PATHOLOGIES OF THE

MUSCULOSKELETAL SYSTEM

Dr. Shahab Uddin

Senior Lecturer
 Infectious
03. Diseases of the
Musculoskeletal
System
1 Osteomyelitis
2 Diskitis
3 Infectious (Septic) Arthritis
4 Infectious (Inflammatory) Muscle
Disease
OSTEOMYELITIS
Osteomyelitis is inflammation of
the bone caused by an infecting
organism.
Although bone is normally
resistant to bacterial colonization,
it can get infected in multiple
ways.
The major cause of bone
infections is Staphylococcus
aureus; however, the causative
organism however depends on
age and underlying conditions,
among other factors.
 OSTEOMYELITIS
PATHOPHYSIOLOGY
1. Bone is normally resistant to infection.
2. However, when microorganisms are introduced into bone hematogenously from surrounding
structures or from direct inoculation related to surgery or trauma, osteomyelitis can occur. Bone
infection may result from the treatment of trauma, which allows pathogens to enter bone and
proliferate in the traumatized tissue. When bone infection persists for months, the resulting infection is
referred to as chronic osteomyelitis and may be polymicrobial.
3. Important factors in the pathogenesis of osteomyelitis include the following:
a. Virulence of the infecting organism
b. Underlying disease
c. Immune status of the host
d. Type, location, and vascularity of the bone
 OSTEOMYELITIS
MANAGEMENT
1. The principles of management of osteomyelitis necessitate a multipronged, multidisciplinary approach
that may involve a team consisting of the orthopedic surgeon, an infective disease consultant, a
plastic surgeon, a microbiologist, and others as needed.
2. This approach should first determine whether the disease is acute, chronic, or an acute exacerbation
of a chronic disease or (in some cases) a partially treated subacute osteomyelitis. Acute osteomyelitis
must be treated surgically to drain pus and prevent bone necrosis.
3. Antibiotics suitable to the patient's age and the organism are given to control hematogenous spread
and to treat the local infection. In other words, antibiotics save life, and surgery helps save bone.
4. Debridement of necrotic tissues, removal of foreign materials, and sometimes skin closure ofchronic
unhealed wounds are necessary in some cases.
DISKITIS
Diskitis is an inflammation of the
vertebral disk space often related
to infection.
Infection of the disk space must
be considered with vertebral
osteomyelitis; these conditions
are almost always present
together, and they share much of
the same pathophysiology,
symptoms, and treatment.
 DISKITIS
PATHOPHYSIOLOGY
1. An infection does not ordinarily originate in the vertebra or disk space; rather, it typically spreads
there from other sites via the bloodstream
2. observation that pelvic disease is one of the most common primary sitesof infection in patients with
diskitis.
3. Infarction of the vertebral endplates is followed by localized infection that subsequently spreads
through the vertebral body and into the poorly vascularized disk space. Infection can then spread to
the epidural space or paraspinal soft tissues
 DISKITIS
MANAGEMENT
Antibiotics
1. Antibiotic treatment must be tailored to the isolated organism and any other sites of infection. Broad-
spectrum antibiotics must be used if no organism is isolated; however, this is very rare, and other
disease processes (eg, spinal tuberculosis) must be considered in the face of persistently negative
cultures.
Immobilization
1. Immobilization is necessary, especially in the initial stages of the disease. The goal ofimmobilization is
to provide the opportunity for the affected vertebrae to fuse in an anatomically aligned position
Pain control
1. Pain medications can be a useful adjunct to antibiotic therapy, in that they allowincreased
mobilization.
INFECTIOUS (SEPTIC) ARTHRITIS
Septic arthritis, also known as infectious
arthritis, represents a direct invasion of a
joint space by various microorganisms, most
commonly bacteria.
Viruses, mycobacteria, and fungi may be
involved. Bacteria are the most significant of
these pathogens because of their rapidly
destructive nature.
For this reason, the current discussion
concentrates on the bacterial septic
arthritides. Failure to recognize and to
appropriately treat septic arthritis results in
significant rates of morbidity and mortality.
 INFECTIOUS (SEPTIC) ARTHRITIS
PATHOPHYSIOLOGY
1. Organisms may invade the joint by direct inoculation, by contiguous spread from infectedperiarticular
tissue, or via the bloodstream (the most common route)
2. Previously damaged joints, especially those damaged by rheumatoid arthritis, are the most
susceptible to infection. The synovial membranes of these joints exhibit neovascularization and
increased adhesion factors; both conditions increase the chance of bacteremia, resulting in ajoint
infection
3. The major consequence of bacterial invasion is damage to articular cartilage. This may be due to the
particular organism's pathologic properties,
4. As the destructive process continues, pannus formation begins, and cartilage erosion occurs at the
lateral margins of the joint. Large effusions, which can occur in infections of the hip joint, impair the
blood supply and result in aseptic necrosis of bone. These destructive processes are well advanced
as early as 3 days into the course of untreated infection
 INFECTIOUS (SEPTIC) ARTHRITIS
MANAGEMENT
1. Medical management of infective arthritis focuses on adequate and timely drainage of the infected
synovial fluid, administration of appropriate antimicrobial therapy, and immobilization of the joint to
control pain.

2. Acute prosthetic joint infection (PJI) (< 3 wk in duration) can be cured medically if it is of the early type
or secondary to hematogenous spread without any evidence of periarticular soft-tissue involvement or
joint instability. [9]

3. Overall, the mean length of hospitalization for septic arthritis is 11.5 days. However,outpatient
antibiotic therapy in stable patients can significantly reduce hospital stays

4. in general, obtain a consultation with an orthopedic surgeon or rheumatologist. If the initial treatment
response is poor or the etiology of the synovitis remains unknown, consult with an infectious disease
specialist
MYOSITIS
Myositis refers to any condition causing
inflammation in muscles. Weakness,
swelling, and pain are the most common
myositis symptoms.
Myositis causes include infection, injury,
autoimmune conditions, and drug side
effects.
Treatment of myositis varies according to the
cause.

.
 MYOSITIS
PATHOPHYSIOLOGY
1. Single or multiple muscle groups in the limbs can be involved, a notable exception being trichinosis,
which commonly involves orbital muscles. In most instances, involvement of proximal muscles is
predominant.
2. Characteristic myopathic features and findings of polymyositis, including inflammatory infiltrates, may
be seen
 MYOSITIS
MANAAGEMENT
1. All medical care should be provided in conjunction with an infectious disease specialist and the
primary care physician.
2. HIV polymyositis: Corticosteroids remain the mainstay of treatment of polymyositis.
3. Viral myositis Treatment comprises bed rest, intravenous fluids, and symptomatic management with
antipyretics and analgesics. Antiviral agents such as amantadine could be considered in adults.
4. Pyomyositis: During the suppurative phase, abscess aspiration under ultrasonic or CT guidance may
be required. Surgical drainage is especially necessaryfor large abscesses.
5. Fungal myositis: Focal fungal abscesses may require surgical drainage/debridement.
04. Musculoskeletal
Neoplasms
1 Primary Benign Bone Tumors
2 Primary malignant bone tumors
3 Multiple myeloma
4 Primary Soft tissue Tumors
5 Metastatic tumors
BONE TUMORS
When cells divide abnormally and uncontrollably, they can form a mass or lump of tissue. This
lump is called a tumor. Bone tumors form in your bones. As the tumor grows, abnormal tissue
can displace healthy tissue. Tumors can either be benign or malignant.

Benign tumors aren’t cancerous. While benign bone tumors typically stay in place and are
unlikely to be fatal, they’re still abnormal cells and may require treatment. Benign tumors can
grow and could compress your healthy bone tissue and cause future issues.

Malignant tumors are cancerous. Malignant bone tumors can cause cancer to spread
throughout the body.
.
TYPES OF BENIGN TUMORS
OSTEOCHONDROMAS

Benign tumors are more common than malignant ones. According to the American Academy of
Orthopaedic Surgeons (AAOS), the most common type of benign bone tumor is an
osteochondroma. This type accounts for between 35 and 40 percent of all benign bone
tumors. Osteochondromas develop in adolescents and teenagers.

These tumors form near the actively growing ends of long bones, such as arm or leg bones.
Specifically, these tumors tend to affect the lower end of the thighbone (femur), the upper end
of the lower leg bone (tibia), and the upper end of the upper arm bone (humerus).

These tumors are made of bone and cartilage. Osteochondromas have been considered to be
an abnormality of growth. A child may develop a single osteochondroma or many of them.
TYPES OF BENIGN TUMORS
NONOSSIFYING FIBROMA UNICAMERAL

Nonossifying fibroma unicameral is a simple solitary bone cyst. It’s the only true cyst of bone.
It’s usually found in the leg and occurs most often in children andadolescents.
TYPES OF BENIGN TUMORS
GIANT CELL TUMORS

Giant cell tumors grow aggressively. They occur in adults. They’re found in the rounded end of
the bone and not in the growth plate. These are very rare tumors
TYPES OF BENIGN TUMORS
ENCHONDROMA

An enchondroma is a cartilage cyst that grows inside the bone marrow. When they occur, they
begin in children and persist as adults.

They tend to be part of syndromes called Ollier’s and Mafucci’s syndrome. Enchondromas
occur in the hands and feet as well as the long bones of the arm and thigh.
TYPES OF BENIGN TUMORS
FIBROUS DYSPLASIA

Fibrous dysplasia is a gene mutation that makes bones fibrous and vulnerable to fracture.
TYPES OF BENIGN TUMORS
ANEURYSMAL BONE CYST

An aneurysmal bone cyst is an abnormality of blood vessels that begins in the bone marrow. It
can grow rapidly and can be particularly destructive because it affects growth plates
TYPES OF MALIGNANT TUMORS
There are also several types of cancer that produce malignant bone tumors. Primary bone
cancer means that the cancer originated in the bones. According to the National Cancer
Institute (NCI)Trusted Source, primary bone cancer accounts for less than 1percent of all types
of cancer.

The three most common forms of primary bone cancers are osteosarcoma, Ewing sarcoma
family of tumors, and chondrosarcoma
TYPES OF MALIGNANT TUMORS
OSTEOSARCOMA

Osteosarcoma, which occurs mostly in children and adolescents, is the second most common
type of bone cancer. This usually develops around the hip, shoulder, or knee. This tumor
grows rapidly and tends to spread to other parts of thebody.

The most common sites for this tumor to spread are areas where the bones are most actively
growing (growth plates), the lower end of the thighbone, and the upper end of the lower leg
bone. Osteosarcoma is also sometimes known as osteogenic sarcoma
TYPES OF MALIGNANT TUMORS
EWING SARCOMA FAMILY OF TUMORS (ESFTS)

▪ Ewing sarcoma family of tumors (ESFTs) strikes adolescents and young adults, but
these tumors can sometimes affect children as young as 5 years old. This type of
bone cancer usually shows up in the legs (long bones), pelvis, backbone, ribs, upper
arms, and the skull.
▪ It begins in the cavities of the bones where the bone marrow is produced (the medullary
cavities). In addition to thriving in bone, ESFTs can also grow in soft tissue, such as fat,
muscle, and blood vessels. According to the NCITrusted Source, African-American children
very rarely develop ESFTs. Males are more likely to develop ESFTs than females. ESFTs
grow and spread rapidly
TYPES OF MALIGNANT TUMORS
CHONDROSARCOMA
Middle-aged people and older adults are more likely than other age
groups to develop
chondrosarcoma. This type of bone cancer usually develops in the hips,
shoulders, and pelvis.
SECONDARY BONE CANCER
The term “secondary bone cancer” means that the cancer started somewhere else in
the body and then spread to the bone. It usually affects older adults. The types of
cancer most likely to spread to your bones are:

• kidney
• breast
• prostate
• lung (particularly osteosarcoma)
• thyroid gland
MULTIPLE MYELOMA

The most common type of secondary bone cancer

is called multiple myeloma. This bone cancer
shows up as tumors in the bone marrow. Multiple
myeloma most commonly affects older adults
 POTENTIAL SYMPTOMS OF BONE
TUMORS
A dull ache in the affected bone is the most common symptom of bone cancer. The pain starts off
as occasional and then becomes severe and constant. The pain may be severe enough to wake
you up in the night.
Sometimes, when people have an undiscovered bone tumor, what seems like an insignificant injury
breaks the already weakened bone, leading to severe pain. This is known as a pathologic fracture.
Sometimes there may be swelling at the site of thetumor.

Or you might not have any pain, but you’ll notice a new mass of tissue on some part of your body.
Tumors can also cause night sweats, fevers, or both.

People with benign tumors might not have any symptoms. The tumor might not be detected
until an imaging scan reveals it while receiving other medicaltesting.

A benign bone tumor, such as an osteochondroma, may not require treatment unless it starts
to interfere with your day-to-day function and movement.
DIAGNOSIS
First, your doctor will do a physical exam with a focus on the area of your suspected
tumor. They’ll check for tenderness in your bone and test your range of motion. Your
doctor willalso ask you questions about your family medical history

Blood and urine tests

Your doctor may order tests, including blood or urine samples. A lab will analyze these
fluids to
detect different proteins that may indicate the presence of a tumor or other medical
problems.

An alkaline phosphatase test is one common tool doctors use to diagnose bone tumors.
When your bone tissue is especially active in forming cells, large quantities of this
enzyme show up in your blood. This could be because a bone is growing, such as in
young people, or it could mean a tumor is producing abnormal bone tissue. This test is
more reliable in people who’ve stopped growing.
DIAGNOSIS
IMAGING TESTS

Your doctor will probably order X-rays to determine the size and exact location of the tumor.
Depending on the X-ray results, these other imaging tests may be necessary:

A CT scan is a series of detailed X-rays of the inside of your body that are taken from several
angles.

An MRI scan uses magnets and radio waves to provide detailed pictures of the area in
question.

In a positron emission tomography (PET) scan, your doctor will inject a small amount of
radioactive sugar into your vein. Since cancer cells use more glucose than regular cells,
this activity helps your doctor locate the site of the tumor.
An arteriogram is an X-ray of your arteries and veins.
A bone scan may also be needed
DIAGNOSIS
Biopsies

Your doctor may want to perform a biopsy. In this test, a sample of the tissue
that makes up your tumor will be removed. The sample is examined in a
laboratory under a microscope. The main types of biopsies are a needle
biopsy and an incisional biopsy

An incisional biopsy, also called an open biopsy, is done in an operating room

under general anesthesia so you’ll sleep through the procedure. Your doctor
will make an incision and remove your tissue through the incision.

Completing a bone biopsy is important to make a definite diagnosis of the

condition.
TREATMENT
BENIGN TUMORS

If your tumor is benign, it may or may not require action. Sometimes doctors just keep
an eye on benign bone tumors to see if they change over time. This requires coming
back periodically for follow-up X-rays.

Bone tumors can grow, stay the same, or eventually disappear. Children have a higher
likelihood of having their bone tumors disappear as they mature.

However, your doctor may want to surgically remove the benign tumor. Benign tumors
can
sometimes spread or transform into malignant tumors. Bone tumors can also lead to
fractures
 TREATMENT
MALIGNANT TUMORS

If your tumor is malignant, you’ll work closely with a team of doctors to treat it.
Although malignant tumors are a cause of concern, the outlook for people with
this condition is improving as treatments are developed and refined.

Your treatment will depend on what type of bone cancer you have and whether it’s
spread. If your cancer cells are confined to the tumor and its immediate area, this is
called the localized stage. In the metastatic stage, cancerous cells have already
spread to other partsof the body. This makes curing the cancer moredifficult.

Surgery, radiation, and chemotherapy are the main strategies for treating cancer
TREATMENT
CRYOSURGERY

Cryosurgery is another treatment possibility. This treatment involves

killing cancer cells by freezing them with liquid nitrogen. A hollow tube

is inserted into the tumor, and liquid nitrogen or argon gas is pumped

in. In some cases, cryosurgery can be used to treat bone tumors

instead of regular surgery.

RECOVERY & LONG TERM OUTLOOK
Your doctor will want you to stay in close contact with them while you recover. Follow-up X-
rays and blood tests will be necessary to make sure the whole tumor is gone and that it
doesn’t return. You may need to have follow-up tests every fewmonths.

How quickly you recover will depend on what type of bone tumor you had, how big it was, and
where it was located.

Your outlook varies according to the type of cancer, size, location, and your generalhealth.
Your outlook is also good if the bone is localized.

Both malignant and benign bone tumors can recur. People who have had bone cancer,
especially at an early age, are at higher risk of developing other types of cancer. If you have
any symptoms or health concerns, be sure to discuss them with your doctor promptly.
ANY QUESTIONS
THANK YOU