Musculoskeletal Disorders

Musculoskeletal Disorders

Introduction

·       The musculoskeletal system is a complex network comprising bones, muscles, joints, ligaments, tendons, and cartilage.

·       Musculoskeletal disorders are a broad group of diseases and injuries affecting the bones, muscles, joints, and connective tissues.

·       They may be traumatic (fractures, injuries), degenerative (arthritis, osteoporosis), infectious (osteomyelitis), metabolic (rickets, gout), or autoimmune/neuromuscular (myasthenia gravis).

·       These disorders often impair mobility, cause pain, and reduce quality of life.

·       It provides:

·        Support and shape to the body

·        Protection to vital organs (e.g., skull protects brain, rib cage protects heart/lungs)

·        Movement and locomotion via interaction of bones, joints, and muscles

·        Mineral storage (especially calcium and phosphate)

·        Hematopoiesis (blood cell formation in bone marrow).

Fractures

Definition:

A fracture is a break in the continuity of bone due to trauma, pathological weakness, or stress.

Types:

• Closed (simple) – bone breaks without piercing skin.
• Open (compound) – bone pierces skin, high risk of infection.
• Greenstick – incomplete break (common in children).
• Comminuted – bone shattered into multiple fragments.
• Impacted – ends driven into each other.
• Pathological – occurs in weakened bone (e.g., cancer, osteoporosis).
• Stress fracture – due to repeated stress/microtrauma.

Clinical Features:

• Pain, swelling, deformity
• Loss of function
• Crepitus (grating sound)
• Abnormal mobility
• Bleeding in open fractures

Management:

• First aid: Immobilization, bleeding control, splinting
• Definitive treatment:
• Closed reduction (manual realignment)
• Open reduction and internal fixation (ORIF)
• External fixation (pins, rods)
• Rehabilitation: Physiotherapy, nutrition (calcium, vitamin D).

Arthritis

Definition:

Inflammatory disorders of joints leading to pain, stiffness, swelling, and reduced mobility.

Types:

1. Osteoarthritis (OA):
• Degenerative joint disease due to wear and tear of cartilage.
• Common in weight-bearing joints (knees, hips, spine).
• Symptoms: Joint pain, stiffness (worse after activity), crepitus, limited movement.
2. Rheumatoid Arthritis (RA):
• Autoimmune disease causing chronic synovial inflammation.
• Symmetrical joint involvement (small joints first – fingers, wrists).
• Symptoms: Morning stiffness > 1 hr, swelling, deformities (ulnar deviation).
• Extra-articular: nodules, vasculitis, lung fibrosis.
3. Gouty Arthritis:
• Deposition of uric acid crystals in joints.
• Sudden severe pain, redness, swelling (often big toe – podagra).

Management:

• Analgesics, NSAIDs
• DMARDs (e.g., methotrexate for RA)
• Corticosteroids
• Lifestyle: weight control, physiotherapy, assistive devices.

Osteoporosis

Definition:

A metabolic bone disorder characterized by low bone mass and micro-architectural deterioration, leading to fragile bones.

Causes/Risk Factors:

• Aging (postmenopausal women due to estrogen deficiency)
• Sedentary lifestyle, low calcium/vitamin D intake
• Prolonged corticosteroid use
• Smoking, alcohol
• Endocrine disorders (thyroid, parathyroid abnormalities).

Clinical Features:

• Often silent until fracture occurs
• Fragility fractures (hip, vertebra, wrist)
• Stooped posture (“dowager’s hump”)
• Loss of height, back pain.

Management:

• Prevention: Adequate calcium & vitamin D, weight-bearing exercise
• Treatment: Bisphosphonates, SERMs (Raloxifene), Calcitonin, Hormone replacement therapy (HRT).

Paget’s Disease (Osteitis Deformans)

Definition:

A chronic disorder of bone remodeling where there is excessive bone resorption followed by disorganized bone formation, leading to enlarged but weak bones.

Etiology:

• Exact cause unknown
• Possible viral infection in genetically predisposed individuals.

Clinical Features:

• Bone pain, deformities (bowed legs, enlarged skull)
• Fractures
• Neurological symptoms (hearing loss due to skull involvement).

Complications:

• Osteoarthritis
• Spinal cord compression
• Rarely osteosarcoma.

Management:

• Bisphosphonates, Calcitonin
• Analgesics, physiotherapy
• Orthopedic correction of deformities.

Rickets

Definition:

A metabolic bone disorder of children due to vitamin D deficiency, leading to defective mineralization of bone.

Etiology:

• Inadequate sunlight exposure
• Malnutrition, malabsorption
• Chronic renal/liver disease.

Clinical Features:

• Delayed closure of fontanelles
• Bowed legs (genu varum), knock knees (genu valgum)
• Rachitic rosary (beading of costochondral junctions)
• Harrison’s groove (depression of lower chest).

Management:

• Vitamin D supplementation
• Adequate calcium intake
• Sunlight exposure
• Treat underlying cause (renal/hepatic disease).

Gout

Definition:

A metabolic disorder caused by hyperuricemia leading to deposition of monosodium urate crystals in joints and tissues.

Etiology:

• Overproduction or underexcretion of uric acid
• Risk factors: high purine diet, alcohol, obesity, renal disease.

Clinical Features:

• Sudden severe joint pain (often at night)
• Swelling, redness, warmth (esp. great toe – podagra)
• Tophus formation (urate deposits in soft tissue)
• Kidney stones, nephropathy.

Management:

• Acute attack: NSAIDs, colchicine, corticosteroids
• Chronic: Allopurinol, Febuxostat (lower uric acid levels)
• Lifestyle: Avoid alcohol, red meat, organ meats; hydration.

Myasthenia Gravis

Definition:

A chronic autoimmune neuromuscular disorder causing weakness of skeletal muscles due to autoantibodies against acetylcholine receptors at neuromuscular junction.

Clinical Features:

• Muscle weakness that worsens with activity (fatigability)
• Ptosis (drooping eyelids), diplopia (double vision)
• Difficulty chewing, swallowing, speaking
• Weakness of limb and respiratory muscles (myasthenic crisis).

Diagnosis:

• Tensilon test (edrophonium improves weakness temporarily)
• Antibody assays (AChR, MuSK antibodies)
• Electromyography.

Management:

• Anticholinesterase drugs (pyridostigmine)
• Immunosuppressants (corticosteroids, azathioprine)
• Thymectomy if thymoma present
• Plasmapheresis, IVIG (in severe crisis).

Osteomyelitis

Definition:

An infection of bone and bone marrow, usually caused by bacteria (most commonly Staphylococcus aureus).

Etiology:

• Hematogenous spread (children)
• Direct inoculation (fractures, surgery)
• Spread from nearby infection.

Clinical Features:

• Acute: Fever, chills, severe bone pain, swelling, redness, tenderness
• Chronic: Sinus tract formation, persistent drainage, bone deformity.

Diagnosis:

• Blood tests: raised ESR, CRP, leukocytosis
• Imaging: X-ray (later changes), MRI (early detection)
• Bone biopsy and culture.

Management:

• Prolonged antibiotics (IV initially, then oral)
• Surgical debridement of necrotic bone
• Drainage of abscesses
• Supportive care (nutrition, pain control).

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