PBL of MSK

PBL Day 1
1. Causes of Lordosis
Lordosis, also known as swayback, is a condition in which the spine in the lower back has an excessive curvature. The spine naturally curves at the neck, upper back, and lower back to help absorb shock and support the weight of the head. Lordosis occurs when the natural arch in the lower back, or lumbar region, curves more than normal. This can lead to excess pressure on the spine, causing pain. People with lordosis often have a visible arch in their lower backs. When looking at them from the side, their lower backs form a defined C shape. In addition, people with swayback appear to be sticking out their stomachs and buttocks. Lordosis is the inward curvature of a portion of the lumbar and cervical vertebral column.[1] Two segments of the vertebral column, namely cervical and lumbar, are normally lordotic, that is, they are set in a curve that has its convexity anteriorly (the front) and concavity posteriorly (behind), in the context of human anatomy. When referring to the anatomy of other mammals, the direction of the curve is termed ventral. Curvature in the opposite direction, that is, apex posteriorly (humans) or dorsally (mammals) is termed kyphosis. Excessive or hyperlordosis is commonly referred to as swayback or saddle back, a term that originates from the similar condition that arises in some horses. A major factor of lordosis is anterior pelvic tilt, when the pelvis tips forward when resting on top of the femurs. Causes A consequence of the normal lordotic curvatures of the vertebral column, (also known as secondary curvatures) is that there are differences in thickness between the anterior and posterior part of the intervertebral disc. Lordosis may also increase at puberty sometimes not becoming evident until the early or mid-20s. Imbalances in muscle strength and length are also a cause, such as weak hamstrings, or tight hip flexors (psoas). Excessive lordotic curvature is also called hyperlordosis, hollow back, saddle back, and swayback. Common causes of excessive lordosis include tight low back muscles, excessive visceral fat, and pregnancy. Although lordosis gives an impression of a stronger back, incongruently it can lead to moderate to severe lower back pain. Rickets, a vitamin D deficiency in children, can cause lumbar lordosis. Achondroplasia. A disorder in which bones do not grow normally, resulting in the short stature associated with dwarfism Spondylolisthesis. A condition in which a vertebrae, usually in the lower back, slips forward Osteoporosis, a condition in which vertebrae become fragile and can be easily broken (compression fractures) Obesity, or being extremely overweight Kyphosis. A condition marked by an abnormally rounded upper back Discitis. Inflammation of the disc space between the bones of the spine most often caused by infection

PBL of MSK Benign (harmless) juvenile lordosis The following conditions can cause kyphosis: o Abnormal vertebrae development in utero (congenital kyphosis) o Poor posture or slouching (postural kyphosis) o Scheuermann's disease, a condition that causes vertebrae to be misshaped (Scheuermann's kyphosis) o Arthritis o Osteoporosis o Spina bifida, a birth defect in which the spinal column of the fetus does not close completely during development inside the womb o Spine infections o Spine tumors

2. Gowers Sign and its Causes

Gowers' sign is a medical sign that indicates weakness of the proximal muscles, namely those of the lower limb. The sign describes a patient that has to use his hands and arms to "walk" up his own body from a squatting position due to lack of hip and thigh muscle strength. It is named after William Richard Gowers. He noticed that boys who suffered from a condition called pseudohypertrophic muscular paralysis used a specific movement pattern when they stood. Causes: Gowers' sign is classically seen in Duchenne muscular dystrophy, but also presents itself in centronuclear myopathy, myotonic dystrophy and various other conditions associated with proximal muscle weakness. For this maneuver, the patient is placed on the floor away from any objects that could otherwise be used to pull oneself to a standing position. It is also used in testing paraplegia.

3. Causes of Progressive Muscle Weakness

Causes of Asthenia and Fatigue Addisons disease Anemia Anxiety Chemotherapy Chronic fatigue syndrome Chronic pain Deconditioning/sedentary lifestyle Dehydration and electrolyte disorders

PBL of MSK Depression Diabetes Fibromyalgia Heart disease Hypothyroidism Infections (such as influenza, Epstein-Barr virus, HIV, hepatitis C, tuberculosis) Medications Narcotics Paraneoplastic syndrome Pregnancy/postpartum Pulmonary disease Renal disease Sleep disorders

Medications and Narcotics that Can Cause Muscle Weakness Amiodarone (Cordarone) Corticosteroids Antithyroid agents: methimazole (Tapazole); Fibric acid derivatives: gemfibrozil (Lopid) propylthiouracil Interferon Antiretroviral medications: zidovudine Leuprolide acetate (Lupron) (Retrovir); lamivudine (Epivir) Nonsteroidal anti-inflammatory drugs Chemotherapeutic agents Penicillin Cimetidine (Tagamet) Sulfonamides Cocaine Statins Infectious and Neurologic Causes of Muscle Weakness Infectious Epstein-Barr virus Human immunodeficiency virus Influenza Lyme disease Meningitis (multiple agents) Polio Rabies Syphilis Toxoplasmosis Neurologic Amyotrophic lateral sclerosis Cerebrovascular disease Stroke Subdural/epidural hematomas Table Additional Selected Causes of Muscle Weakness Electrolyte Hypercalcemia Hyperkalemia/hypokalemia Hypermagnesemia/hypomagnesemia

Demyelinating disorders Guillain-Barr syndrome Multiple sclerosis Neoplasm Neuromuscular disorders Botulism Lambert-Eaton myasthenic syndrome Myasthenia gravis Organophosphate intoxication Radiculopathies Cervical spondylosis Degenerative disc disease Spinal cord injury Spinal muscle atrophy

Endocrine Acromegaly Primary hyperparathyroidism Hypopituitarism

PBL of MSK Vitamin D deficiency (osteomalacia) Rheumatologic Polymyalgia rheumatica Systemic sclerosis/scleroderma Genetic Distal myopathies Oculopharyngeal muscular dystrophy Myotonic dystrophy type 2 (proximal myotonic myopathy) Metabolic Glycogenoses Acid maltase deficiency Aldolase A deficiency Brancher enzyme deficiency Myophosphorylase deficiency Phosphofructokinase deficiency Lipidoses Carnitine deficiency Carnitine palmitoyltransferase II deficiency Trifunctional protein deficiency Mitochondrial defects Miscellaneous Amyloidosis Sarcoidosis