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Chapter 8
The Musculoskeletal System
Muscular Dystrophy
It refers to a variety of diseases characterized by
wasting of the muscles. Muscle cells die and are
phagocytized by cells of the inflammatory system,
leading to scaring and loss of muscle function.
The most common form of muscular dystrophy is
Duchenne's muscular dystrophy, a sex-linked
disorder passed on the X chromosome and seen
almost exclusively in males. In approximately 50%
of cases, the disease shows a clear family history
and is passed from mother to son.
Clinical Manifestations of Duchenne's Muscular
Dystrophy
- Waddling gait, and frequent falls in toddlers.
- Walking on toes because of anterior tibial
weakness.
- Decreased deep tendon reflexes.
- Pseudohypertrophy of the calf muscles.
- Gowers' maneuver, whereby the child uses his arms
to push up onto his legs when standing up from the
floor, is seen during the toddler years.
- Immobility and confinement to a
wheelchair by the early teens.
- Curvature of the spine
(kyphoscoliosis) caused by weakness
of the postural muscles.
- Frequent respiratory infections from
failure to fully expand the lungs.
Diagnostic Tools
- Serum levels of the muscle enzyme
creatinine phosphokinase (CPK) are
elevated.
- Muscle biopsy will demonstrate cell
death, scar tissue, and fatty infiltration.
- Electromyography recordings
(measurements of electrical signals in a
muscle) will be reduced.
Acute Osteomyelitis
Osteomyelitis is an acute infection of the
bone that may occur in two froms:
1-Hematogenous osteomyelitis :bloodborne infection
2-Exogenous osteomyelitis after
contamination of an open fracture or
surgical reduction.
Clinical Manifestations
-In children may include fever, chills, and a
reluctance to move a particular limb.
-In adults, symptoms may be vague and include
fever, fatigue, and malaise.
-A urinary, respiratory tract, ear, or skin
infection frequently precedes hematogenous
osteomyelitis.
-Exogenous osteomyelitis typically presents
with evidence of injury and inflammation at
the site of pain. Fever and regional lymph node
enlargement occur.
Osteoporosis
Is a metabolic bone disease characterized by a
severe reduction in bone density, leading to easy
bone fracture. Osteoporosis occurs when the rate of
bone resorption greatly exceeds the rate of bone
formation.
Causes of Osteoporosis
The rate of bone formation decreases progressively
with age, beginning at approximately age 30 or 40.
The denser the bones are before that time, the less
likely osteoporosis will occur. As people age into
their 70s and 80s, osteoporosis becomes a common
disease.
Osteomalacia and Rickets
Osteomalacia is a metabolic bone disease
seen in adults. It is caused by decreased
mineralization of the osteoid as a result of a
deficiency of calcium, phosphate, or from a
vitamin D deficiency or from renal disease.
Rickets is a bone disease in children caused by
vitamin D deficiency.
Clinical Manifestations
- Osteomalacia may be symptomless until a
fracture occurs. Vertebral collapse is common, with
associated changes in posture and height.
- Rickets is characterized by permanent skeletal
deformity, including bowed legs, lumbar lordosis, and
rib and skull deformity. Inability to to walk without
support and may also show poor dentition.
Diagnostic Tools
- Radiograph evaluation can demonstrate reduced
bone ossification.
- Measurements of serum calcium and phosphate
will be low in severe cases.
Osteoarthritis
Is a degenerative bone disease characterized by loss of
articular (joint) cartilage. Without cartilage buffering,
the underlying bone is irritated, leading to
degeneration of the joint.
CLinical Manifestations
- Pain and stiffness in one or more of the joints,
commonly the hands, wrists, feet, knees, upper and
lower spine, hips, and shoulders. Pain may be
associated with tingling or numbness, especially at
night.
- Swelling of the affected joints, with a decreased range
of motion. Joints may appear deformed.
Rheumatoid Arthritis
(RA) is a chronic, inflammatory disease that causes
degeneration of connective tissue ,first is the synovial
membrane and spreads to the surrounding structures
of the joint, including the articular cartilage and the
fibrous joint capsule. Eventually, the ligaments and
tendons become inflamed.
Clinical Manifestations
- Onset of RA is characterized by general symptoms of
inflammation, including fever, fatigue, body aches, and
joint swelling. Joint tenderness and stiffness develop.
- Decreased range of motion, joint deformity and
muscular contractions.
Talipes Equinovarus
Talipes equinovarus, also called
clubfoot, is a congenital abnormality
characterized by deformity of the
bones and soft tissue of the foot.
The front portion of the foot is
turned in whereas the rear of the
foot is inverted.