Ultrasound

Musculoskeletal

What is musculoskeletal system? The human musculoskeletal system is the organ system that gives humans the ability to physically move, by using the muscles and skeletal system. It consists of the muscular system and the human skeleton. Bones are connected to each other at the joints by ligaments or cartilage and skeletal muscle is attached to bones, usually by tendons. Cartilages help reduce friction in joints and supports bones.

Congenital hip dysplasia

A malformation of the hip joint that is present at birth. Genetic factors likely play a role in this disorder. Features include hip dislocation, asymmetry of leg positions, asymmetric fat folds, and diminished movement on the affected side. Some children will exhibit little or no features and must be diagnosed by physical examination of the hip joints.

Symptoms Although some dislocated hips show no signs, contact a doctor if your baby has: • Legs of different lengths. • Uneven thigh skin folds. • Less mobility or flexibility on one side. In children who have begun to walk, limping, toe walking and a waddling "duck-like" gait are also signs.

Causes Clinical studies show a familial tendency toward Congenital hip dysplasia, with more females affected than males. This disorder is found in many cultures around the world. However, statistics show that the Native American population has a high incidence of hip dislocation. This has been documented to be due to the common practice of swaddling and using cradleboards for restraining the infants. This places the infant's hips into extreme adduction (brought together). The incidence of congenital Congenital hip dysplasia is also higher in infants born by caesarian and breech position births.

Evidence also shows a greater chance of this hip abnormality in the first born compared to the second or third child. Hormonal changes within the mother during pregnancy, resulting in increased ligament laxity, is thought to possibly cross over to the placenta and cause the baby to have lax ligaments while still in the womb. Other symptoms of complete dislocation include a shortening of the leg and limited ability to abduct the leg.

Diagnosis Because the abnormalities of this hip problem often vary, a thorough physical examination is necessary for an accurate diagnosis of congenital Congenital hip dysplasia. The hip disorder can be diagnosed by moving the hip to determine if the head of the femur is moving in and out of the hip joint. One specific method, called the Ortolani test, begins with each of the examiners hands around the infant's knees, with the second and third fingers pointing down the child's thigh. With the legs abducted (moved apart), the examiner may be able to discern a distinct clicking sound with motion. If symptoms are present with a noted increase in abduction, the test is considered positive for hip joint instability. It is important to note this test is only valid a few weeks after birth.

X-ray films can be helpful in detecting abnormal findings of the hip joint. X rays may also be helpful in finding the proper positioning of the hip joint for treatments of casting. Ultrasound has been noted as a safe and effective tool for the diagnosis of congenital Congenital hip dysplasia. Ultrasound has advantages over x rays, as several positions are noted during the ultrasound procedure. This is in contrast to only one position observed during the x ray.

5 month old female: hip evaluated for congenital dysplasia Ultrasound of a normal hip. a. gluteus muscle b. ilium c. acetabulum d. head of femur

Treatment The objective of treatment is to replace the head of the femur into the acetabulum and, by applying constant pressure, to enlarge and deepen the socket. In the past, stabilization was achieved by placing rolled cotton diapers or a pillow between the thighs, thereby keeping the knees in a frog like position. More recently the Pavlik harness and von Rosen splint are commonly used in infants up to the age of six months. A stiff shell cast may be used, which achieves the same purpose, spreading the legs apart and forcing the head of the femur into the acetabulum. In some cases, in older children between six to 18 months, surgery may be necessary to reposition the joint.

Also at this age, the use of closed manipulation may be applied successfully, by moving the leg around manually to replace joint. Operations are not only performed to reduce the dislocation of the hip, but also to repair a defect in the acetabulum. A cast is applied after the operation to hold the head of the femur in the correct position. The use of a home traction program is now more common. However, after the age of eight years, surgical procedures are primarily done for pain reduction measures only. Total hip surgeries may be inevitable later in adulthood.

Bone Spur

Bone spurs, also known as osteophytes, are bony projections that form along joints. Bone spurs form due to the increase in a damaged joint's surface area. This is most commonly from the onset of arthritis. Bone spurs usually limit joint movement and typically cause pain.

Cause Osteophyte formation has been classically related to any sequential and consequential changes in bone formation due to aging, degeneration, mechanical instability, and disease. Often osteophytes form in osteoarthritic joints due to damage and wear from inflammation. Calcification and new bone formation can also occur in response to mechanical damage in joints, or at the attachment points for ligaments and tendons.

Symptoms A bone spur may have existed for years with no symptoms. Common symptoms include • Pain in the area of the bone spur especially afer activity that uses or puts preasure on the area. • Inflammation of the surround tissue or joint. Symptoms of Spinal Bone Spurs • Sensory symptoms include pain, numbness, burning and pins and needles in the extremities below the affected spinal nerve root • Motor symptoms include muscle spasm, cramping, weakness, or loss of muscular control in a part of the body.

Diagnosis With a physical examination and taking the patient’s medical history into consideration a doctor can diagnose if the condition is caused by a bone spur. This process will include consideration of the patients symptoms to rule out conditions that have similar symptoms but very different causes. • MRI (Magnetic resonance imaging) • Electroconductive tests to show the seriousness of the nerve injury • CT scan (computed tomography) • X-Ray (not generally notice in routine X-rays, unless specifically looking)

Treatment Several approaches can be taken to treatment depending on the severity of the symptoms. A conservative approach for persons with mild or moderate pressure on the nerves or spinal cord might include: • Cortisone shots to help reduce joint swelling and pain. The effects of these are temporary and may need to be repeated. • Drugs to reduce swelling, relieve pain and relax muscles for four to six weeks. • Physical therapy and manipulation of joints to restore flexibility and strength, improve posture and reducing the pressure on the nerves. • Rest . If this approach isn't successful, surgery may be needed, such as a laminectomy to remove bone spurs.

Osteoarthritis

Osteoarthritis, sometimes called degenerative joint disease or osteoarthrosis, is the most common form of arthritis. Osteoarthritis occurs when cartilage in your joints wears down over time. Osteoarthritis can affect any joint in your body, though it most commonly affects joints in your hands, hips, knees and spine. Osteoarthritis typically affects just one joint, though in some cases, such as with finger arthritis, several joints can be affected. Osteoarthritis gradually worsens with time, and no cure exists. But osteoarthritis treatments can relieve pain and help you remain active. Taking steps to actively manage your osteoarthritis may help you gain control over your osteoarthritis pain.

Causes Osteoarthritis occurs when the cartilage that cushions the ends of bones in your joints deteriorates over time. The smooth surface of the cartilage becomes rough, causing irritation. Eventually, if the cartilage wears down completely, you may be left with bone rubbing on bone — causing the ends of your bones to become damaged and your joints to become painful. It isn't clear what causes osteoarthritis in most cases. Researchers suspect that it's a combination of factors, including being overweight, the aging process, joint injury or stress, heredity, and muscle weakness.

Symptoms

Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms of osteoarthritis include:

• Pain in a joint during or after use, or after a period of inactivity. • Tenderness in the joint when you apply light pressure. • Stiffness in a joint, that may be most noticeable when you wake up in the morning or after a period of inactivity.

• Loss of flexibility may make it difficult to use the joint. • Grating sensation when you use the joint. • Bone spurs, which appear as hard lumps, may form around the affected joint. • Swelling in some cases Osteoarthritis symptoms most commonly affect the hands, hips, knees and spine. Unless you've been injured or placed unusual stress on a joint, it's uncommon for osteoarthritis symptoms to affect your jaw, shoulder, elbows, wrists or ankles.

diagnosis If your doctor suspects you have osteoarthritis, he or she will examine your affected joint and ask you questions about your joint pain. To better understand the cause of your pain, he or she may also recommend: • X-rays. X-ray images of your affected joint may reveal a narrowing space within a joint, which indicates that the cartilage is breaking down. An X-ray may also show bone spurs around a joint. • Blood tests. Blood tests may help rule out other causes of joint pain, such as rheumatoid arthritis.

• Joint fluid analysis. Your doctor may use a long needle to draw fluid out of the affected joint. Examining and testing the fluid around your joint can determine if your pain is caused by gout or an infection. • Examining the joint with a tiny camera (arthroscopy). In some cases, your doctor may recommend arthroscopy to see inside your joint in order to determine the cause of your pain. During arthroscopy, small incisions are made around your joint and a tiny camera is inserted to see inside your joint. Your doctor watches a video screen to look for abnormalities within your joint.

Evident irregularities of the femoral bone profile (f). The arrows indicate the thickening of the joint capsule. a = acetabulum.

Bursitis

Bursitis is the inflammation of one or more bursae (small sacs) of synovial fluid in the body. The bursae rest at the points where internal functionaries, such as muscles and tendons, slide across bone. Healthy bursae create a smooth, almost frictionless functional gliding surface making normal movement painless. When bursitis occurs, however, movement relying upon the inflamed bursa becomes difficult and painful. Moreover, movement of tendons and muscles over the inflamed bursa aggravates its inflammation, perpetuating the problem.

Causes Bursitis is commonly caused by repetitive movement and excessive pressure. Elbows and knees are the most commonly affected. Inflammation of the bursae might also cause other inflammatory conditions such as rheumatoid arthritis. Although infrequent, scoliosis might cause bursitis of the shoulders, however, shoulder bursitis is more commonly caused by overuse of the shoulder joint and related muscles.

Symptoms Bursitis symptoms vary from local joint pain and stiffness, to burning pain that surrounds the joint around the inflamed bursa. In this condition, the pain usually is worse during and after activity, and then the bursa and the surrounding joint become stiff the next day in the morning.

diagnosis Your doctor may have you undergo a physical examination and ask you about your recent activities. By feeling the painful joint and surrounding area, your doctor may be able to identify a specific area of tenderness. If it appears that something else may be causing the discomfort, your physician may request an X-ray of the affected area. If bursitis is the cause, X-ray images can't positively establish the diagnosis, but they can help to exclude other causes of your discomfort.

Ileopsoas bursitis. * = synovial fluid.

Treatments Bursitis treatment is usually simple and includes: • Resting and immobilizing the affected area. • Applying ice to reduce swelling • Taking nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and reduce inflammation With simple self-care and home treatment, bursitis usually disappears within a couple of weeks. Sometimes, doctor may recommend physical therapy or exercises to strengthen the muscles in the area. Additionally, your doctor may inject a corticosteroid drug into the bursa to relieve inflammation. This treatment generally brings immediate relief and, in many cases, one injection is all you'll need.

Rheumatoid arthritis

Rheumatoid arthritis is an inflammatory form of arthritis that causes joint pain and damage. Rheumatoid arthritis attacks the lining of your joints (synovium) causing swelling that can result in aching and throbbing and eventually deformity. Sometimes rheumatoid arthritis symptoms make even the simplest activities — such as opening a jar or taking a walk — difficult to manage. Rheumatoid arthritis is two to three times more common in women than in men and generally occurs between the ages of 40 and 60. But rheumatoid arthritis can also affect young children and older adults.

Cause Rheumatoid arthritis occurs when white blood cells — whose usual job is to attack unwanted invaders, such as bacteria and viruses — move from your bloodstream into the membranes that surround your joints (synovium). The blood cells appear to play a role in causing the synovium to become inflamed. The inflammation causes the release of proteins that, over months or years, cause the synovium to thicken. The proteins can also damage the cartilage, bone, tendons and ligaments near your joint. Gradually, the joint loses its shape and alignment. Eventually, it may be destroyed.

Signs and symptoms of rheumatoid arthritis may include: • Joint pain • Joint swelling • Joints that are tender to the touch • Red and puffy hands • Firm bumps of tissue under the skin on your arms (rheumatoid nodules) • Fatigue • Morning stiffness that lasts at least 30 minutes • Fever • Weight loss Signs and symptoms appear in smaller joints first. Rheumatoid arthritis usually causes problems in several joints at the same time. Early rheumatoid arthritis tends to affect your smaller joints first — the joints in your wrists, hands, ankles and feet. As the disease progresses, your shoulders, elbows, knees, hips, jaw and neck can also become involved.

Signs and symptoms of a rheumatoid arthritis flare. Rheumatoid arthritis signs and symptoms may vary in severity and may even come and go. Periods of increased disease activity — called flare-ups or flares — alternate with periods of relative remission, during which the swelling, pain, difficulty sleeping, and weakness fade or disappear.

Diagnosis Diagnosing rheumatoid arthritis usually begins with a physical exam. Your doctor will ask you about your signs and symptoms and examine your affected joints. In addition, your doctor may recommend: • Blood tests. People with rheumatoid arthritis tend to have an elevated erythrocyte sedimentation rate (ESR, or sed rate), which indicates the presence of an inflammatory process in the body. Other common blood tests look for antibodies called rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies in the blood. While commonly found in the blood of people with rheumatoid arthritis, rheumatoid factor and anti-CCP antibodies aren't present in all cases.

• In early rheumatoid arthritis, the presence of rheumatoid factor and anti-CCP antibodies in the blood may be associated with an increased risk of joint damage. Rheumatoid factor and anti-CCP antibodies can be present in people who have chronic infections, such as active tuberculosis, and other autoimmune rheumatic diseases, such as lupus and Sjogren's syndrome. • Joint fluid analysis. Your doctor may draw fluid from your joint using a needle. The fluid can be tested to help rule out other diseases and conditions. • X-rays. Your doctor may recommend X-rays to help track the progression of rheumatoid arthritis in your joint over time.

Treatment There's no known cure for osteoarthritis, but treatments can help to reduce pain and maintain joint movement so that you can go about your daily tasks. While medications and joint replacement surgery are key components of treatment for osteoarthritis, your doctor will likely recommend you try all other possible solutions before you consider those options. Eventually the pain may become severe so that medications and surgery may be necessary.

The presence of crystals of steroids (red arrow) within the coxofemural joint was demonstrated. green arrows = distension of the joint capsule; white triangles = bony profile of the femural head.

Treatments There is no cure for rheumatoid arthritis. Treatment for rheumatoid arthritis aims to reduce inflammation in your joints in order to relieve pain and prevent or slow joint damage. Early and aggressive rheumatoid arthritis treatments may slow joint damage and help reduce the risk of disability. Treatment typically involves medications, though surgery may be necessary in cases of severe joint damage.