pathology

example: fracture, Paget's disease of bone

trabecular

less dense - end of long bones

more elastic

heals faster

increased blood flow

compact

80% of skeleton

shaft of long bones

high resistance to torsion and bending

Salter-Harris fractures

SALT

S - same

A - above growth plate

L - lower than growth plate

T - through growth plate

short-limbed dwarfism

normal sitting height but limbs are short

normal intelligence

'brittle bone disease'

teeth abnormalities

bluish sclerae

Osteoporosis

Primary (2 types)

Secondary

'porous bones'

Primary (2 types)

Type 1: post-menopausal/estrogen deficient

Type 2: age-related/senile

Secondary- result of meds

no loss of present bone matrix, but insufficient mineralization leads to softening of bone

due to Ca, Vit D, and phosphate deficiency

- Chron's, inadequate sun exposure, hyperparathyroidism, antacid overuse

(form of osteomalacia)

causedd by Vit D deficiency in growing children

PE: bowlegs, delayed dentition, speckled teeth, "rachitic rosary"

excessive breakdown of bone by activated osteoclasts

excessive, unorganized new bone formation

- increased incidence of fractures

can lead to heart failure

Multiple myeloma

(malignant or benign?)

malignant

bone marrow tumor

"punched out lesions"

Osteosarcoma

(malignant or benign)

malignant

most common primary tumor of bone

75% in pts <20 yrs.

Chondrosarcoma

(malignant or benign?)

malignant

spine, ribs, pelvis, vertebrae

Ewing's sarcoma

(malignant or benign?)

malignant

tumor of childhood (10-20)

proximal long bones around growth plates

Osteochondroma (exostosis)

(malignant or benign?)

benign

mushroom-shaped bony protuberance

Enchondroma

(malignant or benign?)

benign

occurs in the long bone of the hands

Fibrous cortical defect

(benign or malignant?)

benign

developmental defect and not a true neoplasm

caused by mechanical "wear and tear"

may be primary (without a specific cause) or secondary to a specific stress

mainly affects weight-bearing joints

Pain is activity related - relieved by a short rest

rheumatoid arthritis

(virus that causes)

- chronic systemic autoimmune disease of synovial joints

- Epstein-Barr virus suspected of triggering a reaction that attacks synovial membrane

- Diagnosed with rheumatoid nodules and RF (or anti-CCP)

bones of hand deviate to radial side, fingers deviate to ulnar side

(associated with RA)

Juvenile RA

(juvenile idiopathic arthritis)

sudden onset; systemic; "toxic" high fever

mostly large joints (opposite RA for adults)

Spondyloarthropathies

(3 types)

negative for RF antibody

confined to vertebrae and SI joints

1. ankylosing spondylitis

2. reactive arthritis

3. psoriatic arthritis

infections seem to trigger onset of disease

chronic relapsing arthritis

spinal rigidity and chronic back pain

caused by an infection somewhere other than joints.

low back, ankles, knees, and feet most often involved

chronic metabolic disease associated with high blood uric acid levels

can be primary (genetic) or secondary (leukemia)

uric acid accelerates ahterosclerosis (high incidence of heart disease)

Tx: less meat, seafood, EtOH

great toe affected by gout

sever joint inflammation and tenderness

most common cause is gonorrhoeae

IV drug users

suppresed immune system

pts with RA at increased risk

usually only a single joint is involved

due to ticks

rash associated

can produce joint pain similar to arthritis

quick onset of muscle and joint pain and stiffness

usually in proximal joints: shoulders, neck, hips

typically a disease of age >65

if it's only wrist and knees that hurt, it's probably something else

RF negative and significant joint abnormalities neg

20% of patients hav ro will develop giant cell arteritis (temporal arteritis)

parasthesia

progressive pain

paralysis