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MSK Pathophysiology - Coggle Diagram

- - - - description
        
        Muscle fiber shortening without an action potential
      - cause
        
        Failure of the sarcoplasmic reticulum (calcium pump) even with available ATP
      - temporary or permanent
        
        usually temporary
    - - description
        
        muscle shortening caused by muscle spasm or weakness
      - temporary or permanent
        
        permanent
      - fact to know
        
        plentiful ATP and occurs despite a normal action potential
  - - - chronic anxiety
    - - Abnormally increased muscle tension
    - - Neck stiffness, back pain, and headache
  - - - Chronic widespread joint and muscle pain, fatigue, and tender points
    - - unknown
  - - - Normal size of muscle fibers are reduced as a result of prolonged inactivity.
  - - - description
        
        muscle relaxation is delayed after voluntary contractions
      - caused mostly by what
        
        inherited disorders
      - causes what (2)
        
        disabling muscle stiffness and weakness
    - - description
        
        Autosomal dominant inherited mutations of the skeletal muscle channels that causes the muscle unable to contract
      - 2 types
        
        hypkalemic periodic paralysis
        
        description
        
        Alterations in potassium ion channels regulated by T3
        
        hyperkalemic periodic paralysis
        
        description
        
        Genetic mutation of sodium channels
  - - - when Stored glycogen or lipids cannot be used because of a lack of an enzyme
        
        what does this lead to (3)
        
        Cramps, fatigue, and exercise intolerance result
    - - McArdle disease
        
        what does this disease lack
        
        myophosphorylase
      - Acid maltase deficiency
        
        aka
        
        pompe disease
        
        description
        
        prevents the body from breaking down glycogen into glucose
      - Myoadenylate deaminase deficiency
        
        what is this
        
        enzyme that helps produce energy in skeletal muscles
      - lipid deficiencies
  - - - what occurs
        
        Granulomas found in muscle
        
        what is a granuloma
        
        a small, noncancerous collection of immune cells that forms in response to an infection, irritant, or foreign object in the body
      - what type of infection is TB
        
        bacterial
        
        what about sarcoidosis
        
        non infectious
    - - description
        
        parasitic infection caused by eating raw or undercooked meat that causes m. stiffness
    - - what type of infection is this
        
        viral
      - clinical manifestations (4)
        
        Muscle pain, tenderness, signs of inflammation, and creatine kinase (CK) elevation
      - Polymyositis and dermatomyositis
        
        description
        
        Inflammation of connective tissue and muscle fibers
        
        difference between the 2
        
        Polymyositis: Mediated by T cells
        
        Dermatomyositis: Humorally mediated
- - - - most common bone disease in humans
    - - when the remodeling cycle is disrupted leading to an imbalance in the coupling process
        
        what is the coupling process
        
        process that links bone resorption to formation
    - - osteoporosis (osteopenia is like the precursor to osteoporosis)
    - - Decreased levels of estrogen and testosterone
      - Decreased activity level
      - Inadequate levels of vitamins D and calcium or magnesium
      - alterations in the OPG/RANKL/RANK system
      - Postmenopausal osteoporosis
        
        how can this occur (4)
        
        Increased osteoclast activity, changes in OPG, insulin-like growth factor (IGF), and family history
      - Glucocorticoids
        
        how does this occur
        
        Increase RANKL expression and inhibit OPG production by osteoblasts, leading to lower bone density
    - - Reduced bone mass or density and an imbalance of bone resorption and formation
    - - Pain, bone deformity, fractures, kyphosis (hunchback), and diminished height
    - - Estrogen
      - Bisphosphonates, denosumab, teriparatide, parathyroid hormone
  - - - Deficiency of vitamin D lowers the absorption of calcium from the intestines causing inadequate or delayed mineralization
    - - osteoid formation
        
        but what process does not occur
        
        calcification
        
        what does this result in
        
        soft bones
    - - Pain, bone fractures, vertebral collapse, bone malformation, waddling gait, facial deformities, knock knees
  - - - osteitis deformans
    - - State of increased metabolic activity in bone
        causing bone reabsorption and formation to be excessive
      - what 2 things does do to the affected bones
        
        enlarges and soften the bone
        
        most often affects axial or appendicular skeleton
        
        axial
    - - Symmetric skull, impaired motor function, deafness, atrophy of the optic nerve, obstruction of lacrimal duct
  - - - infectious bone disease
        
        usually caused by what infection
        
        Staphylococcus aureus infection
        
        where is it often found
        
        outside the body (exogenous), but it can be from a bloodborne (endogenous) infection
        
        how does the infection spread
        
        under the periosteum and along the bone shaft or into the bone marrow
      - in adults, what bone does it affect
        
        cortical cortex bone
    - - sequestra
        
        description
        
        Sections of dead bone from periosteal separation
      - involucrum
        
        description
        
        Periosteal new bone that is formed around the dead bone
    - - Acute and chronic inflammation, fever, pain, necrotic bone
  - - - avascular necrosis
  - - - bone cells, cartilage, fibrous tissue, marrow, or vascular tissue
    - - Increased nuclear-cytoplasmic ratio, irregular borders, excess chromatin, prominent nucleolus, increase in the mitotic rate
        
        difference between malignant and benign bone tumors
        
        benign or non cancerous and usually don't spread to other parts of the body
    - - geographic
        
        description
        
        Well-defined margins of lytic bone with normal bone
      - moth-eaten
        
        description
        
        Areas of partially destroyed bone adjacent to completely lytic areas
      - permeative
        
        description
        
        Abnormal lytic bone imperceptibly merges with surrounding normal bone
    - - chondrosarcoma
        
        what occurs
        
        produces cartilage or chondroid in the trabeculae in spongy bone
        
        is frequently in what parts of bone (2)
        
        metaphyses and diaphyses of long bones
        
        which cartilage
        
        lobules of hyaline cartilage
        
        what does this do
        
        1 more item...
        
        what can occur in result
        
        Can expand into the neighboring soft tissues
        
        affects what population
        
        middle aged and older adults
        
        clinical manifestations (2)
        
        Pain and swelling
        
        treatment
        
        wide surgical excision
      - osteosarcoma
        
        predominant in what population
        
        adolescents and young adults
        
        occurs in seniours with a history of what
        
        radiation therapy
        
        contains masses of what
        
        osteoids (description)
        
        bone forming tumors
        
        location
        
        metaphyses of long bones
        
        50% occurs in what area in the body
        
        knees
        
        clinical manifestations (2)
        
        pain and swelling
        
        treatment (2)
        
        Systemic chemotherapy and surgery
      - fibrosarcoma
        
        description
        
        Are firm, fibrous masses of collagen, malignant fibroblasts, and osteoclast-like giant cells
        
        usually affects which bones (2)
        
        femur or tibia
        
        what part of these long bones
        
        metaphyses
        
        what is a common thing that can occur from this
        
        Metastasis to the lungs is common
        
        clinical manifestations (6)
        
        Pain, swelling, local tenderness, palpable mass, and limitation of motion; pathologic fracture
        
        treatment (2)
        
        Radical surgery and amputation
      - myeloma
        
        what does this develop from
        
        various bone marrow cells
      - giant cell tumors
        
        what does this cause
        
        extensive bone resorption as a result of the osteoclastic origin
        
        located in which bones (4)
        
        epiphyses of femur, tibia, radius, or humerus.
        
        fast or slow growth rate
        
        slow and relentless growth rate; metastasis is rare
        
        clinical manifestations (3)
        
        Pain, local swelling, and limitation of movement.
        
        treatment (2)
        
        Cryosurgery and resection with adjuvant polymethylmethacrylate (PMMA) for bone grafts
- - - - absence of synovial membrane inflammation
      - lack of systemic signs and symptoms
      - normal synovial fluid
  - - - Loss of articular cartilage, sclerosis of underlying bone, and formation of bone spurs (osteophytes)
  - - - arthritis
    - - Inflammatory damage or destruction in the synovial membrane or articular cartilage
    - - Fever, leukocytosis, malaise, anorexia, and hyperfibrinogenemia
    - - Rheumatoid Arthritis
        
        description
        
        Systemic autoimmune destruction to synovial membrane and joints
        
        how does this occur physiologically (long response)
        
        Multiple immuno-regulatory cytokines and inflammatory enzymes, interlukins and T & B cells, which contribute to the development of the immune response resulting in leukocyte infiltration into the synovium leads to bone erosion
        
        it will have presence of what
        
        rheumatoid factors (RFs) (antibodies)
        
        which antibodies (3)
        
        immunoglobulin G [IgG] and IgM, sometimes IgA
        
        clinical manifestations (4)
        
        Symmetric joint swelling, joint deformities
        
        Systemic manifestations of inflammation
        
        Rheumatoid nodules in organs
        
        what is this called
        
        caplan syndrome
        
        painful, tender, stiff joints
  - - - Chronic inflammatory joint disease of the spine or sacroiliac joints, causing stiffening and fusion of the joints
    - - Low back pain, stiffness, pain, and restricted motion,
        
        Loss of normal lumbar curvature
        
        what is this know as
        
        Kyphosis
        
        Chest pain/restricted chest movement
        
        Fibrotic changes to organs
  - - - Purine synthesis or breakdown is accelerated.
        
        2 examples purines
        
        adenine and guanine
      - Poor uric acid secretion in the kidneys
    - - metabolic disorder that disrupts the body’s control of uric acid production or excretion
        
        how much does the concentration increases
        
        high enough levels to crystallize, causing crystal deposits in CT throughout the body
    - - Low body temperatures
        
        Decreased albumin or glycosaminoglycan levels
        
        Changes in ion concentration and pH
        
        Trauma
    - - Asymptomatic hyperuricemia
        
        description
        
        Urate level is high with no symptoms
      - acute gouty arthritis
        
        description
        
        Attacks develop
      - tophaceous gout
        
        description
        
        Urate crystal deposits (tophi) appear
        
        where does it appear (4)
        
        cartilage, synovial membranes, tendons, and soft tissues
    - - Pain in the great toe (usually, but not always): Worse at night
      - Increase in serum urate concentration
        
        what is this called
        
        Hyperuricemia
      - Recurrent attacks of monoarticular arthritis
        
        description
        
        Inflammation of a single joint
      - Deposits of monosodium urate monohydrate in and around the joints
        
        what is this called
        
        tophi
      - Renal disease
        
        involving what 4 structures
        
        glomerular, tubular, and interstitial tissues and blood vessels
      - Formation of renal stones
- - - - comminuted
        
        Bone breaks into more than two fragments
      - linear
        
        Fracture runs parallel to the long axis of the bone
      - oblique
        
        Fracture of the shaft of the bone is slanted
      - spiral
        
        Encircles the bone
      - transverse
        
        Occurs straight across the bone.
      - torus
        
        Cortex buckles but does not break
      - greenstick
        
        Perforates one cortex and splinters the spongy bone
      - bowing
        
        Longitudinal force is applied to a bone
      - pathologic
        
        Break occurs at the site of a preexisting abnormality
      - stress (includes what 3 types of fxs)
        
        transchondral
        
        description
        
        break in the articular surface of a bone that occurs when force is transmitted across a joint and through the cartilage
        
        Fatigue
        
        description
        
        Abnormal stress or torque applied to a bone with normal ability to deform and recover
        
        insufficiency
        
        description
        
        Fragility fractures of oseteoporosis and osteomalacia
    - - why does bone heal differently than other tissue
        
        bc it will heal w normal tissue, not scar tissue
      - what are the 3 phases of healing
        
        inflammatory phase
        
        what happens during this phase (2 things)
        
        forms hematoma (blood clot)
        
        inflammatory response triggered
        
        lasts how long
        
        3-4 days
        
        repair
        
        lasts how long
        
        several days
        
        what occurs (2 things)
        
        hematoma turns into granulation tissue
        
        what 3 things causes this
        
        Capillary ingrowth, mononuclear cells, and fibroblasts
        
        Osteoblasts within the procallus synthesize collagen and matrix to form callus
        
        remodeling
        
        lasts how long
        
        months to years
        
        what occurs (2)
        
        Unnecessary callus is reabsorbed and trabeculae are formed
    - - Impaired function, unnatural alignment, swelling, muscle spasm, tenderness, pain, impaired sensation
    - - Closed manipulation, traction (skeletal or skin), open reduction, internal fixation, external fixation
        
        if a fracture has an improper reduction or immobilization, what 3 things can occur
        
        nonunion
        
        description
        
        failure of the bone ends to grow together
        
        what occurs at the gap between the broken ends
        
        1 more item...
        
        delayed union
        
        description
        
        healing does not occur until approx 8-9 months after a fx
        
        malunion
        
        description
        
        healing of bone in a non anatomical position
        
        what does an improper reduction mean
        
        broken bone not being properly aligned
        
        what is the treatment for this designed to do
        
        stimulate new bone formation
        
        what treatment can be used to fix this (7)
        
        Implantable or external electric current devices, electromagnetic field generations, and low-density ultrasound
        
        Stem cell and gene therapy
        
        Bone graft or synthetic materials
        
        2 more items...
      - Splints and casts
  - - - sprain
        
        Tear or injury to a ligament
      - avulsion
        
        Complete separation of a tendon or ligament from its bony attachment site
      - strain
        
        Tear or injury to a tendon
    - - Inflammatory exudate develops between the torn ends
        
        Granulation tissue grows inward, and then collagen formation begins 3–4 days after injury
        
        Vascular fibrous tissue fuses the new and surrounding tissues into a single mass
        
        Healing tendon or ligament lacks sufficient strength to withstand a strong pull until how long
        
        4–5 weeks after the injury
    - - pain, soft tissue swelling changes in tendon or ligament contour
      - Dislocation or subluxation of bones
        
        difference between Dislocation or subluxation of bones
        
        dislocation means both bones in joints are completely out of place
        
        subluxation is when bones are partial out of place and still maintain some contact w eachother in joint
    - - Splinting, early motion, and rehabilitation
      - what is used to c=treat a complete rupture
        
        sutureing
        
        what occurs if suturing is not possible
        
        Tendon or ligament grafting
  - - - description
        
        inflammation of tendon
    - - description
        
        painful degeneration of collagen fibers
    - - description
        
        inflammation of bursa
        
        what are bursas
        
        sacs lined with synovial membrane and filled with synovial fluid
      - what is septic bursitis caused by
        
        wound infection
      - treatment
        
        aspiration to drain excess fluid
  - - - Results from a sudden, forced motion, causing the muscle to become stretched beyond its normal capacity
    - - up to 6 weeks
    - - myositis ossificans
        
        aka
        
        heterotopic ossification
        
        what occurs
        
        Inflammation of muscular tissue with subsequent calcification and ossification of the muscle
    - - Life-threatening complication of severe muscle trauma with muscle cell loss
        
        what happens because of this
        
        causes the release of intracellular contents
        
        what specfically eill get into the bloodstream
        
        myoglobin protein
        
        what 3 things happens (called the classic triad)
        
        Muscle pain, weakness, and dark urine (from myoglobin)
      - what are 3 different types
        
        Crush syndrome vs. crush injuries
        
        what is the difference
        
        Crush injury is a direct physical trauma to the body, while crush syndrome is the systemic result of a severe crush injury
        
        compartment syndromes
      - what is a treatment for this
        
        Rapid intravenous hydration
        
        what does this do
        
        maintain adequate kidney flow
        
        treatment if someone becomes hyperkalemia
        
        may require temporary hemodialysis