Reaction of Musculoskeletal

Tissues to Disorders and Injuries

Agus Eka Wiradiputra

Bone
Basic nature of reaction BEST concidered at
mycroscopic or cellular
4 basic Reaction Bone :
Local Death c:/ avaskular necrosis
Alteration of bone deposition
Alteration of bone resorption
Mechanical failure c:/ Fracture

Location :
Local reaction as an structure
Generalized as an organ

Bone
Altered Deposition
Increased deposition (formation of matrix >, N calcification)
Decreased deposition (decreased matrix formation or
hypocalcification)

Altered resorption of bone

Increased resoption
Decreased resoption

Combination

Bone
Bone an organ Generalized
Deposition > Resorption
Osteopetrosis (Marble bone)
bone deposition N, bone resorption devective increase total ammount of
bone
Acromegaly
bone deposition >>,
e/c.excessive intramembranous ossification from periosteum

Deposition < Resorption

Osteoporosis (osteopenia)
Decrease matrix formation by osteoblast
Bone absorption inceased
C:/ osteogenesis imperfecta (fragile bones), diuse osteoporosis, steroid induce osteoporosis,
post menopausal osteoporosis.

Rickets and osteomalacia

Osteoblastic formation N, Decreased calcification (hypocalcification of the matrix) decrease
ammout of calcified bone

Bone
Local reaction as an structure
Bone deposition > resorption
Work Hypertophy
Extra stress & strain increase deposition
Wolffs Law

Degenerative osteoarthritis
Subchondral bone, Excessive intermitent pressure increased
bone deposition, X-ray subchondral sclerosis.

Fracture
Increased bony deposition callus

Infection
Periosteum elevated by pus deposition of new bone

Osteosclerotic neoplasm
Increased bone deposition reactive bone
Produced by malignat bone neoplasm tumor bone

Increased Radiographic
Density / Sclerosis
Osteopetrosis (Marble
Bone)

Decrease Radiographic Density

Osteoporosis (osteopenia)
Osteogenesis Imperfecta

Bone
Local reaction as an structure
Bone Deposition < Resorption
Dis-use Athropy
Decrease bone deposition, resoption N

Rhematoid Arthritis
Decrease bone deposition, increase bone resoption

Infection
Inflamatory process destruction of exsisting bone
Increased resorption locally (osteolysis)

Neoplasm
Localised destruction of existing bone
Increased resorption (osteolysis)

Bone
Mechanical failure of bone
Fracture
Collagen fiber & organic matrix strength in
tension
Calcified anorganic matrix strength in
compression
Adult bone, deposition of organic matrix
hard fragile, less plasticity.

Physis
Longitudinal Growth
Reaction :
Increased growth
Decreased growth
Torsional growth

N growth require :
Intact structure
Normal blood suply

Intermiten pressure normal physical activity

Excessive continous pressure retard growth
Decrease continous pressure retard growth

Injury @ G.Plate close, ossify stop grow

Physis
Generalized Reaction GP Increase Growth
GIGANTISM
Arachnodactyly (hyperchondroplasia),
(marfans syndrome)
Inborn error of development
Excessive cartilaginous growth (hyperchondroplasia)

Pituitary Gigantism
Excessive growth hormone ec, eosinophylic adenoma

Physis
Generalized Reaction GP Decrease Growth
Dwarfism
Achondroplasia
Deficient cartilaginous growth

Pituitary dwarfism
Deficient growth hormone growth retard

Rickets
Hypocalcification pre osseus cartilage of the epipheseal
plate in the zone of calcifying growth retard

Physis
Localized Reaction GP Increase Growth
Chronic Inflamation
Near epihysieal plate stimulate local grow
Chronic Osteo Mielitis / Rhematoid Arthritis
Displaced Fracture Of The Shaft Of a Long
Bone
Nutrient artery disrupted compensation
hyperemia @ ephypeseal ends temporary
stimulation of growth
Congenital AVM
Continuing stimulation of the epiphyseal plate
overgrowth

Physis

Localized Reaction GP Decrease Growth

Dis-use Retardation

Physical Injury
Thermal Injury
Cold (frossbite)
Burns

Ischemia
Total avascular necrosis decrease growth

Infection

Synovial joints
Smooth, reprociprocally shaped
frictionless & painless movement

Irregularity / damage
progressive degenerative joint changes,
limited ROM, pain in movement.

Joint capsule sensitive to streching and increased

pressure of the joint
Injury disability = morbidity

Hyaline articular cartilage ruberlike consistency

Compresible and resilient
N compresion enchance difussion of the nutrient synovial fluid.
Prolonged immobilization decrease diffusion of synovial fluid.

Articular Cartilage
Contain :
No blood vessels
No lymphatic
No Nerves

React to abN
condition :
Destruction
Degeneration
Peripheral
proliferation

Regeneration so
limited
Irrepable Serious
Interfere with mainsource of
nutrition : synovial fluids
Chondrolitic enz. In pus

X-ray :
N RadioLucent
abN RadioOpaque

Articular Cartilage
Destruction :
Rhematoid Arthritis
Pannus adheres the cartilage
interfereing with synovial fluid

Infection
Pus chondrolytic

Ankylosing Spondilitys
Joints become gradually
completely obliterated by bony
fussion.

Articular Cartilage
Prolonged immobilization of
synovial joint
Synovial membrane adherent to articular
cartilage blocking normal synovial fluid.
Obliterative degeneration of articular
cartilage.

Continous compression of articular

cartilage
Min 8 day, defisit synovial fluid nutrition
Pressure Sore
Compresion necrosis of articular cartilage

Articular Cartilage
Intra articular inj. hydrocortisone
2/more weekly inj.
progressive degenerative changes :
Thinning
Fissuring
Fibrilation
defisit of proteoglicans
Cystic lession containing calcium deposit within the
matrix

Hydrocortisone arthropathy

Articular Cartilage
Degeneration
Slowly progressive Normal
Become Thinner & less cellular
Less resilient susceptible to injury
Diperparah o/ beban >> obese
Viskositas cairan synovial <<
Local damage

Initiated by
Perubahan kandungan intercellular dr matrix
Subsequent uncovering of colagen fibrils (fibrilation)
Erosi expose subchondral bone
berlanjut menjadi dense (sclerotic) & polished (eburnated)

Articular Cartilage
Hal-hal yang mempengaruhi kondisi
abN dari art. Cartilage
Premature aging
Agrevated by excessive wear and tear

Previous Destruction of Cartilage

Lead to progressive degeneration in the
remaining cartilage

Iregularity of joint surface

Increased joint friction degeneration

Articular Cartilage
Peripherral Proliferation
Presence degeneration @ central area
+ contiued movement
Peripheral perichondrium proliferates
Produce almost complete peripheral ring
of thickened cartilage
Composed by chdrophyte & osteophyte
formation

Articular Cartilage
Damaged articular cartilage
extemely limited ability to
heal/regenerate.
Continous Passive Movement
Stimulates and accelerate healing and
regeneration of articular cartilage, ligament,
and tendons.

Non weight bearing sport

Reaction of Synovial Membrane

Function : secrete synovial fluid
Nutrition and lubrication

React to abN condition by:

Producing an excessive mount of synovial fluid (effusion)
Becoming Thicker (hypertrophy)
Forming adhesion

Joint Effusion :
Serous : Mild sprain
Inflamatory exudate : synovitis, rheumatoid arthritis.
Grossly Purulent : Septic arthritis
Hemoragic : severe injury/ hermofilia

Reaction of Synovial Membrane

Synovial adhesion
Prolonged limitation of joint movement
Immobilization in a cast or rigid splint.

Synovial membranes and tendon

sheat and bursae are capable of the
same reaction.

Reaction of Joint capsule &

Ligaments
Provide stability by preventing undesired movement
React to abN condition by :
Unduly strechted and elongated (joint Laxity) joint instability
Generalized congenital laxity of the capsules and ligaments (GENETICS)
Injury : Traumatic dislocation subluxation with the rupture of the
capsule/ligaments instability of the joints.
Infection : septic arthritis capsule destroyed by pus pathological
dislocation.

Become tight and shortened ( contracture ) limiting the ROM

Congenital Joint contrracture : Clubfoot
Infection : fibrosis and scar formation
Chronic arthritis : RA and DJ disease progressive joint contracture
Muscle contracture. : ischaemic contracture

Reaction of Skeletal muscle

Disuse Atrophy
Not being used normally weaker +
smaller
Poliomyelitis, polyneuritis, myastenia gravis

Work Hypertophy
Repeatedly excercised againts resistance
isometric contraction,
enlargement of individual muscle fibers.

Reaction of Skeletal muscle

Ischemic Necrosis
Traumatic vascular spasm, thrombosis, embolism,
compartment syndrome occlusion of arteries
Golden period 6hrs

Contracture
Shortened state for a prolonged period persistent
shortening and resistant to streching.
The muscle fibre of a necrotic muscle subsequently replaced
by dense fibrous scar tissue

Regeneration
Can regenerate to some degree

Musculoskeletal Deformities
Confronting musculoskeletal
deformities:
1st consider the structure the deformity
taking place
Cause of the deformity
Congenital
Acquired

Significance of deformities concerning to

not only its appearance
Future effect on function

Bony Deformity
Types of bony Deformity :
Loss of alignment
Twisted (torsional)
Crooked (angulatory)

AbN Length
Limb length discrepancy

Bony outgrowth
Osteochondroma

Bony Deformity
Causes of bony Deformity :
Congenital
Aplasia ( failure to develop)
Hypoplasia (under developed)
DysPlasia (abN developed)
Duplication (doubly developed)

Fracture
Loss of alignment by time of fracture healing + not corrected with adequate reduction
Mal-union salah sambung
Non union

Disturbance of epiphyseal growth

Bending of abnormally soft bone
Overgrowth of adult bone

Joint Deformity
Types :
Displacement of the joint
N recriprocal relationship between two joint surface is lost
Complete displaced (dislocated, luxatio)
Partially displaced ( sub luxatio)

Hypermobility
Prevent excessive mobility
Congenital, streched, torn hypermobility appear when stress
transmitted trough that joint.

Restricted mobility of the joint

Joint Deformity
Causes :
Congenital
Acquired
Mechanical blocks
Joint adhesion
Muscle contracture
Muscle imbalance
Fibrous contracture of fascia and
skin
External pressure
Idiopathic

THANK YOU