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9
Lecture Notes
Musculoskeletal System
Diseases and Disorders
Classroom Activity to Accompany
Diseases of the Human Body
Fifth Edition
Carol D. Tamparo
Marcia A. Lewis
Copyright © 2011 by F.A. Davis Company. All rights
reserved. This product is protected by copyright. No part
of it may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means—electronic,
mechanical, photocopying, recording, or otherwise—
without written permission from the publisher.
Seeing yourself as you want to be
is the key to personal growth.
—Anonymous
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Common Signs and Symptoms of
Musculoskeletal System Diseases and
Disorders
• Pain
• Tenderness,
swelling
• Malaise, weakness,
fatigue
• Fever
• Obvious bone
deformation, including
spontaneous
fractures
• Inflammation
• Stiffness
• Weight, height loss
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Deformities of the Spine
• Description
• Lordosis: abnormal inward curvature of the lumbar
spine, also called “swayback”
• Kyphosis: abnormal outward curvature of the upper
thoracic vertebra, also called “humpback”
• Scoliosis: abnormal sideways curvature to either the
right or the left
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Herniated Intervertebral Disk
• Description
• Nucleous pulposus leaks through disk wall into
the spinal canal, pressing on spinal nerves
• Called slipped or ruptured disk
• Commonly occurs between 4th and 5th lumbar
or 5th lumbar and 1st sacral vertebrae
• More common in men
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Herniated Intervertebral Disk
• Etiology
• Spinal trauma from fall, straining, heavy lifting
• Intervertebral joint degeneration
• Signs and symptoms
• Severe back pain; worse with movement
• Paresthesia; pain in sciatic nerve
• May be referred to as “sciatica”
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Herniated Intervertebral Disk
• Diagnostic procedures
• Sciatic pain with straight-leg raising test
• CT scan, MRI
• Myelography
• Rule out other causes of back pain
CT = computed tomography; MRI = magnetic resonance imaging.
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Herniated Intervertebral Disk
• Treatment
•
•
•
•
•
•
Rest
Alternating heat/cold applications
Analgesics
Muscle relaxants
Microdiskectomy
Laminectomy if conservative treatment unsuccessful
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Herniated Intervertebral Disc
Complementary therapy
• Prolotherapy may be successful
• Acupuncture and massage
Client communication
• Tell clients to be “patient” with treatment
• Rest is essential but can frustrate client
• Refer to physical therapist
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Herniated Intervertebral Disk
• Prognosis
• 80% to 90% get better over time
• Disabling pain after 3 months may require
surgery
• Prevention
• Proper exercise and correct lifting techniques
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Osteoporosis
• Description
• Metabolic bone disease affecting
10 million Americans
• Bones are brittle, porous, fracture easily due
to decreased calcium, phosphate
• Women, over age 50, small boned at greater
risk
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Osteoporosis
• Etiology
• Heredity
• Longtime steroid therapy, alcoholism, lactose
intolerance, hyperthyroidism
• Diet high in protein, fat; low lifetime intake of
calcium
• Cigarette smoking
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Osteoporosis
• Signs and symptoms
• Bone fracture
• Bone pain, especially in lower back and hips
• Diagnostic procedures
• DEXA to measure bone mineral density
• Blood tests
• X-ray
DEXA = Dual-energy x-ray absorptiometry.
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Osteoporosis
• Treatment
• Dependent upon cause
• Goal: slow loss of mineral calcium, prevent
fractures, control pain
• Calcium, phosphate supplements,
multivitamins
• Bisphosphonate drug therapy
• Physical therapy
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Osteoporosis
Complementary therapy
• Increase natural calcium substances
• Stop smoking
• Avoid sugar, soft drinks, caffeine, alcohol,
fried foods
• Vitamins B, C, D, magnesium, zinc,
phosphorous may benefit
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Osteoporosis
Client communication
• Teach proper body mechanics
• Nutritional support for beneficial diet
• Encourage weight-bearing exercise
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Osteoporosis
• Prognosis
• Fracture risk increases with age as bone mass
weakens
• Strict adherence to therapy helps
• Permanent disability is possible
• Prevention
• Calcium-rich diet
• DEXA screening for women age 65 and over
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Osteoporosis
• A DEXA scan measures bone
1. mineral density
2. mass
3. ossification
4. mineral deposits
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Fractures
• Description
• Break or crack in a bone
• Closed simple: break with no external skin
wound
• Open or compound: break protrudes through the
skin
• Greenstick: bone is partially bent or split
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Fractures
• Description (cont.)
• Comminuted: bone is broken or splintered
• Impacted: one bone end is forced into the
interior of the other
• Incomplete partial: fraction line does not
include whole bone
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Dislocations
• Description
• A dislocation or luxation occurs when bone is
separated from the joint
• A subluxation is a partial dislocation
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Osteoarthritis
• Description
• Chronic inflammatory degeneration of joint
cartilage and bone
• Most common form of arthritis
• Occurs equally in the sexes until after age
55; then women are more at risk
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Osteoarthritis
• Etiology
• Unknown
• Autoimmune, genetic, metabolic, mechanical
factors possible; aging and obesity are risk
factors
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Osteoarthritis
• Signs and symptoms
• Insidious onset
• Deep, aching joint pain
• Stiffness
• Aching during weather changes
• Crepitation
• Minimal deformity
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Osteoarthritis
• Diagnostic procedures
• History and physical examination
• X-rays
• Bone scan
• MRI
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Osteoarthritis
• Treatment
• Goal: minimize pain, inflammation, disability,
maintain joint function
• NSAIDs
• Physical therapy
• Injection of artificial joint fluid
• Orthopedic surgery in some cases
NSAIDs = nonsteroidal anti-inflammatory drugs.
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Osteoarthritis
Complementary therapy
• Proper nutrition, stress reduction
• Biofeedback, glucosamine, acupuncture, massage therapy
• Low intensity exercise, especially in warm water
Client communication
• Promote personal care, adequate rest, appropriate exercise
• Physical therapy
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Osteoarthritis
• Prognosis
• Depends upon site, severity
• Disability can be minor or severe
• No cure
• Prevention
• None known
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Rheumatoid Arthritis (RA)
• Description
• Chronic, systemic, inflammatory disease of
synovial membranes of multiple joints
• RA destroys cartilage; erodes bone; deforms
joints, causing immobility
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Rheumatoid Arthritis (RA)
• Etiology
• Unknown
• Genetic predisposition
• Autoimmune disease
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Rheumatoid Arthritis (RA)
• Signs and symptoms
• Insidious development
• Malaise, fatigue, fever, weight loss
• Joint pain, stiffness
• Swollen interphalangeal joints
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Rheumatoid Arthritis (RA)
• Diagnostic procedures
• Positive rheumatoid factor blood test
• ESR, CBC, x-rays
• MRI or CT scan
ESR = erythrocyte sedimentation rate; CBC = complete blood count.
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Rheumatoid Arthritis (RA)
• Treatment
• Goal: reduce inflammation, pain, joint
deformity
• Preserve joint function
• NSAIDs or DMARDs
• Biological injectables
• Surgical repair if necessary
DMARDs = disease-modifying antirheumatic drugs.
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Rheumatoid Arthritis (RA)
Complementary therapy
• Same as for osteoarthritis
• 8 to 10 hours of sleep at night
• Periodic rests during daily activities
Client communication
• Provide emotional support
• Recommend occupational therapy
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Rheumatoid Arthritis (RA)
• Prognosis
• RA requires lifelong treatment
• Has no cure
• Disease generally is progressive
• Prevention
• None known
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Gout (Gouty Arthritis)
• Description
• Chronic disorder of uric acid metabolism
• Uric acid crystals appear in synovial joint
fluid
• Urate compound deposits (tophi) are in,
around extremity joints
• Affects men more than women
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Gout (Gouty Arthritis)
• Etiology
• Metabolic gout inherited
• Renal gout caused by renal dysfunctions
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Gout (Gouty Arthritis)
• Signs and symptoms
• Sudden, excruciating joint pain; usually in big
toes, feet, ankles, or knees
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Gout (Gouty Arthritis)
• Diagnostic procedures
• Identify urate crystals in joint fluid, tophi in
joints
• UA
• ESR
• Differential (WBC)
• Skeletal x-rays
UA = urine analysis; WBC = white blood cell count.
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Gout (Gouty Arthritis)
• Treatment
• Rest, immobilization of affected part,
applications of heat or cold
• Analgesics, NSAIDs, corticosteroids,
colchicines
• Low purine diet
• Drink fluids frequently
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Gout (Gouty Arthritis)
Complementary therapy
• Abstinence from alcohol
• Low-fat, high-fiber diet
• Intake of bioflavinoids
• Increase fluids
Client communication
• Take NSAIDs with meals
• Encourage increased fluid intake
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Gout (Gouty Arthritis)
• Prognosis
• Good with proper treatment
• Complications include hypertension, kidney stones,
renal damage
• Prevention
• None known
• Low-purine diet, adequate hydration may lessen risk
of gout
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Gout (Gouty Arthritis)
• Gout is characterized by ____
synovial fluid.
in the
1. calcium crystals
2. urea
3. uric acid crystals
4. carbonate
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Sprains and Strains
• Description
• Sprains: tearing or stretching of a ligament
surrounding a joint
• Strains: over-stretching of a tendon or
muscle
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Bursitis and Tendonitis
• Description
• Bursitis: inflammation of bursa; commonly
found in shoulder, arm, elbow, knee
• Tendonitis: inflammation of tendon;
commonly found in shoulder rotator cuff, hip,
Achilles tendon, or hamstring
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Bursitis and Tendonitis
• Etiology
• Bursitis: caused by frictional forces, trauma,
systemic diseases, infection
• Tendonitis: results from overuse, RA,
postural misalignment, or hypermobility
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Bursitis and Tendonitis
• Signs and symptoms
• Tenderness or pain upon movement of
affected part
• Swelling, edema at site
• Pain may interfere with sleep
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Bursitis and Tendonitis
• Diagnostic procedures
• Clinical picture and history
• CT and MRI
• X-ray
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Bursitis and Tendonitis
• Treatment
• Applications of cold and heat
• Immobilization of affected part, analgesics,
NSAIDs, local steroid injections
• Physical therapy or hydrotherapy to help
maintain range of motion
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Bursitis and Tendonitis
Complementary therapy
• Immobilization and rest of affected part
• Acupuncture, gentle massage
Client communication
• Teach clients to avoid offending activity
• Impress the necessity for rest
• Teach daily activity skills using decreased
mobility as necessary
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Bursitis and Tendonitis
• Prognosis
• Bursitis is good if treated promptly; can
become chronic
• Tendonitis can become disabling if untreated
• Prevention
• Avoid trauma, strenuous exercise, or
overuse of joints
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Carpal Tunnel Syndrome
• Description
• Common syndrome compresses median
nerve in wrist within the carpal tunnel
• Seen in individuals performing repetitive
motion
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Carpal Tunnel Syndrome
• Etiology
• Overuse and incorrect use of hands and
fingers causes inflammation
• Edema, compression of the median nerve
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Carpal Tunnel Syndrome
• Signs and symptoms
• Pain, burning, numbness, or weakness in
one or both hands
• Inability to make a fist or grip
• Pain may interfere with sleep
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Carpal Tunnel Syndrome
• Diagnostic procedures
• History
• Decreased sensation to pinpricks
• Positive Tinel sign
• Tingling over median nerve
• Electromyogram
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Carpal Tunnel Syndrome
• Treatment
• Rest of wrist, wearing splint
• NSAIDs
• Surgical decompression of the nerve through
resection of the carpal tunnel ligament
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Carpal Tunnel Syndrome
Complementary therapy
• Yoga, relaxation techniques, acupuncture
Client communication
• Information on posture; wrist rests; ergonomic
keyboards; proper holding, carrying, lifting can be
helpful
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Carpal Tunnel Syndrome
• Prognosis
• Good, especially with proper care and
attention
• Prevention
• Proper work place ergonomics
• Avoid repetitive movements of the hand and
wrist
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Carpal Tunnel Syndrome
• Carpal tunnel is caused by compression of
the
1. median nerve
2. ulnar nerve
3. radial nerve
4. carpal nerve
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Systemic Lupus Erythematosus
• Description
• Chronic, inflammatory connective-tissue
disorder damaging cells and tissues in the
body
• Affects women 8 times more than men
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Systemic Lupus Erythematosus
• Etiology
• Autoimmune response that is unknown
• Genetic, hormonal, environmental factors
considered
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Systemic Lupus Erythematosus
• Signs and symptoms
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•
•
•
•
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•
•
Weight loss
Fatigue
Fever
“Butterfly rash” on face and neck
Skin photosensitivity
Joint, muscle pain
Nausea, vomiting, diarrhea
Raynaud phenomenon
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Systemic Lupus Erythematosus
• Diagnostic procedures
• Anti-DNA test is most specific test for SLE
• CBC with differential
• ESR, serum electrophoresis
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Systemic Lupus Erythematosus
• Treatment
• Dependent upon organs affected
• Corticosteroids
• Protective clothing/sunscreen to protect skin
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Systemic Lupus Erythematosus
Complementary therapy
• Avoid cow’s milk, beef products
• Increase green, yellow, orange vegetables
• Supplements with vitamins C, B complex
Client communication
• Rest, low-sodium, low-protein diet
recommended
• Heat for joint pain and stiffness
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Systemic Lupus Erythematosus
• Prognosis
• Improves with early detection, careful
treatment
• Poor if cardiovascular, renal, or neurologic
complications occur
• Prevention
• None known
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Fibromyalgia
• Description
• Chronic condition characterized by pain in
the muscles, ligaments, tendons, muscle
tenderness, and constant fatigue
• Women are 80% more likely than men to
develop this condition
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Fibromyalgia
• Etiology
• Unknown, though genetics may be a factor
• There may be an increase in pain signals to
the brain
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Fibromyalgia
• Signs and symptoms
• Pain begins as a dull muscle ache
• Tender points develop
• Exhaustion due to lack of restful sleep
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Fibromyalgia
• Diagnostic procedures
• Physical examination showing widespread
pain lasting 3 months at 11 out of 18
possible tender points
• CBC, ESR, thyroid function
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Fibromyalgia
• Treatment
• Goal is reduction of pain and to improve
sleep
• Analgesics, antidepressants, antiseizure
medications
• The drug milnacipran
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Fibromyalgia
Complementary therapy
• Acupuncture, massage, chiropractic
• Yoga, meditation, low impact exercise
Client communication
• Advise that healthy diet, reduction of stress, and
adequate sleep can help alleviate symptoms
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Fibromyalgia
• Prognosis
• Chronic condition
• Dependent on response to treatment
• Prevention
• None known
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Fibromyalgia
• Fibromyalgia begins as
1. sharp muscle pain
2. dull muscle aches
3. widespread pain
4. muscle weakness
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Credits
Publisher: Margaret Biblis
Acquisitions Editor: Andy McPhee
Developmental Editors: Yvonne Gillam, Julie Munden
Backgrounds: Joseph John Clark, Jr.
Production Manager: Sam Rondinelli
Manager of Electronic Product Development: Kirk Pedrick
Electronic Publishing: Frank Musick
The publisher is not responsible for errors of omission or for consequences from application of information in this
presentation, and makes no warranty, expressed or implied, in regard to its content. Any practice described in this
presentation should be applied by the reader in accordance with professional standards of care used with regard to the
unique circumstances that may apply in each situation.
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