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MusculoSkeletal Disorders
Kaplan MedEssentials p423
31
Medical
Post-Graduate
04/21/2008

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Term
achondroplasia
Definition

AD form of dwarfism

abnl cartilage synthesis

mutation of FGFR3 (receptor) 

Term
enchondromatosis
Definition
cartilaginous masses w/n medullary cavity of bone
 
ollier dx: non-hereditary, multiple, most commonly hands and feet
 
present with pain and fx -> may undergo malignant transformation
 
Maffuci syndrome: familial; enchondromas and hemangiomas of skin
Term
fibrous dysplasia
Definition
focal fibrous replacement of bone that begins in medullary cavity and remains encased in cortical bone.
 
esp male teenagers
affects long bones, ribs, skull, facial bones -> pathologic fx
 
McCune-Albright syndrome: assoc of polyostotic fibrous dysplasia, cafe-au-lait spots, and sexual precocity in W
Term

hyperparathyroidism

aka

osteitis fibrosa cystica 

Definition
osteoclasts resorb bone, kidney wastes Ca++
more common in primary hyperparathyroidism
 
presents c bone pain and fracture (fx)
fibrous replacement of marrow -> cystic spaces in bone and "brown tumors" 
Term
hypertrophic osteoarthropathy
Definition
etiology: intrathoracic carcinoma, cyanotic congenital heart dx, IBD
 
presents as idiopathic painful swelling of wrists, fingers, ankles, knees or elbows
 
periosteal inflammation, new bones form at end of long bones, MC and MTs
 
arthritis often seen with digital clubbing 
Term
osteochondromatosis
Definition

bony metaphyseal projections capped with cartilage

 

Gardner syndrome: exostoses and colonic polyps -> may become carcinomas

Term
osteogenesis imperfecta
Definition
defect in type I collagen charac by
  • fragile bones
  • blue sclera
  • lax ligaments
Type 1: AD - mild to mod dx
Type 2: AR - stillborn infant - generalized crumpled bones
Type 3: AR - prog severe deformity; white sclera
Type 4: AD - var severity; nl sclera
Term
osteomalacia and rickets
Definition
Vitamin D deficiency due to:
  • chronic renal insufficiency
  • intestinal malabsorption
  • dietary deficiency
osteoid produced in nl amounts, but cannot calcify properly -> diffuse radiolucency on bone films
 
lo Ca++ and P, high alk phos
 
Rickets: children, prior to closure of epiphyses -> "rachitic rosary", bowing of legs and fxs
Osteomalacia: impaired mineralization of nl osteoid matrix; fx and deformities
Term
osteomyelitis
Definition
spread by direct inoculation of bone or hematologenous seeding
 
Staph aureus
Strep
Haem. influenzae
Salmonella (sickle cell dx)
Pseudomonas (IV drug users and diabetics)
Mycobac tuberculosis (Pott dx - spine)
 
presents with fever, localized pain, erythema and swelling
Term
osteopetrosis
Definition
osteoclasts unable to resorb bone
inc density of cortex with narrowing of erythropoeitic medullary cavities
 
presents with
  • brittle bones
  • anemia
  • blindness
  • deafness
  • hydrocephalus
  • CN palsies
AR: affects children -> early death (via anemia and infxn)
AD: affects adults -> fx 
Term
osteoporosis
Definition
dec in bone mass (esp postmenopausal F)
RF: estrogen deficiency, low density of orig bone, lack of exercise
 
all bones affected (XR: generalized radiolucency)
weight-bearing bones predisposed to fx 
Term
Paget disease
Definition
excessive bone resorption c replacement by soft, poorly mineralized matrix (woven) -> XR: enlarged, radioluscent bones
 
presents c pain, deformity, fxs
Lab: high high! alk phos
polyostotic: skull, pelvis, femur, vertebrae
 
alternates osteolytic -> osteoblastic phase
may cause bone hypervascularity c inc warmth of overlying skin 
Term
osteoblastoma
Definition
similar to osteoid osteoma
BUT large, painless
often involves vertebrae
may be malignant 
Term
osteoid osteoma
Definition
benign
affects diaphysis of long bones (often tibia or femur)
causes pain worse at night and relieved by ASA
 
XR: central radiolucency surr by sclerotic rim
 
Pathology: brown nodule surrounded by dense sclerotic cortical bone 
Term
osteoma
Definition
benign
freq involves skull
hyperostosis frontalis interna: osteoma extends into orbit or sinuses
 
pathology: dense nl bone 
Term
osteosarcoma
Definition
malignant
produces osteoid and bone
most common bone tumor
 
M>F, usua 2nd-3rd decade
assoc c Paget dx in older pts
 
presents c localized pain, swelling, weight loss, anemia
 
XR: Codman triangle (periosteal elevatoin) + bone destruxn
 
Pathology: large, necrotic, hemorrhagic mass
 
poor prog, met to lungs common 
Term
chondromyxoid fibroma
Definition

benign, rare

affects young M

firm mass w/n metaphyseal marrow cavity of the tibia or femur

 

contains fibrous and myxomatous tissue 

Term
chondrosarcoma
Definition

malignant tumor

30-60 yrs

M>F

 

de-novo or from pre-existing enchondroma

 

slower growing than osteosarcomas

presents c pain and swelling

involves spine, pelvic bones and upper extremities 

Term
enchondroma
Definition
solitary cartilaginous growth with spongiosa of bone
solitary growths similar to those in multiple form (ollier) 
Term
osteochondroma
Definition
benign epiphyseal growth
may be solitary
lesions identical to those in multiple form 
Term
ewing sarcoma
Definition
malignant , rare
usual adolescents, often M
 
from mesenchymal cells
presents as pain, tenderness and early widespread dissemination
 
commonly affects pelvis, metaphysis of long tubular bones
t(11;22) 
Term
giant cell tumor
Definition
malignant, uncommon
ages 20-50
arises in epiphyseal region of long bones
 
present as bulky mass c pain and tenderness
 
XR: expanding area of radiolucency without sclerotic rim 
Term
ankylosing spondylitis
Definition
mostly young M & +HLA-B27
assoc c IBD
involves SI joint + spine 
Term
felty syndrome
Definition

polyarticular RA assoc with HLA-B27

with splenomegaly + leukopenia 

Term
gout
Definition
hyperuricemia -> deposition of monosodium urate crystals (needle-shape, neg birefringent) in jts -> recurrent bouts of arthritis
 
primary gout: 90%: due to inborn error of purine metabolism, usua from unknown enzyme deficiency (rare: Lesh-Nyhan)
 
secondary gout: unrelated to purine metabolism (example: leukemia) 
Term
juvenile RA (still dx)
Definition
peak 1-3 yrs
F>M
often preceded by acute febrile illness
 
sxs: periarticular swelling, LA, hepatosplenomegaly, neg RF
 
var course; resolution possible 
Term
osteoarthritis
Definition
degenerative joint dx
incidence inc with age (80% 70 y.o. in one jt)
 
aging or wear and tear most important mech
 
insidious onset with joint stiffness, dec ROM, and effusions
 
XR: narrowing of joint space due to loss of cartilage and osteosclerosis
 
joints: vertebrae, hips, knees, DIP jts of fingers
 
pathology:
subchondral cysts, eburnation, osteophytes, Heberden's nodes (DIP),Bouchard's nodes (PIP) 
Term
pseudogout
Definition
calcium pyrophosphate crystal deposition
assoc with multiple dx (Wilson dx, hypothyroidism, DM)
 
pos birefringence, rhomboid appearance 
Term
psoriatic arthritis
Definition
similar to RA, but no RF
assoc with HLA-B27 
Term
Rheumatoid Arthritis (RA)
Definition
progressive arthritis
F>M; 20-60 yrs
 
autoimmune rxn with formation of circulating Ab (Rheumatoid Factor)
 
sxs: low grade fever, malaise, fatigue, AM stiffness
PE: joint swelling, redness, warmth
SF: inc cells (PMNs) + poor mucin
inc ESR and hypergammaglobulinemia
XR: erosions and osteoporosis
 
starts in small jts of hands & feet; symmetrical 
Term
suppurative arthritis
Definition
tender, red swollen ("hot knee")
monoarticular - high PMN count in joint fluid
 
Staphylococcus
Streptococcus
Gonococci
 
Reiter syndrome: arthritis, uveitis, and conjunctivitis - possibly due to Chlamydia (can't pee, can't see, can't climb a tree)
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