Disorders of Musculoskeletal Function

immature stem cells from bone marrow that differentiate into osteoblasts

bone-forming cells which help to rebuild new bone,“Bone makers” or the bone-building cells

mature osteoblasts

function in resorption and degradation of existing bone, Bone breakers” or break down bone

Bone is in a constant state of change as osteoblasts are forming new bone while osteoclasts are resorbing old bone.

The body has many types of these such as such as skeletal, cardiac, and smooth Which are responsible for movement. All movement in the body occurs as a result of this

Attach muscles to bone and are responsible for movement

Attach bone to bone and are responsible for providing stability to the joint.

A joint is the location where two or more bones come together and are classified structurally and functionally according to their degree of mobility. There are three main types of joints

are freely moveable., Also known as synovial joints, They contain a small sack known as a bursa which is located between the joint structures and serves to protect the joint from wear or friction., The bursa is filled with fluid known as synovial fluid

joints move sightly

these are non moving joints

reduce the angle of the joint

increase the angle of the joint

to move away from the midline

move towards midline

Moving around an axis

moving in circular motion

These are when trauma or overuse occurs to muscles, tendons or ligaments. The two most common soft tissue injuries are sprains and strains. The clinical manifestations for both are similar and the extent of the injury impacts the degree of clinical manifestations. These injuries are usually self limiting, meaning they should improve over a period of a few weeks.

occur when there is excessive stretching of our ligaments, usually from twisting movements during activity or as a result of a fall, Patients experience pain, swelling, heat (warmth) and decreased range of motion which can limit function. The most common site is the ankle however, they can occur in any joint.

occur when a muscle or tendon is excessively stretched, often occurring as a result of hyperextension, heavy lifting, and falls, Patients experience swelling, pain, and reduced function of the affected area, Common sites for strains are the lumbar and cervical regions of the spine as well as the shoulder and elbow.

Are a discontinuity (break) of the bone and are one of the most common musculoskeletal disorders, They can occur as a result of injury, stress, or as a result of other pathologic conditions.

happen as a result of injury occur from direct force such as a fall or blow

•also referred to as fatigue fractures which occur as a result of repeated wear and tear on the bone.

fracture where there is a break in the skin, leading to increased incidences of fracture complications such as infection

skin remains intact

the bone fragments separate completely from one another

one in which the bone has not divided into two separate pieces and the bone fragments are still partially joined

defined as a fracture of the proximal end of the femur. These are usually further identified as occurring in the femoral head or neck. 

occurs within the shaft of a femur.

Occurs in the radius closer to the wrist.

Often identified as a tib-fib fracture, is a fractures that occur in the long bones of the lower extremities.

There are three stages of fracture healing; the inflammatory, reparative, and remodeling stages and typically it takes about 6 months for a bone to completely heal. However, there are many factors such as age, medications, diabetes, immunocompetency, stress to fracture site, circulatory problems, coagulation disorders and poor nutrition that all impact the time it takes for bones to health. 

Peaks at about 48 hours but lasts up to 1 week, This phase begins when the bone breaks and injury is recognized by the body. This triggers the inflammatory response and WBC are brought to the site of injury, causing redness, swelling, inflammation and pain. Simultaneously platelets arrive on scene and form a hematoma (blood clot) around the broken bone, creating the first bride between the pieces of broken bone.

Starts about 1 week after injury and lasts 2-6 weeks, During this phase, a soft callus (soft bone) sometimes referred to as a cartilaginous callus, replaces the hematoma that formed during the inflammatory stage. Although the callus is strong enough to hold the bones together, it is not strong enough to support use of the body part, Over the next 2-6 weeks, the callus hardens and is replaced by stronger bone (hard callus or bony callus).

Begins around week 6 after injury and lasts for 3-6 months depending on the degree of injury, Here the hard callus is replaced by regular bone, Initially the bone is uneven but over the next few months, the bone is sculpted and refined, reshaping the bone so it looks the way it did before the injury occurred.

Occurs when the bone heals with a deformity, This typically occurs as a result of inadequate reduction or alignment of the fracture site at time of immobilization.

occurs if there is failure of the fracture site to heal within a normal period, This can occur as a result of inadequate immobilization, infections at the fracture site , excessive loss of bone or inadequate circulation

occurs when there is failure of the bone to heal.

can occur at time of fracture or in the immediate post up from fracture repair. All our bones are highly vascular in nature which places our patients at risk for hemorrhage but injury or surgery to the long bones are the ones most associated with larger volume blood loss. Monitor your patient for pallor (paleness), decreasing heart rate and blood pressure as well as hematologic lab values such as declining hemoglobin and hematocrit to determine if bleeding is occurring.

Pts who experienced open fractures for those who need to have surgical correction of their fracture are most at risk for infection. Despite just identifying that the bones are highly vascular in nature we identified earlier that the healing process is quite lengthy. Therefore, patients who experience infection within the bone often experience a delay in bone healing. Typical signs of infection such as warmth, redness and swelling over the fracture site may be evident. Monitor patient's laboratory values especially pay close attention to their white blood cell count. The patient may also have an elevated ESR/CRP as a result of the inflammatory process occurring in the setting of an infection.

is a life-threatening condition that results when fat globules from the bone marrow of a fractured bone enter the circulation. These fat globules may enter circulation at the time of the fracture injury or during surgical procedures to realign and immobilize the fracture.  These fat globules can become lodged in the vessels of the lungs, kidneys, brain, and other organs.

the development of a blood clot, can occur in patients who have sustained a fracture. These clots are most likely to develop in the deep veins of legs due to prolonged immobilization. Additional risk factors include age and hypercoagulability states. 

is a limb-threatening condition that occurs when pressure in one or more limb compartments increases, compromising the circulation and function of the tissues within the compartment. Compartments are groups of muscles, nerves, and blood vessels within a space that is contained by a tough, inflexible fascial membrane. If the pressure in the compartment is not relieved and circulation to the tissue remains compromised permanent tissue damage can occur within 6 hours of decreased perfusion and lead to loss of function and need for amputation.

is a metabolic bone disease, and its name literally means porous bone. It is characterized by a loss of mineralized bone mass and deterioration of bone structures placing the patient at risk to develop fractures. Essentially the bone is more “fragile”.

slows reabsorption of bone

is a common disorder of our weight bearing joints and is the leading cause of disability and pain in the United States. It is most often seen in the hips, knees and lumbar/cervical vertebrae, however, can also occur in the hands and feet and affects men and women equally.Rheu

is a systemic inflammatory disease which is chronic and progressive. It not only destroys the patients' synovial joints but also affects other connective tissues including some of our major organs.

inflammation of the lining of the joint capsule

is an infection of the bone, most commonly caused by a bacterial microorganism, There are multiple causes, and are classified based on where the infectious agent comes from

osteomyelitis occurs if the infectious agent comes from outside of the body such as what would occur in a penetration injury or contamination of an open fracture or wound. This is the most common in the U.S.

osteomyelitis occurs if an infection spreads to the bone through the blood stream

•osteomyelitis occurs as a result of infectious agents in surrounding areas invading the bone like what we see in many of our chronic osteomyelitis pts who have vascular insufficiency and have chronic or ischemic foot ulcers such as our long-standing diabetic patients.

sometimes referred to as “gouty arthritis” is a disorder characterized by increased serum uric acid and urate crystal deposits in the kidneys and joints causing severe inflammation. We categorize gout as either primary or secondary.

the patient has a problem metabolizing uric acid meaning it is produced at a rate greater than the kidneys can excrete it, causing the uric acid to build up in the blood stream which is known as hyperuricemia. The cause of why this happens is unknown

occurs as a result of another health problem such as renal insufficiency, medications or diuretic therapy.