Transcript Skeletal System Diseases & Disorders

Skeletal
System
Diseases &
Disorders
Osteoporosis
Osteoporosis
bone mass reduced; hormone-related; need calcium
and Vitamin D when young; leads to spontaneous
fractures; curvature of spine
Osteomalacia
“soft bones”; bones are
inadequately mineralized; bone
pain; aka Rickets in children; need
for sunlight - Vit. D; calcium needs
to be absorbed
Paget’s Disease
Paget’s Disease
age >40
 excessive bone
formation and
breakdown
usually spine, pelvis,
femur, skull
 virus?
Osteomyelitis
-bacterial infection
-area is tender and swells
-need for antibiotics
Scoliosis
“twisted disease”; abnormal lateral curvature in
thoracic vertebrae; treat with surgery or body braces
Scoliosis
Kyphosis
“hunchback”; exaggerated
curvature of thoracic
vertebrae; common in
osteoporosis, rickets,
osteomalacia
Lordosis
•“swayback”; accentuated
curvature of lumbar vertebrae
• common in spinal tuberculosis,
osteomalacia, men with
potbellies or pregnant women
Cleft Palate
•congenital
•right and left halves of palate fail to
fuse
•interferes with sucking & inhalation
•surgery at 6 months & speech
therapy
Bursitis
Bursitis
•inflammation of a bursa
•from blow or friction
• “student’s elbow”
•anti-inflammatory drugs or
removal of fluid
Osteoarthritis
•AKA degenerative joint disease
(DJD)
•MOST COMMON CHRONIC
ARTHRITIS
•articular cartilage deteriorates
• leads to stiffness
•no known cause
•more common in women
•joint replacement
Osteoarthritis
Rheumatoid Athritis
Rheumatoid Athritis
•chronic autoimmune
disease
•ages 40-50 onset
•Effects joints of fingers,
wrists, ankles, and feet
•cartilage is eroded
•Antibiotics, antiinflammatory drugs, &
immunosuppressants to
treat it
Dislocation
Dislocation
•AKA subluxation
•treatment is realignment or surgery
•common for
athletes
Sprain
•damage to
ligaments
•synovial membrane
•twisting of joint
•treatment is to limit
joint motion
Sprain
Osteosarcoma
•bone cancer
•10-25 years old
•painfully erodes bone
•spread to lungs
Time to see what you are
made of
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PATIENT HISTORY: This 19
year old man complained of
unremitting, progressive low back
pain for several months.
Otherwise, he was in good
general health without other
medical problems. Physical
examination revealed no sensory
or motor deficits.
Radiology images including plain
radiographs, computer assisted
tomography (CT) and magnetic
resonance imaging (MRI) were
obtained. These images
demonstrated a large, destructive
mass involving lumbar vertebra 3
with extension into the paraspinal
soft tissues.
Case 1
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FINAL DIAGNOSIS: EWING'S SARCOMA/PNET
Contributor's Note: Ewing's sarcoma (ES) is a
malignant neoplasm of bone and soft tissues with
characteristic radiographic, morphologic,
immunohistochemical and cytogenetic features. ES
represents perhaps a more primitive, less differentiated
neoplasm in the spectrum of peripheral primitive
neuroectodermal tumors. Primitive neuroectodermal
tumor (PNET), characterized by neuroectodermal
differentiation (rosette formation, presence of neuropil),
may be considered a more differentiated neoplasm in the
same family. Both share the same cytogenetic
abnormality (11;22)(q24q12) or (21;22)(q22;q12) in
about 90% of cases.
Patient History
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female with left nipple discharge
and an inverted nipple. The patient
stated that left nipple retraction
was chronic for many years, and
described crusting of the left
nipple.
Digital diagnostic mammogram
showed calcifications in the
anterior left breast, some vascular,
some coarse benign-appearing and
others punctate benign-appearing.
There were also benign-appearing
calcifications in the anterior right
breast. Ultrasound of the left
retroareolar area revealed a focally
dilated duct at 5 o'clock with
abrupt termination of dilation
approximately 2 cm from the
nipple. No intraductal mass was
identified.
Paget’s Disease
 Paget's disease (PD) of the
breast is rare, with a
reported incidence of 0.5-2%
of all patients with breast
cancer. However, this
disorder should be
considered in the differential
diagnosis of all the patients
presenting with lesions of the
nipple.
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The characteristic erythema and
eczematous changes of the nipple with
this disease were first described by
Velpeau in 1856, but the association of
nipple-areolar changes with underlying
carcinoma of the breast was not
reported until 1874 by Paget (1).
Ulceration, crusting and serous or
bloody discharge characterize more
advanced cases.
Surgical biopsy is the
diagnostic standard.
Case Study 3
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A 66 year old woman with a 20 year history of
rheumatoid arthritis comes to your office for a new
patient consultation complaining of swelling and pain in
her left knee.
She was diagnosed with rheumatoid arthritis when she
was 45 years old, when she presented with swelling and
pain in multiple joints including her elbows, wrists,
hands, knees, ankles and feet.
She recalls being treated with a variety of non-steroidal
medications (NSAIDs) and low dose prednisone. She
initially was started on hydroxychloroquine and then
intramuscular gold therapy. She did well on gold,
eventually stopping therapy after 8 years.
Her rheumatologist told her she was "in remission" and
stopped seeing her. She has been treated with NSAIDs
alone for the past 7 years.
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Her current knee problems began about 8 months ago. Over
the past several months she has had 4 to 5 episodes of
severe swelling and pain in her left knee. She has morning
stiffness lasting 15 minutes daily, mainly in her hands. She
is currently only taking Ibuprofen 800 mg 4 times daily. On
exam she has chronic deformities at the wrists, MCP and
PIP joints, with chronic synovial thickening. Her left knee
has good range of motion with crepitus but no
demonstrable swelling, warmth or tenderness. Her right
knee exam is similar to her left. Her shoulders have good
active range of motion. Her feet show cock-up deformities
at the MTP joints.
She has x-rays of her hands, which show deformities of
rheumatoid arthritis.
What to do next?
Your diagnostic impression is:
a. gout
b. osteoarthritis
c. rheumatoid arthritis
d. pseudogout