Welcome to week 5!! Midterm Chapter 15 Orthopaedics

1. Welcome to week 5!!MidtermChapter 15Orthopaedics

2. Error review from OB GYN

3. Osteology: The study of bones • Orthopaedics: The science of diagnosis and treatment of musculoskeletal diseases and disorders • Etymology: • Ortho: straight • Pais: child • Orthopaedist: A physician who treats the special problems associated with the musculoskeletal system

4. Anatomy of the Musculoskeletal System • Bone • One of the hardest tissues in the body • Provides support for the body • Storage site for calcium • Site for formation of blood cells (hematopoiesis) • Types of Bone Tissue: • Compact bone: tightly packed, on surfaces of bones • Spongy: less dense, thin, bony plates • Remodeling: continual growth and replacement of bone

5. Types of Bones • Long Bones • Diaphysis (tubular shaft) • Epiphysis (expanded end) • Metaphysis (where diaphysis meets epiphysis) • Medullary cavity: where bone marrow is produced

7. Red marrow: marrow that actively produces blood cells • Yellow marrow: produces fat cells • Types of Bones • Short bones: shorter, allow for flexibility • Flat bones: thin, plate-like structures for protection (skull) • Irregular bones: variety of sizes and shapes (vertebrae)

8. Divisions of the Skeleton • Axial: bones of the skull, vertebral column, and chest • Appendicular: bones of the limbs as well as the shoulder and pelvic girdles • Pectoral girdle: attaches arms to the axial skeleton • Pelvic girdle: attaches base of spine to hips and legs

9. Joints • Joint (articulation): point of connection between two or more bones, or between cartilage and bone • Classified by range of movement: • Fibrous: do not move (sutures of the skull) • Cartilaginous: some movement (vertebrae of the spine) • Synovial: full movement (most joints of the body). Contain synovial fluid to help joints move easily

10. Cartilage • Menisci: between the two joints formed by the femur and the tibia • Lateral meniscus (outer side) • Medial meniscus (inner side) • Ligaments

11. Muscle: enables movement of bones and joints • Voluntary: controlled by cerebral motor cortex and cerebellum • Involuntary: controlled by brain stem and spinal cord • Muscles move by pulling and relaxing • Flexor muscles: bend a limb at the joint • Extensor muscles: extend or straighten the limb at the joint

12. Types of Muscle: • Skeletal: attached to bones at both ends by tendons • Named by their characteristics: • Number of origins and insertions • Location of origin • Shape • Direction of muscle fibers • Size • Action or movement generated • Involuntary muscles: movements cannot be controlled consciously • Cardiac muscle: found only in the heart

13. Tendons: attach each end of a muscle to bone and allow muscles to pull on bones • Bursas: protect bones and tendons from injury or from rubbing against each other

14. Anatomic regions of the body: considers the organization of the body as segments • Anatomic terms of movement: describe the movement and direction of body parts at the joints

15. Common Musculoskeletal Diseases and Treatments • Sprains: a stretch or tear of a ligament • Strain: a stretch or tear of a muscle or tendon • Treatments: reduce pain, immobilize injured ligament • RICE: rest, ice, compression, and elevation • NSAIDs reduce pain and inflammation

16. Fracture: a break or crack in the bone • Types: according to appearance and characteristics • Treatments: realign broken bones, then immobilize to heal • Open reduction: makes incision in the skin over fracture site • Closed reduction: does not make an incision in the skin

17. Fixation: immobilizing parts of fractured bone • ORIF: open reduction and internal fixation • Internal fixation: placement of instruments underneath the skin • External fixation: instruments connected to a metal bar outside the skin Immobilizing fracture: use of cast, brace, or splint

18. Dislocation: displacement of a joint from its normal position • Subluxation: an incomplete or partial dislocation • Treatment: Reducing dislocation back into position and tightening ligaments around it

19. Scoliosis: abnormal lateral curvature of the spine; unknown cause • Treatment: surveillance of curvature over time • Surgery: fusing and pinning of bones to help keep the spine straight

20. Avascular necrosis: the death of bone tissue due to a permanent loss of blood supply; also called osteonecrosis • Treatments: • NSAIDs to reduce pain and inflammation • Core decompression • Osteotomy • Bone grafting • Total joint replacement • Total knee arthroplasty (TKA) • Total hip arthroplasty (THA)

21. Osteoporosis: bones become weak and brittle; unknown cause • Dowager hump: forward curvature of spine from compression fractures • Treatments: • Hormonal drugs (estrogen) • Selective estrogen receptor modulators (SERMs). • Bisphosphonates

22. Meniscal tears: injury to the menisci on either side of the knee joint • Three zones: • Anterior horn: front third • Posterior horn: back third • Body: middle third • Treatment: • Arthroscopy: endoscopic repair of the joint • Meniscectomy: surgical removal of the tear

23. Osteoarthritis: degenerative joint disease (DJD), a chronic disorder of joint cartilage and surrounding tissues • Treatments: • NSAIDs relieve pain and reduce inflammation. • Cyclooxygenase-2 (COX-2) inhibitors to relieve pain and swelling of joints. • Surgical treatments: • Arthroplasty • Arthrodesis: surgical fusion of bones to help relieve pain

24. Muscular Dystrophy (MD): muscle wasting and weakness • Duchenne muscular dystrophy (DMD): more aggressive, onset at early age • Becker muscular dystrophy (BMD): milder, onset in teens or early adulthood • Myotonic muscular dystrophy: most common adult form • Treatment: No cure, purely supportive

25. Bone Tumors– abnormal growth of cells in bones. • Benign—do not spread to other tissues • Osteochondroma most common – bony spur on surface of the bone • Pedunculated – stalk is present • Sessile – broad base of attachment

26. Malignant – can spread to other tissues • Osteosarcoma – bone-forming cells • Ewing sarcoma – primarily in children • Chondrosarcoma – develops in cartilages around bones • Multiple myeloma – tumor of plasma cells of bone marrow

27. Diagnostic Studies and Procedures • Muscle and Flexibility Tests • Laboratory Tests • Complete blood count (CBC) • Erythrocyte sedimentation rate (ESR) and cAMP receptor protein (CRP). • Salicylate level • Creatine kinase (CPK) and aldolase • Liver function tests • Cultures: identify organisms that cause infection.

28. Biopsy: • Bone marrow aspiration and biopsy • Bone marrow aspiration: liquid sample of bone marrow is removed. • Core biopsy: a small solid piece of bone marrow is obtained • Doppler ultrasound: used to detect blockages in blood vessels

29. Imaging Studies • Radiography: x-ray, most common diagnostic tool • Bone densitometry: also called dual-energy x-ray absorptiometry (DEXA) • Bone scan: also called radionuclide study • Computerized tomography (CT) scan • Myelogram: an x-ray exam of the spinal cord and space around it (subarachnoid space) • CT myelogram: the use of a CT scan immediatelyafter myelogram

30. Magnetic resonance imaging (MRI) • Lumbar discography: discogram. • Electromyography (EMG) • Nerve conduction studies

31. The end-questions???????