Chapter 3

Reaction of Musculoskeletal Tissues

to Disorders and Injuries
 Reactions of bone
1. Local death (avascular necrosis)
2. Alteration of bone deposition
Osteoblastic formation
Matrix calcification
3. Alteration of bone resorption
4. Mechanical failure/fracture
 Increase radiographic density sclerosis
Decrease radiographic density rarefaction
Normal balance of osteoblastic deposition
and osteoclastic resorption
 Bone as an organ (generalized)
Deposition > resorption
Osteopetrosis / Marble bones
Acromegaly
Resorption > depostion
Osteoporosis / Osteopenia; congenital (O.
imperfecta), disuse, steroid induced,
postmenopausal
Rickets in chlidren / Osteomalacia in adults
 Bone as a structure (localized)
Deposition > resorption
Work hypertrophy (Wolffs law)
Degenerative OA
Fractures
Infection
Osteosclerosic neoplasm
Resorption > depostion
Disuse atrophy / disuse osteoporosis
RA
Infection
Osteolytic neoplasm
Mechanical failure/Fracture:
In children bone is elastic, less stress may
bend the bone plastic deformation of bone
 Reactions of epiphyseal plate
1. Increased growth
2. Decreased growth
3. Torsional growth
Normal growth needs blood supply and
intermittent pressure regarding physical
activity.
 Generalized reaction
Increased growth (Gigantism)
Arachnodactily (Hyperchondroplasia/Marfans
syndrome)
Pituitary Gigantism
Decreased growth (Dwarfism)
Achondroplasia
Pituitary dwarfism (Lorain type)
Rickets
 Localized reaction
Increased growth
Chronic inflammation
Displaced fracture of the shaft of a long bone
Congenital arteriovenous malformations
Decreased growth
Disuse retardation
Physical injury
Thermal injury
Ischemia
Infection
Torsional growth
 Reactions of synovial joints
Normal joint smooth cartilage surface
painless and frictionless movement
Joint capsule is sensitive to increased pressure
(by fluid -- effusion) / stretching
Articular cartilage produces proteoglycans
and collagen, that is stimulated by cyclical
pressure that transmitted by the matrix
 Reactions of articular cartilage
1. Destruction (nutritions dependent from
synovial fluid)
Ro: decreased normal width
2. Degeneration
Slowly progressive, thinner and less cellular,
aggravated by excessive load (obesity), decrease
viscosity of synovial fluid, local damage
3. Peripheral proliferation
 Destruction of articular cartilage
1. RA
2. Infection
3. Ankylosing spondylitis
4. Prolonged immobilization of a synovial joint
5. Continuous compression of articular cartilage
6. Intra-articular injections of hydrocortisone
(hydrocortisone arthropathy)
Degeneration of articular cartilage
1. Premature aging of cartilage
2. Previous destruction of cartilage
3. Incongruity / irregularity of joint surfaces

Peripheral proliferation: composed of cartilage

(chondrophyte formation) but subsequently
ossifies (osteophyte formation) peripheral
ring / lip
 Healing and regeneration
Possibility CPM (continuous passive
motion) would stimulate the healing &
regeneration of articular cartilage
Through differentiation of pluripotential
mesenchym cells in subchondral bone.
 Reactions of synovial membrane
Effusion (produce of excessive amount of fluid)
Serous mild sprain
Exudate synovitis, RA
Purulent Septic athritis
Hemorrhagic severe injury, hemophilia
Hypertrophy ( thicker)
Adhesion Prolonged immobilization
(cast/rigid splint)
Reactions of joint capsule and ligaments
Joint laxity (unduly stretch & elongated) joint
instability
Joint contracture (tight & shortened) limited
ROM

Joint laxity, caused by:

Genetically generalized
Injury dislocation, subluxation, rupture.
Infection Septic arthritis.
Reactions of joint capsule and ligaments

Joint contracture, caused by:

Congenital clubfeet
Infection fibrosis & scar formation
Chronic arthritis RA & joint degeneration
Muscle contracture Ischemic contracture, 2nd to
compartment syndrome; muscle imbalance;
prolonged muscle spasm.
 Reactions of skeletal muscle
1. Disuse atrophy
2. Work hypertrophy
3. Ischemic necrosis
4. Contracture
5. Regeneration
 Disuse atrophy
Unused muscle weaker and smaller

Poliomyelitis (anterior horn cell)

Polyneuritis (peripheral nerve fiber)
Myasthenia gravis (myoneural junction)
Muscular dystrophy (Individual muscle fiber)
Prolonged immobilization
 Work hypertrophy: isometric contraction
enlargement of muscle fiber.
Ischemic necrosis: within 6 hours.
 Contracture
Persistent shortening, resistant to stretching
fibrous tissue

Polymyositis
Muscular dystrophy
Cerebral palsy
 Regeneration
from sarcolemma, satellite cell in each fiber.
Musculoskeletal deformities
 Bony deformity
Types:
Loss of alignment
Abnormal length
Bony outgrowth
Causes:
Congenital
Fracture
Disturbances of epiphyseal plate growth
Bending of abnormality soft bone
Overgrowth adult bone
 Joint deformity
Types:
Displacement of the joint
Completely: luxated
Partially: subluxated, dislocated
Excessive mobility (hypermobility) of joint
Restricted mobility of joint
 Joint deformity
Causes:
Congenital DDH/developmental dysplasia of the hip,
clubfeet, radioulnar synostosis
Acquired dislocation traumatic, pathological
Mechanical blocks OA, displaced intraarticular #
Joint adhesions RA, septic arthritis
Muscle contractures
Muscle imbalance spastic, flaccid
Fibrous contracture of fascia & skin burns, dupuytrens
External pressure pointed shoe hallux valgus
Idiopathic scoliosis