Musculoskeletal

What is musculoskeletal system?

The human musculoskeletal system is the organ

system that gives humans the ability to physically
move, by using the muscles and skeletal system.
It consists of the muscular system and the human
skeleton. Bones are connected to each other at
the joints by ligaments or cartilage and skeletal
muscle is attached to bones, usually by tendons.
Cartilages help reduce friction in joints and
supports bones.
Congenital hip dysplasia
 A malformation of the hip joint that is present at
birth. Genetic factors likely play a role in this
disorder. Features include hip dislocation,
asymmetry of leg positions, asymmetric fat folds,
and diminished movement on the affected side.
Some children will exhibit little or no features and
must be diagnosed by physical examination of
the hip joints.
Symptoms
Although some dislocated hips show no signs,
contact a doctor if your baby has:

• Legs of different lengths.

• Uneven thigh skin folds.
• Less mobility or flexibility on one side.

In children who have begun to walk, limping, toe

walking and a waddling "duck-like" gait are also
signs.
Causes

Clinical studies show a familial tendency toward

Congenital hip dysplasia, with more females
affected than males. This disorder is found in
many cultures around the world. However,
statistics show that the Native American
population has a high incidence of hip dislocation.
This has been documented to be due to the
common practice of swaddling and using
cradleboards for restraining the infants. This
places the infant's hips into extreme adduction
(brought together). The incidence of congenital
Congenital hip dysplasia is also higher in infants
born by caesarian and breech position births.
 Evidence also shows a greater chance of this hip
abnormality in the first born compared to the
second or third child. Hormonal changes within
the mother during pregnancy, resulting in
increased ligament laxity, is thought to possibly
cross over to the placenta and cause the baby to
have lax ligaments while still in the womb. Other
symptoms of complete dislocation include a
shortening of the leg and limited ability to abduct
the leg.
Diagnosis
Because the abnormalities of this hip problem
often vary, a thorough physical examination is
necessary for an accurate diagnosis of congenital
Congenital hip dysplasia. The hip disorder can be
diagnosed by moving the hip to determine if the
head of the femur is moving in and out of the hip
joint. One specific method, called the Ortolani
test, begins with each of the examiners hands
around the infant's knees, with the second and
third fingers pointing down the child's thigh. With
the legs abducted (moved apart), the examiner
may be able to discern a distinct clicking sound
with motion. If symptoms are present with a
noted increase in abduction, the test is
considered positive for hip joint instability. It is
important to note this test is only valid a few
weeks after birth.
 X-ray films can be helpful in detecting abnormal
findings of the hip joint. X rays may also be
helpful in finding the proper positioning of the hip
joint for treatments of casting. Ultrasound has
been noted as a safe and effective tool for the
diagnosis of congenital Congenital hip dysplasia.
Ultrasound has advantages over x rays, as
several positions are noted during the ultrasound
procedure. This is in contrast to only one position
observed during the x ray.
5 month old female: hip evaluated for congenital dysplasia
Ultrasound of a normal hip.
a. gluteus muscle b. ilium c. acetabulum d. head of femur
Treatment
The objective of treatment is to replace the head
of the femur into the acetabulum and, by
applying constant pressure, to enlarge and
deepen the socket. In the past, stabilization was
achieved by placing rolled cotton diapers or a
pillow between the thighs, thereby keeping the
knees in a frog like position. More recently the
Pavlik harness and von Rosen splint are
commonly used in infants up to the age of six
months. A stiff shell cast may be used, which
achieves the same purpose, spreading the legs
apart and forcing the head of the femur into the
acetabulum. In some cases, in older children
between six to 18 months, surgery may be
necessary to reposition the joint.
 Also at this age, the use of closed manipulation
may be applied successfully, by moving the leg
around manually to replace joint. Operations are
not only performed to reduce the dislocation of
the hip, but also to repair a defect in the
acetabulum. A cast is applied after the operation
to hold the head of the femur in the correct
position. The use of a home traction program is
now more common. However, after the age of
eight years, surgical procedures are primarily
done for pain reduction measures only. Total hip
surgeries may be inevitable later in adulthood.
Bone Spur
 Bone spurs, also known as osteophytes, are
bony projections that form along joints. Bone
spurs form due to the increase in a damaged
joint's surface area. This is most commonly from
the onset of arthritis. Bone spurs usually limit
joint movement and typically cause pain.
Cause
Osteophyte formation has been classically
related to any sequential and consequential
changes in bone formation due to aging,
degeneration, mechanical instability, and disease.
Often osteophytes form in osteoarthritic joints
due to damage and wear from inflammation.
Calcification and new bone formation can also
occur in response to mechanical damage in joints,
or at the attachment points for ligaments and
tendons.
Symptoms
A bone spur may have existed for years with no symptoms.

Common symptoms include

• Pain in the area of the bone spur especially afer activity

that uses or puts preasure on the area.
• Inflammation of the surround tissue or joint.

Symptoms of Spinal Bone Spurs

• Sensory symptoms include pain, numbness, burning and

pins and needles in the extremities below the affected
spinal nerve root
• Motor symptoms include muscle spasm, cramping,
weakness, or loss of muscular control in a part of the body.
Diagnosis
With a physical examination and taking the
patient’s medical history into consideration a
doctor can diagnose if the condition is caused by
a bone spur. This process will include
consideration of the patients symptoms to rule
out conditions that have similar symptoms but
very different causes.

• MRI (Magnetic resonance imaging)

• Electroconductive tests to show the seriousness
of the nerve injury
• CT scan (computed tomography)
• X-Ray (not generally notice in routine X-rays,
unless specifically looking)
Treatment
Several approaches can be taken to treatment depending on
the severity of the symptoms.

A conservative approach for persons with mild or moderate

pressure on the nerves or spinal cord might include:
• Cortisone shots to help reduce joint swelling and pain. The
effects of these are temporary and may need to be
repeated.
• Drugs to reduce swelling, relieve pain and relax muscles for
four to six weeks.
• Physical therapy and manipulation of joints to restore
flexibility and strength, improve posture and reducing the
pressure on the nerves.
• Rest .

If this approach isn't successful, surgery may be needed,

such as a laminectomy to remove bone spurs.
Osteoarthritis
Osteoarthritis, sometimes called degenerative joint disease
or osteoarthrosis, is the most common form of arthritis.
Osteoarthritis occurs when cartilage in your joints wears
down over time.

Osteoarthritis can affect any joint in your body, though it

most commonly affects joints in your hands, hips, knees
and spine. Osteoarthritis typically affects just one joint,
though in some cases, such as with finger arthritis, several
joints can be affected.

Osteoarthritis gradually worsens with time, and no cure

exists. But osteoarthritis treatments can relieve pain and
help you remain active. Taking steps to actively manage
your osteoarthritis may help you gain control over your
osteoarthritis pain.
Causes
Osteoarthritis occurs when the cartilage that
cushions the ends of bones in your joints
deteriorates over time. The smooth surface of the
cartilage becomes rough, causing irritation.
Eventually, if the cartilage wears down
completely, you may be left with bone rubbing on
bone — causing the ends of your bones to
become damaged and your joints to become
painful.

It isn't clear what causes osteoarthritis in most

cases. Researchers suspect that it's a
combination of factors, including being
overweight, the aging process, joint injury or
stress, heredity, and muscle weakness.
 Symptoms
Osteoarthritis symptoms often develop slowly and worsen over
time. Signs and symptoms of osteoarthritis include:
• Pain in a joint during or after use, or after a period of inactivity.
• Tenderness in the joint when you apply light pressure.
• Stiffness in a joint, that may be most noticeable when you wake up in the
morning or after a period of inactivity.
• Loss of flexibility may make it difficult to use the joint.
• Grating sensation when you use the joint.
• Bone spurs, which appear as hard lumps, may form around the
affected joint.
• Swelling in some cases

Osteoarthritis symptoms most commonly affect the hands, hips,

knees and spine. Unless you've been injured or placed unusual
stress on a joint, it's uncommon for osteoarthritis symptoms to
affect your jaw, shoulder, elbows, wrists or ankles.
 diagnosis

If your doctor suspects you have osteoarthritis, he or

she will examine your affected joint and ask you
questions about your joint pain. To better understand
the cause of your pain, he or she may also
recommend:
• X-rays. X-ray images of your affected joint may reveal
a narrowing space within a joint, which indicates that
the cartilage is breaking down. An X-ray may also
show bone spurs around a joint.
• Blood tests. Blood tests may help rule out other
causes of joint pain, such as rheumatoid arthritis.
• Joint fluid analysis. Your doctor may use a long needle
to draw fluid out of the affected joint. Examining and
testing the fluid around your joint can determine if
your pain is caused by gout or an infection.
• Examining the joint with a tiny camera (arthroscopy).
In some cases, your doctor may recommend
arthroscopy to see inside your joint in order to
determine the cause of your pain. During
arthroscopy, small incisions are made around your
joint and a tiny camera is inserted to see inside your
joint. Your doctor watches a video screen to look for
abnormalities within your joint.
Evident irregularities of the femoral bone profile (f). The
arrows indicate the thickening of the joint capsule. a =
acetabulum.
Bursitis
 Bursitis is the inflammation of one or more bursae
(small sacs) of synovial fluid in the body. The bursae
rest at the points where internal functionaries, such
as muscles and tendons, slide across bone. Healthy
bursae create a smooth, almost frictionless functional
gliding surface making normal movement painless.
When bursitis occurs, however, movement relying
upon the inflamed bursa becomes difficult and
painful. Moreover, movement of tendons and muscles
over the inflamed bursa aggravates its inflammation,
perpetuating the problem.
Causes

Bursitis is commonly caused by repetitive movement

and excessive pressure. Elbows and knees are the
most commonly affected. Inflammation of the bursae
might also cause other inflammatory conditions such
as rheumatoid arthritis. Although infrequent, scoliosis
might cause bursitis of the shoulders, however,
shoulder bursitis is more commonly caused by
overuse of the shoulder joint and related muscles.
Symptoms

Bursitis symptoms vary from local joint pain and

stiffness, to burning pain that surrounds the joint
around the inflamed bursa. In this condition, the pain
usually is worse during and after activity, and then
the bursa and the surrounding joint become stiff the
next day in the morning.
diagnosis

Your doctor may have you undergo a physical

examination and ask you about your recent activities.
By feeling the painful joint and surrounding area, your
doctor may be able to identify a specific area of
tenderness.

If it appears that something else may be causing the

discomfort, your physician may request an X-ray of
the affected area. If bursitis is the cause, X-ray
images can't positively establish the diagnosis, but
they can help to exclude other causes of your
discomfort.
Ileopsoas bursitis. * = synovial fluid.
 Treatments
Bursitis treatment is usually simple and includes:

• Resting and immobilizing the affected area.

• Applying ice to reduce swelling
• Taking nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve
pain and reduce inflammation

With simple self-care and home treatment, bursitis usually

disappears within a couple of weeks.

Sometimes, doctor may recommend physical therapy or

exercises to strengthen the muscles in the area. Additionally,
your doctor may inject a corticosteroid drug into the bursa to
relieve inflammation. This treatment generally brings immediate
relief and, in many cases, one injection is all you'll need.
Rheumatoid arthritis
Rheumatoid arthritis is an inflammatory form of
arthritis that causes joint pain and damage.
Rheumatoid arthritis attacks the lining of your joints
(synovium) causing swelling that can result in aching
and throbbing and eventually deformity. Sometimes
rheumatoid arthritis symptoms make even the
simplest activities — such as opening a jar or taking a
walk — difficult to manage.

Rheumatoid arthritis is two to three times more

common in women than in men and generally occurs
between the ages of 40 and 60. But rheumatoid
arthritis can also affect young children and older
adults.
Cause
Rheumatoid arthritis occurs when white blood cells
— whose usual job is to attack unwanted invaders,
such as bacteria and viruses — move from your
bloodstream into the membranes that surround your
joints (synovium). The blood cells appear to play a
role in causing the synovium to become inflamed.
The inflammation causes the release of proteins that,
over months or years, cause the synovium to thicken.
The proteins can also damage the cartilage, bone,
tendons and ligaments near your joint. Gradually, the
joint loses its shape and alignment. Eventually, it may
be destroyed.
Signs and symptoms of rheumatoid arthritis may include:
• Joint pain
• Joint swelling
• Joints that are tender to the touch
• Red and puffy hands
• Firm bumps of tissue under the skin on your arms (rheumatoid
nodules)
• Fatigue
• Morning stiffness that lasts at least 30 minutes
• Fever
• Weight loss
Signs and symptoms appear in smaller joints first.

Rheumatoid arthritis usually causes problems in several joints

at the same time. Early rheumatoid arthritis tends to affect your
smaller joints first — the joints in your wrists, hands, ankles and
feet. As the disease progresses, your shoulders, elbows, knees,
hips, jaw and neck can also become involved.
Signs and symptoms of a rheumatoid arthritis flare.

Rheumatoid arthritis signs and symptoms may vary in severity

and may even come and go. Periods of increased disease
activity — called flare-ups or flares — alternate with periods of
relative remission, during which the swelling, pain, difficulty
sleeping, and weakness fade or disappear.
 Diagnosis
Diagnosing rheumatoid arthritis usually begins with
a physical exam. Your doctor will ask you about your
signs and symptoms and examine your affected
joints.

In addition, your doctor may recommend:

• Blood tests. People with rheumatoid arthritis tend to

have an elevated erythrocyte sedimentation rate
(ESR, or sed rate), which indicates the presence of an
inflammatory process in the body. Other common
blood tests look for antibodies called rheumatoid
factor and anti-cyclic citrullinated peptide (anti-CCP)
antibodies in the blood. While commonly found in the
blood of people with rheumatoid arthritis, rheumatoid
factor and anti-CCP antibodies aren't present in all
cases.
• In early rheumatoid arthritis, the presence of
rheumatoid factor and anti-CCP antibodies in the
blood may be associated with an increased risk of
joint damage. Rheumatoid factor and anti-CCP
antibodies can be present in people who have chronic
infections, such as active tuberculosis, and other
autoimmune rheumatic diseases, such as lupus and
Sjogren's syndrome.
• Joint fluid analysis. Your doctor may draw fluid from
your joint using a needle. The fluid can be tested to
help rule out other diseases and conditions.
• X-rays. Your doctor may recommend X-rays to help
track the progression of rheumatoid arthritis in your
joint over time.
Treatment

There's no known cure for osteoarthritis, but

treatments can help to reduce pain and maintain joint
movement so that you can go about your daily tasks.
While medications and joint replacement surgery are
key components of treatment for osteoarthritis, your
doctor will likely recommend you try all other possible
solutions before you consider those options.
Eventually the pain may become severe so that
medications and surgery may be necessary.
The presence of crystals of steroids (red arrow) within the coxo-
femural joint was demonstrated. green arrows = distension of the
joint capsule; white triangles = bony profile of the femural head.
Treatments

There is no cure for rheumatoid arthritis. Treatment

for rheumatoid arthritis aims to reduce inflammation
in your joints in order to relieve pain and prevent or
slow joint damage. Early and aggressive rheumatoid
arthritis treatments may slow joint damage and help
reduce the risk of disability. Treatment typically
involves medications, though surgery may be
necessary in cases of severe joint damage.