Musculoskeletal System Disorders

Introduction

The aging process has a significant effect on bones, joints, and muscles. As you age, the number and function of your bone cells decline—as well as the amount of cartilage in your body, the flexibility of your joints, and the function of your muscles. As the muscle tissue diminishes, it's replaced by fibrous tissue that can't contract appropriately. Thus, the overall strength of muscle declines with age. Many musculoskeletal diseases are the result of physical injury and aging. Balanced nutrition, vitamin supplementation, and regular exercise can help prevent many musculoskeletal disorders.

 

Injury Disorders

Muscles and joints are at a high risk of wear and tear due to daily activities. Overuse of certain muscle groups and performing high-impact activities may also result in injury to your muscles, joints, and tendons. An accident or trauma may cause injury to musculoskeletal organs. The most common type of musculoskeletal injuries are strains, sprains, and spasms.

A strain is a tear in a tendon or muscle fiber as a result of overstretching a muscle. Strains usually result from an injury or vigorous exercise without appropriate stretching. The tearing of tendons may result in internal bleeding and bruising. Pain and inflammation may also result at the site of an injury when the muscle is contracted. Preventative measures for strains include careful stretching before and after exercise and gradually warming up intense exercise. It should be noted that a muscle strain isn't the same as a joint sprain.

 

A sprain is a tear in a ligament as a result of trauma or due to the joint being twisted beyond its normal range of motion. Based on the severity of the injury or trauma to the affected joint, one or more ligaments can be damaged or torn. Ankle and wrist joints are at the highest risk of sprains. A sprained joint, if severe, may require surgical repair and may result in prolonged immobility. 

A spasm or cramp is a condition characterized by the undesired, prolonged contraction of a muscle. Spasms can range from painless to extremely painful and can occur after vigorous exercise. For example, you might get calf cramps after playing basketball for too long. Muscle spasms can accompany a joint or bone problem because the surrounding muscles are forced to contract constantly to compensate for any joint dysfunction.

 

Treatment of musculoskeletal injuries is decided based on the type and severity of the injury. Minor injuries may only require an ice pack to the affected area or over-the-counter pain relievers or anti-inflammatory medications. Severe injuries may require surgical intervention, prolonged immobility, stronger prescription pain medications, and antibiotics.

 

Bone Disorders

Osteomyelitis

Osteomyelitis is the infection inside a bone. It's a common complication for diabetes patients with foot infections. Inflammation can reduce the blood supply to the bone, resulting in bone necrosis. Necrosis is the process of tissue death that may require amputation of the affected bone. The symptoms of osteomyelitis are pain or tenderness in the affected area, inflammation, redness, and a high fever. Osteomyelitis requires an intense treatment of intravenous antibiotics in high doses and for a long duration. Severe cases may require surgery to clean out the dead bone tissue in addition to antibiotics. Patients are also prescribed medications to reduce pain and swelling.

Common antibiotics used to treat osteomyelitis are:

• Cefazolin (Kefzol, Ancef)
• Daptomycin (Cubicin)
• Linezolid (Zyvox)
• Vancomycin (Vancocin)

Osteoporosis

Osteoporosis is a condition characterized by a decrease in total bone mass. Bones are comprised of 50 percent water and 50 percent solids. Vitamins and minerals make up over half of the solid material, and the rest is white fibrous tissue. Healthy bone breaks down old tissue and manufactures new tissue to replace it. In osteoporosis, the new tissue isn't manufactured fast enough to replace the old one. Consequently, the bones become soft and weak. Osteoporosis most commonly occurs with growing age. However, the disease may also result due to prolonged immobilization, hormonal disorders, and a diet low in protein and calcium. An inadequate amount of calcium and phosphorus in the blood can cause bones to become soft and deformed. Estrogen is also an important hormone to maintain healthy bones. In postmenopausal women with decreased estrogen levels, osteoporosis is the major factor leading to frequent fractures. In the elderly, bones become thin and abnormally porous, causing bones to break or fracture easily and spontaneously. The disease is asymptomatic but may cause "shrinking" to the body. In other words, the elderly affected by severe osteoporosis may appear shorter, with rounded shoulders.

Osteoporosis Treatment

The following are some common medications used in the treatment of osteoporosis:

• Alendronate (Fosamax)
• Calcitonin (Miacalcin)
• Calcium with vitamin D (OsCal D)
• Conjugated estrogen (Premarin)
• Ibandronate (Boniva)
• Medroxyprogesterone (Provera)
• Raloxifene (Evista)
• Risedronate (Actonel)

Bone Marrow Depression

Bone marrow depression decreases the number of red blood cells (RBCs), white blood cells (WBCs), and platelets. Bone marrow depression is a serious adverse reaction linked to many drugs, especially antihistamines, tranquilizers, chloramphenicol (Chloromycetin), phenylbutazone (Butazolidin), sulfonamides, antineoplastics, thyroid medications, antidepressants, and diuretics. Symptoms of bone marrow depression include weakness, pale skin, dyspnea, soreness of mucous membranes, fever, chills, extreme fatigue, urinary and vaginal infections, and bleeding. Severe bone marrow depression may require blood transfusions. If a medication is identified to be the cause of the bone marrow depression, symptoms usually resolve once the offending medication is discontinued. Patients are often given intravenous antibiotics until a normal blood level of WBCs is attained.

 

Joint Disorders

The term arthritis means "inflammation of a joint." The symptoms of arthritis are persistent pain, inflammation, and stiffness, especially in the morning. There are various forms of arthritis, such as rheumatoid arthritis, osteoarthritis, and gouty arthritis.

1) Rheumatoid arthritis, the most serious and crippling form of arthritis, is a systemic autoimmune disease that gradually affects more and more joints as time passes. Your body's own immune system starts attacking the joint tissue. Anti-inflammatory medications are somewhat effective when taken in higher prescription doses. The symptoms of rheumatoid arthritis are loss of appetite, a general feeling of being ill, weight loss, and muscular pain. As the joints become more affected, they become red, swollen, tender to the touch, and painful to move.

2) Ankylosing spondylitis is an inflammation of the joints that link the vertebrae in the spine. As the inflammation recedes, it leaves the joints hardened and damaged. The symptoms of ankylosing spondylitis are a lower backache that may spread to the buttocks; stiff, painful hips; vague chest pains; tenderness over the heels; and red and painful eyes. Some common medications for treatment are

• Adalimumab (Humira)
• Azathioprine (Imuran)
• Celecoxib (Celebrex)
• Cyclosporine (Neoral, Sandimmune)
• Hydroxychloroquine (Plaquenil)
• Etanercept (Enbrel)
• Hydrocortisone (Solu-Cortef)
• Infliximab (Remicade)
• Methotrexate (Trexall)
• Methylprednisolone (Solu-Medrol)
• Rituximab (Rituxan)

3) Osteoarthritis normally occurs due to the wear and tear of the joints. It mostly affects the elderly. It common affects weight-bearing joints such as the spine, hips, and knees. The disease causes the smooth lining of a joint—the articular cartilage—to crack and flake. As the cartilage deteriorates, the underlying bone becomes thickened and distorted. Movement becomes painful, so the muscles begin to decline from lack of use. The symptoms of osteoarthritis are episodes of pain, swelling, and stiffness in the joint area, which sometimes results in knobby-looking joints. Common medications used for treatment include

• Acetaminophen (Tylenol)
• Ibuprofen (Motrin, Advil)
• Naproxen (Naprosyn, Aleve)
• Methylprednisolone (Solu-Medrol)
• Prednisolone (Prelone, Deltasone)
• Morphine (MS Contin)
• Hydromorphone (Dilaudid)
• Oxycodone (Oxycontin)

4) Gouty arthritis is an inflammation of the joints caused by a metabolism defect. This defect results in an excessive amount of uric acid in the blood, which begins collecting in the joints and soft tissues surrounding the joints. The excess uric acid can then crystallize in the joints, tendons, and surrounding tissue, which causes extreme pain and inflammation. Gout mostly affects big toes and the adjoining areas. Common medications used to treat gout include

• Allopurinol (Zyloprim)
• Colchicine (Colcrys)
• Ibuprofen (Motrin)
• Indomethacin (Indocin)
• Methylprednisolone (Solu-Medrol)
• Sulfinpyrazone (Anturane)

 

Joint Dislocation

When a bone is displaced from its normal position in the joint, it's called a dislocation. The usual treatment for this condition is for the bone to be returned to its proper position by gentle force, called reduction. Dislocation causes the ligaments to stretch. After reduction, rest is required so that they can heal.

 

Other Musculoskeletal Disorders

There are other musculoskeletal disorders such as muscle pain, bursitis, and carpal tunnel syndrome.

Muscle Pain: There can be many reasons for myalgia, or pain in the skeletal muscles. Muscle relaxants are the common class of medications used to treat myalgia. Commonly used muscle relaxants include:

• Baclofen (Lioresal)
• Carisoprodol (Soma)
• Chlorzoxazone (Parafon Forte)
• Cyclobenzaprine (Flexeril)
• Diazepam (Valium)

Bursitis: is the inflammation of one or more bursae. Bursae are small sacs filled with synovial fluid, located between bones and ligaments and between bones and muscles. These fluid-filled sacs help in the smooth gliding of the tendons and muscles across bones. Inflammation or infection of the bursae may cause pain, redness, swelling, and decreased muscle movement. Common medications used to treat bursitis include:

• Hydrocortisone (Solu-Cortef)
• Indomethacin (Indocin)
• Naproxen (Naprosyn)

Carpal tunnel syndrome is caused by tissues that swell and compress the median nerve as it runs between the ligament and the bones and tendons of the wrist (the carpal tunnel). The pinching of the nerve causes pain. The symptoms of carpal tunnel syndrome are tingling and intermittent numbness of part of the hand, pains that shoot up the wrist, and numbness or weakness of the thumb and one or more fingers. Anti-inflammatory and pain medications are commonly used to treat pain and discomfort; severe cases may require surgical manipulation of the joint.

 

Key Points

• A strain is a tear in one or more tendons.
• A sprain is tear in one or more ligaments.
• Arthritis is the inflammation of joints.
• Osteoarthritis is a condition that occurs due to the wear and tear of joints that comes with aging, and mostly affects weight-bearing joints such as the spine, hips, and knees.
• Rheumatoid arthritis is a systemic inflammatory disease, which results in the destruction of joints, causing joint deformities.
• Osteomyelitis is a bone infection and requires antibiotics in high doses for a long term to treat the infection.