostic findings are otherwise not definitive. MRI are helpful in patients with signs and symptoms of neurogenic claudication due to suspected central or foraminal stenosis. An MRI, is also used if patients are not considered surgical candidates or are not interested in surgical treatment.

Actual Diagnosis
Lack of Knowledge related to unfamiliarity with prevention and treatment by evidence by patient verbalization

Potential Diagnosis
Amputation related to disease infection as evidenced by compartment syndrome.

Altered body image related to non-union or mal-union as evidenced by deformity.

Aim Of Care
To promote bone strength to help in preventing some fractures.
To ensure that there is the best possible function of the injured part after healing.
Treatment also focuses on providing the injured bone with the best circumstances for optimum healing (immobilization) through the use of surgical or conservative intervention.

Aim Of Care
Physiotherapy may be advised depending on the severity of the injury.

Physiotherapy involves carrying out exercises designed to improve the range of motion and return the normal function of injured area.
This may reduce your risk of experiencing long-term problems or injuring the area again.

Risk Factors
A strain is caused by twisting or pulling a muscle or tendon. Strain can happen suddenly or develop over days or weeks. A sudden (acute) strain is caused by:
- A recent injury.
- Lifting heavy
- Over stressing the muscle.

Chronic strains are usually caused by moving the muscles and tendons the same way over and over.

Poor conditioning -

Lack of conditioning can leave your muscles weak and more likely to sustain injury.

Fatigue -

Tired muscles are likely to provide good support for your joints.

Improper warm-up -
Properly warming up before vigorous physical activity loosens your muscles and increases joint range of motion, making the muscle less tight and less prone to trauma and tears.



Limited R.O.M.( Range of motion).

Muscle spasms and possible muscle weakness.

Severe strains that partially or completely tear the muscle or tendon are painful and disabling.

Actual Diagnosis
Potential Diagnosis
A strain is the stretching injury to a muscle or muscle – tendon unit caused by mechanical overloading. A muscle that is forced to extend past its elasticity will become strained. Lifting heavy objects without bending the knees or a sudden acceleration- deceleration, as in a motor vehicle crash, can cause strains. The most common site for muscle strain are the lower back and cervical regions of the spine.

Diagnostic Tests - Importance

M.R.I ( Magnetic resonance imaging)

CT scan

Actual Diagnosis
Potential Diagnosis
Aim of Care
Impaired physical mobility related to tearing of muscle /tendon secondary to strain.

Risk for falling related to limited R.O.M and muscle weakness.

Reduce swelling and pain.

R.I.C.E- rest, ice, compression and elevation 24-48hrs.

A subluxation is a partial dislocation in which the bone ends in the joint are still in partial contact with each other.
It does not cause as much deformity as a complete dislocation.

Main Cause: Trauma

Risk Factors
Late complication of infection, rheumatoid arthritis, paralysis, and neuromuscular diseases.

Diagnostic Tests- Importance
X-rays confirm the diagnosis and reveal any associated fracture.
Apprehension Test
Relocation Test
Chiropractic Tests

Actual Diagnosis
Acute pain related to edema, and injury to the soft tissue evidenced by reports of pain

Potential Diagnosis
Risk for [additional] Trauma related to movement of bone fragments

Aim of Care
Immobilized affected joint

Displaced parts are placed back in proper anatomic position to preserve joint function

Analgesia, muscle relaxants

Gentle, progressive, active and passive movement is begun to preserve range of motion (ROM) and restore strength

The musculoskeletal system consists of bones, cartilage, muscles, ligaments, and tendons. Primary functions of the musculoskeletal system include support of the body, provision of motion, and protection of vital organs. The skeletal system serves as the main storage system for calcium and phosphorus and contains critical components of the hematopoietic system. Many other body systems, including the nervous, vascular, and integumentary systems, are interrelated, and disorders of one of these systems may also affect the musculoskeletal system and complicate diagnosis.

Diseases of the musculoskeletal system most often involve motion deficits, functional disorders, and lameness. The degree of impairment depends on the specific problem and its severity. Skeletal and articular disorders are by far the most common and have the greatest economic impact.
Musculoskeletal Sysytem
(Merck Manual, 2014)
Pain related to scaring as evidenced by facial grimacing and patient verbalizing pain using pain scale (0 being the least and 10 being the highest)
Risk for scarring related to damaged fibrous muscle tissue
Destruction Phase- characterized by the rupture and ensuing necrosis of the mayofibres.

Repair Phase- Consist of phagocytosis of the necrotised tissue.

Remodeling Phase- Regeneration of the mayofibres
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