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Dislocation vs. subluxation
Dislocation is complete and temporary loss of contact between articular cartilage

Subluxation is a partial loss of contact
Strain vs sprain

Avulsion
Strain involves a tendon

Sprain involves a ligament

Avulsion: complete separation of tendon or ligament from its bony site (happens in fingers, at tips)
Tennis elbow

Golfers elbow
Epicondylitis

Extensor tendon to lateral epicondyl
Myositis ossificans
repetitive injury of muscle leads to calcification of the muscle

  • "Rider's bone"
  • "Drill bone"
  • Thigh muscles in football
Rhabdomyolysis
severe emergency with myoglobinuria that happens with MAJOR trauma
Osteoporosis

what happens

what's involved

what are the pt's experiences
Cortical bone is weaker and trabecular bone is compromised.

RANKL-RANK (receptor)-OPG system involved with apoptosis of osteoclasts

Kyphosis and loss of height occur along with breaks
Osteomalacia

what is it

pathophysiology
inadequate and delayed mineralization of osteoid

vit D deficiency and resulting hypocalcemia are involved. Also tied to low levels of bone phosphate which keeps mineralization from occurring.

Paget's disease

AKA

what happens (2)

treat w/
AKA osteitis deformans

abnormally high bone resorption of the axial skeleton

RANK-NF-kb signaling involved

if the skull is involved there can be sensory repurcussions

treat with calcitonin and biphosphanates
Osteomyelitis

definition

types
infection of the bone and marrow tissue, usually by bacteria (staph) but can be fungus, parasite or virus


Endogenous (hematogenous)
  • Comes from another infected site of the body
Exogenous
  • Commonly comes from bites or other wounds

In children the periosteum is lifted, in adults, it is weakened leading to pathological fractures. Either way, the canaliculi are sealed and there is a lot of bone necrosis.

CM: areas of tender, warm, swollen and painful. Can be acute: systemic manifestations or chronic: vague with flareups of acute.
Bone tumors (4)
 
  1. Osteogenic tumors: contain cells having appearance of osteoblasts and producing an intercellular substance that can be recognized as osteoid. Characterized by formation of bone or osteoid tissue with a sarcomatous tissue. Tissue can appear as compact or spongy bone. Tumors include Osteoid osteoma, Osteoblastoma, and Osteosarcoma. 50% occur in knees; 90% are in metaphysis of long bones. Bimodal prevalence.
  2. Chondrogenic tumors: contain chondroblasts and produce an intercellular substance similar to chondroid (cartilage). Tumors include Endochondroma, Chondroblastoma, Osteochondroma, and Chondrosarcoma. Middle and older age. expand and enlarge metaphysis and diaphysis
  3. Collagenic tumors: contain fibrous tissue cells and produce an intercellular substance similar to type of collagen found in fibrous connective tissue. Tumors include Fibroma, and Fibrosarcoma.
  4. Myelogenic tumors: originate from various bone marrow cells. Tumors include Giant cell tumor, and Ewing sarcoma. Giant cell is slow growing, women. Multiple myeloma also causing pain and cortical and medullary bone damage.
 
Osteoarthritis

AKA

definition/what happens

CM
AKA degenerative joint disease

degradation of joints with loss of articular cartilage, sclerosis of bone beneath cartilage and formation of bone spurs (osteocytes).

CM: pain, stiffness, enlargement of joint, tenderness, limited motion, deformity
Rheumatoid arthritis
An inflammatory joint disease

systemic autoimmune disease involving Rheumatoid factors (RFs) which are autoantibodies in the joint capsule.

Joint capsule becomes inflamed and CD4 Helper T cells are involved leading to B cell involvement with osteoclast degradation of the cartilage. Cytokines such as IL-1, TNF. Macrophages and neutrophils involved.
Ankylosing spondylitis
Inflammatory disease of spine or sacroiliac joints of young (~20) men usually.

Probably involved with enthesis, the site where the ligaments, tendons and joint capsule enter the bone

HLA-B27 involved
Gout

related to:

pathogenesis/primary or seconday

what happens with synovial fluid crystals?

what the crystal formation prefers

3 clinical stages

pathophysiology
related to purine metabolism (dark beer, meat organs, thiazide diuretics, obesity).

Uric acid accumulates in the body fluids. If cause is unknown, primary gout, if it's not secondary gout. Renal or metabolic problem.

If it gets to the joint as uric acid crystals its "gouty arthritis"

Arthritis prefers low temp, decreased albumin or glycosaminoglycan (synovial fluid, cartilage, etc.) levels, changes in ion concentration and pH, trauma

3 clinical stages
  • asymptomatic hyperuricemia
  • acute gouty arthritis
  • tophaceous gout
Monosodium urate involved. When crystals are ingested by phagocytes it results in cell lysis which releases powerful enzymes responsible for tissue damage. Prostaglandins cause the pain.
metatarsus adductus

vs.

talipes equinovarus
Pigeon toe, the toes point inward while walking. Due to 3 different causes.

vs.

congenital defect called "clubfoot"
Legg Calve Perthes
4 stages and happens to kids.

first the synovial membrane and soft tissue swells, then the entire epiphysis dies, becomes remodeled and eventually becomes spongy bone.
Osgood Schlatter
tendonitis of anterior patellar tendon
scoliosis
Nonstructural is caused from something other than the spine (posture, leg length or pain).

Structural is any of 8 causes listed:
 
  1. Congenital skeletal
  2. abnormalities
  3. Neuromuscular disease
  4. Trauma
  5. Extraspinal contractures
  6. Bone infections in the vertebrae
  7. Metabolic bone disorders such
  8. as rickets, osteoporosis
  9. Joint disease
  10. Tumors
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