Lecture 1

Fred Rahimi, DPM

William Scholl College of Podiatric Medicine
Chicago Medical School
Finch U.
 Diarthrodial Joints
• Types
• Movements
• Structure and Function
• Articular Cartilage
• Blood Supply
• Nerve Supply
 Reaction of the Musculoskeletal
System to Disorder and Injury
Local Death
Alteration of Bone Deposition
Alteration of Bone Resorption
 I. Bone As Structure

Rigid Framework for the body

Levers for Skeletal Muscles
Protection
 II. Bone As Organ

Hemopoitic Tissue
Storage for Ca+2, PO 4-2, Mg+, Na+2
Generalized Reaction of Bone
A. Bone Deposition > Bone Resorption

Examples
Osteopetrosis
Acromegaly
“Bone within a bone”
Fx. 4th metahead denote to
the fragility of the bone in
this disease
B. Bone Deposition < Bone Resorption

Examples
Osteoporosis
Rickets/Osteomalacia
Osteogenesis Imperfecta
Thyroid Acropachy
Macrodystrophia
Lipomatosis
Neurofibromatosis
Marfan’s Syndrome
 Hypertrophic
Osteoarthropathy
Caffey’s Disease
Tuberous Sclerosis
Clinical triad of convulsive seizures, mental deficiency and
adenoma sebaceum.
Pycnodysotosis
Melorheostosis
Localized Reactions of Bone
A. Bone Deposition > Bone Resorption
• Work Hypertrophy
• DJD
• Fractures
• Infections
• Osteosclerotic Neoplasms
melorheostosis
osteopoikilosis
Paget’s disease
B. Bone Deposition < Bone Resorption
• Disuse Atrophy (osteopenia)
• Rheumatoid Arthritis
• Infection
• Osteolytic Neoplasms
Madura foot
Reaction of Epiphyseal Plates to Injury
• Increase Growth
• Decrease Growth
• Torsional Growth
Generalized Reaction to Epiphyses
• Increase in Growth (Gigantism)
– Arachnodactly (Marfan’s Syndrome)
– Pituitary Gigantism
Apert’s syndrome
Macrodactaly possibly hemangioma
 Decrease in Growth
• Arachnoplasia
• Pituitary dwarfism
• Rickets
Localized Reactions to Epiphysis
• Increase in Growth
Chronic Infection
Displaced Fractures
Congenital A-V Malformations
Localized Reactions to Epiphysis
• Decrease in Growth
– Disuse
– Injury
– Thermal Injury
– Ischemia
– Infection
 Reaction of Articular Cartilage
• Destruction
• Degeneration
• Peripheral Porliferation
Reaction of Synovial Membrane
• Increase in Fluid ( Effusion)
• Hypertrophy
• Adhesions
Reaction of Joint Capsule & Ligaments
• Joint Laxity
• Contracture
 Rickets
• Failure of Ca++ salt to be Deposited into
the Matrix
• Clinical Enlargement at the Site of the
Epiphyseal Plate
• Widened Radiolucent Zone
• Recalcification of all Bones
Renal Rickets
 Scurvy
• Failure of Osteoblastic Formation of Bone
Matrix
• Subperiosteal and Mucosal Hemmorhage
 Scurvy
• Clinical Picture
– Irritability
– Pain
– Swelling
– Gingival Bleeding
 Scurvy
• Radiographic Findings
– Osteoporosis
– Dense White Line on Metaphyseal Side of
Epiphyseal Plates
– Soft Tissue Shadows
 Differential Diagnosis
• Paralysis
• Osteomyelitis
• Congenital Syphillis
• Child Abuse
Battered child syndrome
 Avitaminosis C
• Pain
• Caumesthisias
• Baresthesia
• Bruising
• Muscle Fatigue