Transcript NOTES part 6 : Problems or Conditions associated with the

NOTES Ch 6-8: Problems or
Conditions associated with
the Skeletal System & Joints
 Imbalances between bone
formation & resorption
1. Osteoporosis: bone resorption
outpaces bone deposit
– Bone matrix remains normal but bones
become more porous & lighter
– Spongy bone is most vulnerable (ex:
head of femur, compression of vertebrae)
Treatments for Osteoporosis:
• Calcium & Vitamin D supplements
• Increased weight-bearing exercises
• HRT- hormone (estrogen) replacement
therapy
Teenagers need at least 1200 mg. of calcium per
day
• The recommended daily dietary allowance (RDA) for
calcium, released in 1997 by the Institute of Medicine,
varies by age group:
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–
–
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–
–
–
0 to 6 months, 210 mg
6 months to 1 year, 270 mg
1 to 3 years, 500 mg
4 to 8 years, 800 mg
9 to 18 years, 1,300 mg
19 to 50 years, 1,000 mg
51 to 70 years, 1,200 mg
• Many nondairy foods are high in calcium, including the
following:
– Green vegetables, such as broccoli and kale (Swiss chard, spinach, and
rhubarb are not listed because the body cannot use their calcium content
they contain substances called oxalates, which block calcium absorption)
– Fish with soft, edible bones, such as salmon and sardines
– Yogurt with active cultures (may be a good source of calcium for many
people with lactose intolerance, as evidence shows that the bacterial
cultures used in making yogurt produce some of the lactase enzyme
required for proper digestion)
• Vitamin D is necessary for the body to absorb calcium,
therefore a diet should provide an adequate supply of
vitamin D. Sources of vitamin D include eggs and liver,
as well as sunlight.
2. Osgood-Schlatter
• Named for an American surgeon—
Osgood and a Swiss surgeon—Schlatter
• Caused by: an inflammation or partial
separation of the quadricep tendon from
the tibial tuberosity (caused by chronic
irritation—usually from overuse of the
Quadriceps muscle.)
– May manifest as knee pain
• It is seen mostly in muscular, athletic
adolescent boys who are in a growth
spurt.
• Treatment: cut down on activity; avoid
deep knee bending exercise; ice and
elevate; wear braces
3. Rickets- “soft bones”
• Bones are inadequately
mineralized in children
– Osteoid is produced but
calcium salts are not
deposited so bones soften &
weaken
– Weight-bearing bones may
fracture or bend & deform
(symptom = pain when weight
is put on the affected bone)
– Caused by: insufficient
calcium and Vitamin D
4. Gigantism
 An abnormal condition
characterized by size and
stature
 It is most commonly caused
by hypersecretion of growth
hormone in early childhood.
 There is excessive growth
at the epiphyseal plates
*Robert Wadlow: the “Alton Giant”
*8 ft. 11 in (490 lbs.) when he died (from an
infected blister)—tallest person ever recorded.
5. Acromegaly
 Excessive growth of
connective tissue and
bone after the
epiphyseal plates have
closed
 Caused by excess
pituitary growth hormone
 Characterized by a
gradual growth in length
of the bones of face, jaw
and extremities
6. Dwarfism
 One type: Abnormally
low levels of pituitary
growth hormone
 This affects the whole
body
 the whole body is
smaller but proportional
7. Achondroplastic dwarfism
• This is the most common kind of
dwarfism.
– It is characterized by abnormal
short limbs, a normal-sized trunk,
large head with a depressed nasal
bridge and small face
– Also, stubby hands and lordosis
– The condition results from an
inherited defect in endochondral
bone-forming tissue
– intelligence is normal!
8. Spina Bifida
• Spina Bifida is one of the most
common birth defects of the brain
and spinal cord.
• The bones of the spine do not
completely form, and the spinal
canal is incomplete.
• This allows the spinal cord and
meninges (the membranes
covering the spinal cord) to
protrude out the child's back.
9. Abnormal Spine Curves
1) Scoliosis:
–
Scoliosis may start in infancy
but is most frequently seen in
adolescence. It is more
common in females by a 2:1
ratio.
–
The cause of the most common
form of scoliosis is unknown—
genetics are a factor
–
In mild forms, the condition may
be barely noticed; whereas in
severe forms there is significant
disfigurement, back pain and
postural fatigue.
2) Lordosis: An abnormal accentuated
arch in the lower back (“swayback”).
–
Everyone has "lordosis". The term simply
describes the curvature.
–
People born with greater lordosis MAY be
subject to more frequent backaches.
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The greater the degree of lordosis, the
greater is the force that the lower spine
structures have to contend with
3) Kyphosis: Kyphosis is the abnormal
curvature of the upper spine (hunched
shoulders/ “hunchback”).
–
Kyphosis may occur in children,
adolescents, or adults. Adolescent
kyphosis, may result from growth
retardation or a disorder in the
vertebrae during periods of rapid
growth.
–
Other causes of kyphosis include
infection, inflammation, disk
degeneration, osteoporosis of the
vertebrae, arthritis, polio, compression
fractures of the vertebrae, cancer,
tuberculosis, or poor posture.
10. Herniated (“slipped”) Disc
• Involves rupture of the
annulus fibrosus followed
by protrusion of the
spongy nucleus pulposus
– Treated with: traction, bedrest,
painkillers, or surgery
11. TMJ (“lock-jaw” syndrome)
• Location: where the mandible
articulates with the temporal bonetemporomandibular joint
• Characterized by: dull pain around
the ear, tenderness of jaw muscles,
clicking/popping noise when
opening or closing the mouth,
headache, tooth sensitivity,
abnormal wearing of teeth
• Treatment: application of moist heat
or ice, soft diet, aspirin, muscle
restraining, adjusting or reshaping
the teeth, orthodontic treatment or
surgery
12. Bursitis
• Inflammation of bursa; usually
caused by direct injury or
excessive friction but may result
from bacterial infection
– Ex: prolonged leaning on one’s
elbow student’s elbow
– Symptoms: pain made worse by
joint movement, redness, &
swelling
– Severe cases are treated by
injecting anti-inflammatory drugs
into the bursa or by needle
aspiration to remove excess fluid
13. Tendonitis
• microscopic tears to tendon lead
to inflammation of tendon sheaths
– Typically caused by overuse
• Symptoms & treatment (rest, ice,
& anti-inflammatory drugs)
14. Arthritis
• Term “arthritis” includes
over 100 types of
inflammatory or
degenerative diseases
that damage the joints
– Depending on the specific
form, synovial membrane,
articular cartilages, or
articulating bones may be
involved
• Initial symptoms: pain,
stiffness, swelling of the
joint
15. Rheumatoid arthritis
• Autoimmune disease: body’s immune
system attacks its own tissues
• RA begins with inflammation of the synovial
membrane of the affected joints; without
treatment, synovial fluid accumulates and
eventually leads to scar tissue on the articular
cartilages that then become ossified and the
bone ends fuse together
– Usually arises between 40-50 yrs. but can be any
age
– 3x as many women as men
– Occurs in more than 1% of Americans
16. Fractures
• Fractures of the bones are classified in a number of ways.
– A simple fracture involves a single fracture line through a bone.
– A comminuted fracture is one in which the bone has been
fractured into two or more fragments.
– An open or compound fracture is one in which the fractured bone
penetrates the skin.
**Bone Marrow Transplants**
PURPOSE: to treat cases of:
1.
2.
3.
Aplastic anemia (low blood cell count)
Certain types of leukemia
Severe combined immunodeficiency disease
(Inherited deficiency of infection fighting blood cells)
4.
5.
6.
7.
8.
Hodgkin’s disease (cancer of lymphocytes)
Non-Hodgkin’s lymphoma (cancer of different lymphocytes)
Hemolytic anemia (RBC’s rupture faster than can be
replaced)
Sickle-cell anemia
Multiple myeloma (cancer of plasma-B cells)
GOAL: to replace unhealthy bone marrow
stem cells with healthy ones
**Bone Marrow Transplants**
PROCEDURE:
•
In order to transfer bone marrow from a donor to a
patient; bone marrow must be very closely matched to
that of the recipient
1.
Recipient is usually irradiated to destroy their own red
marrow & immunosuppressive drugs are administered
2.
Donor marrow is aspirated from the hip-bones, mixed
with heparin (anticoagulant), then passed through
screens; the suspension of bone marrow cells is treated
to remove T-cells of the donor
3.
These cells are then injected into a vein of the recipient;
The cells in the suspension pass through the lungs,
enter the general circulation, and hopefully reseed and
grow in the marrow cavities of the recipient’s bones.
Common Joint Injuries
Sprains
• Occurs when the ligaments reinforcing a joint
are stretched or torn
– Common in the ankle, knee, and lumbar region of
the spine
– Sprains heal slowly because ligaments are poorly
vascularized
– They also tend to be painful and immobilizing
– A completely torn ligament requires surgery
• Must be performed quickly to prevent the ligament
from turning to “mush”
• Important ligaments may also be replaced with other
tendons or collagen bands
Cartilage Injuries
• Usually involves tearing of the knee menisci, growth
plate fissures, and overuse damage to articular
surfaces in other joints
– May feel a snap or a pop
– Cartilage injuries are becoming increasingly more common
in competitive young athletes
• Treatment
– Cartilage is avascular so it does not repair itself
– Cartilage fragments called “joint mice” can become loose
and interfere with the joint function and cause it to lock
– Damaged cartilage is generally removed by arthroscopic
surgery
– Removal of the meniscus does not impair joint function,
but causes the joint to be less stable
Dislocations
• Occurs when bones are forced out of their normal
position at a joint
– May also be accompanied by sprains, inflammation,
and joint immobilization
– Common causes include a serious fall and contact
during sports
• Treatment
– Dislocations must be “reduced”
– This means a physician must realign the bones
• Also, repeat dislocations are not uncommon
because the initial dislocation may stretch out the
joint capsule and supporting ligaments