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Musculoskeletal DiseaseMusculoskeletal Disease
Long Bone FormationLong Bone Formation Long Bone FormationLong Bone Formation
Membranous BoneMembranous Bone Articular Joint FormationArticular Joint Formation
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Articular Joint FormationArticular Joint Formation
Lamellar Bone vs. WovenLamellar Bone vs. Woven
Lamellar BoneLamellar Bone Bone StructureBone Structure
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Bone MetabolismBone Metabolism
Congenital ProblemsCongenital Problems
Matrix problemsMatrix problemsPremature Premature epiphyses closureepiphyses closurePituitaryPituitaryMalabsorptionMalabsorption
Osteogensis ImperfectaOsteogensis Imperfecta
Brittle Bones Dis.Brittle Bones Dis.Multiple SubtypesMultiple Subtypes
Auto DominantAuto DominantAuto RecessiveAuto Recessive
Collagen defectCollagen defectBad bone matrixBad bone matrix
Blue scleraBlue sclera
Osteogenesis ImperfectaOsteogenesis Imperfecta OsteopetrosisOsteopetrosis
RockRock--like boneslike bonesActually Actually ‘‘ChalkChalk’’Osteoclast defectOsteoclast defectCanCan’’t resorbt resorbMany FrxsMany Frxs
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Lamellar Bone vs. WovenLamellar Bone vs. Woven AchondroplasiaAchondroplasia
Premature Premature closure of closure of epiphysesepiphysesAuto dominantAuto dominantHomozygous is Homozygous is lethallethal
OsteochondromaOsteochondroma
Mechanical injury to growth line.Mechanical injury to growth line.Continues to grow as a unit for years.Continues to grow as a unit for years.Problem of diagnosis.Problem of diagnosis.
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EnchondromaEnchondroma
Small rest of Small rest of hyaline cartilagehyaline cartilageDevelopmentalDevelopmentalBony defectBony defectFracturesFracturesSyndrome of Syndrome of multiple multiple enchondromasenchondromasVery disfiguringVery disfiguring
Multiple EnchondromasMultiple Enchondromas
Nonossifying FibromaNonossifying Fibroma
Very commonVery commonDevelopmentalDevelopmentalFibrous cortical Fibrous cortical defectdefectSize determines Size determines what we call what we call them.them.
55--6 cm6 cm
OsteoporosisOsteoporosis
Loss of bone Loss of bone massmassNot problem of Not problem of calcium calcium metabolismmetabolismPeak bone massPeak bone massWomenWomenFracturesFracturesHRTHRT
OsteoporosisOsteoporosis
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OsteoporosisOsteoporosis
Collapse of vertebral Collapse of vertebral bodiesbodiesKyphosisKyphosisLoss of heightLoss of heightHip fracturesHip fracturesPeak bone massPeak bone massPhysical activityPhysical activityGeneticsGenetics
Vitamin D DeficiencyVitamin D Deficiency
RicketsRicketsDeveloping boneDeveloping boneCanCan’’t convert cartilage t convert cartilage model to bonemodel to bonePermanent deformityPermanent deformity
OsteomalaciaOsteomalaciaAdultsAdultsCanCan’’t remodelt remodelSoftening of boneSoftening of bone
HyperparathyroidismHyperparathyroidism HyperparathyroidismHyperparathyroidism
Renal Renal OsteodystrophyOsteodystrophy
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PagetPaget’’s Diseases Disease
Viral infectionViral infectionDestructive and Destructive and proliferativeproliferativeSclerosis of marrow Sclerosis of marrow spacespaceSkull and pelvisSkull and pelvisIncreased incidence Increased incidence of primary bone of primary bone tumortumor
PagetPaget’’s Diseases Disease
ClubbingClubbing
Hypertrophic Hypertrophic osteoarthropathyosteoarthropathySoft tissue and Soft tissue and periosteal boneperiosteal boneCOPDCOPD
Pure emphysema, rarePure emphysema, rare
Lung cancerLung cancerHeart defectsHeart defects
OsteomyelitisOsteomyelitis
Direct infection of Direct infection of bone.bone.Bacterial most oftenBacterial most often
StaphylococcusStaphylococcusSalmonellaSalmonella
Sickle Cell DiseaseSickle Cell Disease
TuberculosisTuberculosisSpine firstSpine first
SyphilisSyphilisPeriosteumPeriosteum
Avascular Necrosis, Avascular Necrosis, Legg-Perthes
Weight bearing jts.Weight bearing jts.Developmental?Developmental?Physically active.Physically active.Compression and Compression and necrosis of bone and necrosis of bone and articular cartilage.articular cartilage.
Legg-Perthes
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FracturesFractures
AnthropologyAnthropologyForensicsForensics
IdentificationIdentificationPattern in child Pattern in child abuseabuse
Bumper heightBumper heightPathologicalPathological
TumorTumorGummaGummaDevelopmental Developmental defectdefect
Greenstick FractureGreenstick Fracture
PseudoarthrosisPseudoarthrosis
Bone TumorsBone Tumors
Benign vs. MalignantBenign vs. MalignantPrimary vs. MetastaticPrimary vs. MetastaticSymptomsSymptoms
PainPainEnlargementEnlargementFracture at site of tumorFracture at site of tumor
Fibrous DysplasiaFibrous Dysplasia
DevelopmentalDevelopmentalMonostoticMonostoticPolyostoticPolyostoticBonesBones
Ribs, femur, jaw, Ribs, femur, jaw, humerushumerus……..
McCuneMcCune--AlbrightAlbrightPolyostoticPolyostoticCafCaféé--auau--lait spotslait spotsSexual precocitySexual precocityHyperthyroidismHyperthyroidismPituitary adenomasPituitary adenomas
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McCuneMcCune--AlbrightAlbright Bone CystsBone Cysts
Fairly commonFairly commonBenignBenignRibsRibsWeakened area tends Weakened area tends to fractureto fracture
Osteoid OsteomaOsteoid Osteoma
TibiaTibiaInjury?Injury?CorticalCorticalVery painfulVery painfulAspirinAspirin
Malignant tumors, metastaticMalignant tumors, metastatic
From practically any From practically any cancercancer
BreastBreastProstateProstateLungLung
To any boneTo any boneVertebraeVertebraeLong bonesLong bones
Osteosarcoma, Primary MalignancyOsteosarcoma, Primary Malignancy
Weight bearingWeight bearingLong bonesLong bonesYoung peopleYoung peopleOsteoblast is malignant Osteoblast is malignant cellcellGenetics of tumor being Genetics of tumor being unraveledunraveled
Rb geneRb geneP53P53MDM2MDM2St. Bernards and Great St. Bernards and Great DanesDanes
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Osteosarcoma, Primary MalignancyOsteosarcoma, Primary Malignancy CodmanCodman’’s Triangles Triangle
XX--Ray findingRay findingLifting of Lifting of periostiumperiostiumby tumorby tumor
ChondrosarcomaChondrosarcomaEwing SarcomaEwing Sarcoma
‘‘Small blue tumorSmall blue tumor’’Primitive neuroectodermal Primitive neuroectodermal tumor (PNET)tumor (PNET)Children and young adults.Children and young adults.Oseous and extraOseous and extra--oseousoseous‘‘Fusion genesFusion genes’’t(11;22)(q24;q12)t(11;22)(q24;q12)
Giant Cell TumorGiant Cell Tumor
OsteoclastsOsteoclastsBenignBenignLocally destructiveLocally destructiveEpiphysesEpiphyses
AdolescentsAdolescents
MetaphysesMetaphysesKneeKneeSolitarySolitary
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ArthritisArthritis
Inflammation of the jointsInflammation of the jointsArticular surface and/or joint capsule.Articular surface and/or joint capsule.
InfectiousInfectiousGCGCLyme & othersLyme & others
Immune mediated, rheumatic feverImmune mediated, rheumatic feverStreptococcal triggerStreptococcal trigger
Autoimmune, rheumatoid arthritisAutoimmune, rheumatoid arthritisWear and Tear, osteoarthritisWear and Tear, osteoarthritisCrystal arthritis, goutCrystal arthritis, gout
Rheumatic Heart DiseaseRheumatic Heart Disease
Rheumatoid Arthritis Rheumatoid Arthritis –– Systemic DiseaseSystemic Disease
Genetically Genetically susceptiblesusceptibleTriggerTrigger
Virus? EBVirus? EB
Autoimmune Autoimmune destructiondestruction
Rheumatoid factorRheumatoid factor
Loss of articular Loss of articular cartilagecartilageJoint fusionJoint fusion
Rheumatoid ArthritisRheumatoid ArthritisRheumatoid FactorsRheumatoid Factors
Present in about 80% of casesPresent in about 80% of casesSome healthy people and other CT diseasesSome healthy people and other CT diseasesRA need titerRA need titerDonDon’’t screen with thist screen with thisIgM generated against persons IgM generated against persons IgGIgG
Rarely Rarely IgGIgG or or IgAIgATargeted against Fc portion of antibodyTargeted against Fc portion of antibody
SelfSelf--associate to form immune complexesassociate to form immune complexesActivate complement, causing cartilage destructionActivate complement, causing cartilage destructionThese circulating immune complexes bring about These circulating immune complexes bring about many of the extramany of the extra--arthritic symptomsarthritic symptoms
TNF, ILTNF, IL--1, IL1, IL--6, IL6, IL--1515
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Rheumatoid FactorRheumatoid Factor
Rheumatoid ArthritisRheumatoid Arthritis Rheumatoid ArthritisRheumatoid Arthritis
Rheumatoid NodulesRheumatoid Nodules Rheumatoid NoduleRheumatoid Nodule
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AnkylosingAnkylosing SpondylitisSpondylitis ReiterReiter’’s Syndromes Syndrome
OsteoarthritisOsteoarthritis
Wear and tear on Wear and tear on joint cartilagejoint cartilageNormally there is very Normally there is very little friction.little friction.Minimal damage leads Minimal damage leads to cartilage fractures.to cartilage fractures.Synovial fluid into Synovial fluid into underlying bone.underlying bone.Microcysts and bone Microcysts and bone necrosis.necrosis.
OsteoarthritisOsteoarthritis
Weight bearing Weight bearing jointsjointsInjury to Injury to cartilagecartilageProgressiveProgressiveMiddleMiddle--age and age and olderolder
OsteoarthritisOsteoarthritis
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Crystal ArthritisCrystal Arthritis GoutGout
Crystal ArthritisCrystal Arthritis
GoutGoutUric acid crystalsUric acid crystalsGenetics and dietGenetics and dietCrystals in joint space Crystals in joint space and soft tissuesand soft tissues
Tophi in soft tissueTophi in soft tissue
Intense inflammatory Intense inflammatory reaction in jointreaction in jointVery PainfulVery Painful
GoutGout
GoutGout GoutGout
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GoutGout PseudogoutPseudogout
Similar symptomsSimilar symptomsCalcium pyrophosphateCalcium pyrophosphateSmallerSmaller
Gout or Pseudogout?Gout or Pseudogout?
Tumors of Soft TissueTumors of Soft Tissue
Nodular FasciitisNodular Fasciitis
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FasciitisFasciitis Myositis OsificansMyositis Osificans
LegsLegsPalmsPalms
Auto mechanicsAuto mechanics
Hematoma that becomes Hematoma that becomes calcifiedcalcifiedOvert bone formationOvert bone formation
Even bone marrowEven bone marrow
DesmoidDesmoid LiposarcomaLiposarcoma
RhabdomyosarcomaRhabdomyosarcoma FibrosarcomaFibrosarcoma
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Malignant Fibrous HistiocytomaMalignant Fibrous Histiocytoma Synovial SarcomaSynovial Sarcoma