Transcript Skeletal System Pathology

Skeletal System
Pathology
Congenital Pathologies
Spina Bifida “split spine” in Latin




Spinous Process of the Arch of a Vertebrae does not
fuse properly allowing the spinal cord to stick out (this is
called myelomeningocele).
Most commonly in C-spine and L-spine
Fixed surgically post-natal but baby will have
permanent motor disabilities.
Etiology: lack of folic acid in utero
Osteopetrosis “stone bones” in Latin






Hyperproduction of osteoblasts over osteoclasts leads
to overly dense/hard bones.
Medullary cavity and spongy bone is not created
properly thus bone marrow is not produced leading to
hematopoetic problems.
Symptoms: stunted growth, easily broken bones,
fatigue
Ideopathic
Treatment is constant bone marrow and blood
transfusions to balance out osteoblastic/osteoclastic
imbalance.
Opposite condition is osteoporosis.
Congenital Conditions
Achondroplasia



Common result of dwarfism.
Lack of GH causes cartilage growth in growth
plates of bones to stop, thus new bone cannot
grow.
Treatment with GH is not effective
Congenital Dysplasia of the Hip (CDH)
Acetabulum of pelvis does not fully form or is too
shallow thus femoral head more prone to slipping
out (subluxing).
Multiple Causes




Increased exposure to hormones in utero
Decreased amniotic fluid puts pressure on the hips
Improper swaddling of child
Breached birth
Treatment: Femoral head must be immobilized;
patient placed in pelvic cast or harness.
Inflammatory/Infectious Disorders
Rheumatoid Arthritis (RA)
Autoimmune disorder which affects the MCP/DIP/PIP joints
of hands/feet called Synovitis.
Results in:





Increased synovial fluid in joint
Fibrous clot development in joint
Ligaments of joint become inflamed
Destruction of cartilage in joint
Ankylosis: Fusion of joint resulting in excessive pain and
diminished/no movement of the joint.
Secondary complications in pleura, pericardium, sclera and
other organs.
Ideopathic
Treatment:


NSAIDs and anti-inflammatory medications
Physical and Occupational Therapy
Osteoarthritis (OA)
aka Degenerative Joint Disease
Not autoimmune; OA is caused by wear-and-tear
and old age.
Most common in weight-bearing bones (hip/knee)
and DIPs and PIPs
Cause:

Cartilage in joints wither away exposing bone
to bone.

Osteophytes (bone spurs or bony peninsulas)
develop in joint space causing pain.
Treatment

Weight loss

Moderate Exercise

Strength Training

Analgesics/NSAIDs
Exercise-Related/Trauma Injuries
Bursitis

Bursas are synovial fluid-filled pads located in key joints to
help reduce friction

Caused by repetitive motion/excessive use/or trauma.
Meniscus Tears

Each knee has two fat pads: Medial Meniscus and Lateral
Meniscus

Most common knee injury

Caused by trauma or wear-and-tear.
Both conditions resolved by rest, immobilization, NSAIDs, and
elevation
Osteomyelitis
Bacterial infection of the bone (osteitis) and/or bone marrow
(myelitis).
In adults, affects spongy bone; in children, the medullary
cavity
Most commonly caused by laceration of tissue near the bone;
bacteria travels to bone.
Bacteria develop abcesses on bone; pus originates from
abcesses and drips down to infects rest of bone.
Treatment: abx; if worse then osteotomy.
Osteoporosis (Latin for “porous bone” is the decrease of bone
density; osteoclastic activity surpasses osteoblastic leading to weaker
bones
Opposite of osteopetrosis
Most commonly seen in menopausal women
Causes

Smoking, alcohol consumption,

Taking steroids (Prednisone), Calcium and Vitamin D deficiency

Sedentary Lifestyle, Excessive soda drinking.
Difficult to diagnose b/c bones look normal; first fx is first indication.

Treatment

Increased calcium and Vit D

Exercise
Gout (Hyperuricemia)
Gout is acute arthritis of the 1st MTP joint of the
foot

Used to be called rich man’s disease” or “King’s
Disease”
Symptoms:

Nocturnal excruciating pain with redness.

It is caused by the accumulation of uric acid
(urea) crystals in the joint. (Hyperurecemia)

Uric Acid is the main waste excreted by the
kidneys.

Kidney is not excreting uric acid sufficiently.
Causes:

High seafood and meat consumption

High Alcohol consumption

Metabolic Syndrome: High cholesterol,
Type II DM, Obesity, Hypertension
Treatment:

Ice, NSAIDs, change of diet, and use of
drugs, Colchicine and Allopurinol.
Benign Bone Tumors
Osteochondroma
“Tumor of the cartilage of the bone”
Most common bone neoplasm/tumor
Growth contains both cartilage and bone cells and
normally occurs at the end of long bones.
No treatment necessary unless growth causes
pain in the joint.
Endochondroma
Benign tumor growth in the medullary cavity of the
long bones.
Malignant Bone Tumors
Ewing’s Sarcoma
Cancer of the connective tissue of bones
Mostly seen in pelvis, ribs, femur, tibia
Occurs to mostly adolescent boys
Treatment
Removal of lesion if possible followed by chemo;
amputation may be necessary if metastasis has not
occurred.
Prognosis: 70% survival after 5 years if Stage 1
diagnosis; 15% if metastasized.
Multiple Myeloma
Deadly Cancer of the bone marrow
Cancer of special WBC cells called plasma
cells
Plasma cells congregate in spongy bone
where it interferes with normal hematopoesis
(blood cell development).
Most common in men, 2x more common in
Blacks.
Death within 5 years is common.
Fractures
Lisfranc
fx in which one/many metatarsal bones are dislocated from tarsal bones.
Jones
fx of the base of the 5th metatarsal of foot
Jefferson
fx of Cervical 1
Hangman
fx of Cervical 2
Seat Belt
fx of the body of the Lumbar vertebrae; normally due to trauma
Blowout
fx to the floor of the orbit (maxillary and zygoma bones)
Tripod
fx to the floor and lateral aspect of the orbit
Colles

fx of distal radius with a buckle fx of distal ulna
Most common wrist fx due to hyperextension of fall.
Bennett’s
fx of the base of the 1st metacarpal of hand
Boxers’
fx of the 5th metacarpal of hand
Chauffeur’s
fx to the styloid process of radius
Monteggia
fx of the ulna with radius dislocation at elbow
Galeazzi
fx of the radius with dislocation at distal radio/ulnar joint of the wrist
Pott’s
fx of both medial and lateral malleoli at ankle. aka bi-malleolar fx
Colles fx
Bennetts fx
Chauffeur
Boxer
Monteggia
Galeazzi
Potts
Lisfranc
Jefferson (fx of C1)
Jones
Hangman
Tripod fx (Lateral Orbit)
Blowout fx (Floor of Orbit)
Seat Belt fx