Hths 2231
Laboratory 13
Alterations in
Musculoskeletal
Watch Movie: Osteoporosis
Answer the movie questions on the worksheet.
Complete activities 1-4.
Activity #1:
Click on the website link in activity 1 to review the structure and
function of bone.
Activity #2:
Click on the website links in activity 2 to review the structure and
function of muscle.
Activity #3:
Using the webpath link on activity 3, complete the musculoskeletal
scavenger hunt on the laboratory worksheet.
Activity #4:
Complete the musculoskeletal case studies on the laboratory worksheet.
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Hthsci 2231 Lab 13
Hths 2231
Laboratory 13
Alterations in
Musculoskeletal
Osteoporosis Movie
1.
Osteoporosis can be defined as
2.
What three areas of the skeleton are especially weakened in osteoporosis?
3.
During bone remodeling damaged bone is ________ and is replaced with
_____________.
4.
At approximately what age does bone resorption begin to exceed bone
formation?
5.
What cells are responsible for bone resorption?
6.
What cells are responsible for bone formation?
7.
Bones become more dense if subjected to ____________ such as weightbearing exercises.
8.
List four functions of bone.
9.
What tool is used to detect bone density with a 1% degree of accuracy?
10.
What 5 genetic conditions affect osteoporosis?
11.
What lifestyle changes can affect environmental risk factors for
osteoporosis?
12.
Although there is no satisfactory treatment for osteoporosis, what
replacement therapy is often used?
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Hthsci 2231 Lab 13
Hths 2231
Laboratory 13
Alterations in
Musculoskeletal
Musculoskeletal Scavenger Hunt
Click on the activity 3 WebPath link.
Click on the “radiology” link.
Click on the “skeletal system” link?
Using the images on WebPath, can you find:
1. An x-ray of a boxer’s fracture? Can you locate the fracture?
2. An x-ray of a tibial and fibular fracture?
3. An x-ray of a spiral comminuted fracture?
4. A radiograph, CT scan, MRI scan, and nuclear medicine scan of:
a. A bone tumor primarily found in adolescents and young adults?
What type of tumor is this? Where is it primarily found? Please
review all slides that apply.
b. A bone tumor that infiltrates spongy bone? What type of tumor
is this? What age group is this primarily found in? Treatment of
choice is often…? Please review all slides that apply.
5. A tumor found in middle-aged adults that will often metastasize to the
lungs? Where is the tumor found in this slide?
6. A radiograph and CT scan of a tumor that originates in the bone
marrow?
7. Cancers that have metastasized to the bone? Please view all slides that
apply.
8. Examples of trophy formed from uric acid crystal deposits. Please view
all slides that apply.
9. Examples of a disease that causes excessive resorption of spongy bone
and accelerated formation of softened bone. Describe the 3 phases of
this disease.
10. A condition primarily found in older women involving a loss of bone mass.
11. Examples of non-inflammatory and inflammatory joint disease. How are
these disease differentiated?
12. Examples of bone infection. What is the most common organism
involved in bone infection?
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Hthsci 2231 Lab 13
Hths 2231
Laboratory 13
Alterations in
Musculoskeletal
Musculoskeletal Case Studies
Case #1
Mr. Jones, his wife, and their child Sally were involved in an automobile
accident. Each of them suffered broken bones, scrapes and bruises.
Look at the slides and match the x-ray with the correct patient.
Slide 1a, Slide 1b, and Slide 1c
Mr Jones. Transverse tibial fracture
Mrs. Jones. Pott’s fracture
Sally Jones. Colles’ fracture
Case #2
An 18 year-old man presents with a six-month history of progressive
pain in his left distal thigh. He had some moderate swelling about his
knee. His pain was worse at night. He did not have pain with ambulation.
Radiographs demonstrated a lesion of the distal femur.
See slide 2a.
This radiograph demonstrates a lesion in the metaphyseal region
of the distal femur.
See slide 2b
This bone scan demonstrates a “hot spot” of increased uptake in
the distal left femur.
a. What is the diagnosis?
b. In whom and at what sites is this lesion most common?
Case #3
A 29 year-old woman complains to her physician that she hasn’t felt well
since having the flu several months ago. She is extremely tired but
often doesn’t sleep well at night. She complains of generalized aching
and pain. She has experienced frequent migraines and is often
incapacitated for days. Her bowel movements are irregular and
fluctuate between constipation and diarrhea.
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Hthsci 2231 Lab 13
Hths 2231
Laboratory 13
Alterations in
Musculoskeletal
Physical exam revealed pain to the touch at the base of the neck,
muscles in upper back, upper muscles of the buttocks, knee joints, and
sides of the elbows.
(See slide 3).
Laboratory tests are unremarkable with normal chemistry, CBC, and
thyroid function. ESR is within the normal range. ANA, RA, and mono
tests are negative.
What condition do you suspect?
Case #4
A 35 year-old man complains of lower back pain, fatigue, and decreasing
range of movement. Physical exam shows severely restricted forward
flexion, rotation, and lateral flexion.
See slide 4a
A radiograph of the spine shows fusion of vertebrate.
See slide 4b
Laboratory Tests are remarkable for an elevated ESR, and elevated
alkaline phosphatase. Serum analysis for HLA-B27 is positive.
Your diagnosis is?
Case #5
A 65 year-old man complains of pain in his left elbow and right great
toe. He has a history of kidney stones. Lab results show normal CBC
and chemistry values other than an elevated uric acid.
See slide 5 for a radiograph of the great toe.
Your diagnosis?
What causes the pain he is experiencing?
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Hthsci 2231 Lab 13
Hths 2231
Laboratory 13
Alterations in
Musculoskeletal
Case #6
A 70 year-old woman fell and broke her hip. Her daughter accompanies
her to the emergency room. See slide 6 for a radiograph of her
opposite hip. What is the most likely cause of her broken hip?
Recommend a treatment regimen to improve her condition.
Can you recommend preventative measures for her daughter?
Case #7
A 46-year-old man presents with progressive pain and swelling of his
right hip region. The swelling is worse than the pain. On physical
examination, he is mildly obese and it is difficult to assess the right hip
region.
Slide 7a
A bone scan showed a large area of increased uptake (a "hot
spot") in the right pelvic wing (seen here on the left).
Slide 7b
A radiograph of the pelvis demonstrates an ill-defined mass
eroding the right pelvic wing and extending into soft tissue. Note
the fluffy calcifications within the mass.
Slide 7c
A pelvic CT scan reveals an ill-defined mass eroding the right
pelvic wing and extending into soft tissue. Note the calcifications
within the mass.
A resection was performed. It was noted that the lesion had invaded
the spongy bone.
What type of tumor do you suspect?
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Hthsci 2231 Lab 13
Hths 2231
Laboratory 13
Alterations in
Musculoskeletal
Case #8
A 58-year-old woman has suffered from arthritis with pain and swelling
of her hands and feet that is aggravated by movement. Over the past
decade she has noted increasing deformity of her hands and feet,
making it difficult to walk and to perform simple daily activities such as
buttoning a blouse or even combing her hair. She has no history of any
trauma. Radiographs show ankylosis of the carpals (immobility) with
residual evidence of MP joint erosion and decreased bone mass of the
metacarpals and carpals. Physical examination reveals firm, non-tender,
less than 1 cm nodules over the elbows.
Slide 8a
Left hand of patient.
Slide 8b
Radiograph of hand shows joint narrowing with marginal erosions
and osteoporosis,
Slide 8c
Synovial fluid shows mononuclear cells with numerous
lymphocytes and some scattered plasma cells.
Laboratory results are remarkable for elevated ESR, and positive RA.
Your diagnosis is?
Why are there numerous cells in the synovial exudates?
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Hthsci 2231 Lab 13
Hths 2231
Laboratory 13
Alterations in
Musculoskeletal
ANSWERS TO OSTEOPOROSIS MOVIE
1.
Osteoporosis can be defined as: LOSS OF BONE TISSUE
2.
What three areas of the skeleton are especially weakened in
osteoporosis? SPINE, WRISTS, HIPS
3.
During bone remodeling damaged bone is ________ and is replaced with
_____________. RESORBED, NEW BONE TISSUE
4.
At approximately what age does bone resorption begin to exceed bone
formation? 30-35
5.
What cells are responsible for bone resorption? OSTEOCLASTS
6.
What cells are responsible for bone formation? OSTEOBLASTS
7.
Bones become more dense if subjected to ____________ such as
weight-bearing exercises. STRESS
8.
List four functions of bone. SUPPORT WEIGHT, CONNECT MUSCLES
AND TENDONS, PROTECTS VITAL ORGANS, CA RESERVOIR
9.
What tool is used to detect bone density with a 1% degree of accuracy?
BONE DENSITOMETER
10.
What 5 genetic conditions affect osteoporosis? GENDER, AGE, RACE,
SIZE, HORMONAL CHANGES
11.
What lifestyle changes can affect environmental risk factors for
osteoporosis? INCREASE CALCIUM AND VITAMIN D, DECREASE USE
OF ALCOHOL, CAFFEINE, AND PROTEIN, INCREASE PHYSICAL
ACTIVITY
12.
Although there is no satisfactory treatment for osteoporosis, what
replacement therapy is often used? ESTROGEN
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Hthsci 2231 Lab 13
Hths 2231
Laboratory 13
Alterations in
Musculoskeletal
ANSWERS TO SCAVENGER HUNT WORKSHEET
1. An x-ray of a boxer’s fracture? Can you locate the fracture? SLIDE 141.
FRACTURE OF 5TH METACARPAL OF THE HAND
2. An x-ray of a tibial and fibular fracture? SLIDE 149
3. An x-ray of a spiral comminuted fracture? SLIDE 147, 148
4. A radiograph, CT scan, MRI scan, and nuclear medicine scan of:
a. A bone tumor primarily found in adolescents and young adults? What
type of tumor is this? Where is it primarily found? Please review all slides
that apply. SLIDES 28-31, 32-36. OSTEOSARCOMA. FOUND IN
THE METAPHYSES OF LONG BONES. 50% ARE FOUND AROUND
THE KNEE
b. A bone tumor that infiltrates spongy bone? What type of tumor is this?
What age group is this primarily found in? Treatment of choice is often…?
Please review all slides that apply. SLIDES 38-41.
CHONDROSARCOMA. FOUND IN MIDDLE-AGED AND OLDER
ADULTS. AMPUTATION IS OFTEN TREATMENT OF CHOICE
5. A tumor found in middle-aged adults that will often metastasize to the
lungs? Where is the tumor found in this slide? SLIDE 45. DISTAL FEMUR
6. A radiograph and CT scan of a tumor that originates in the bone marrow?
SLIDES 12-15
7. Cancers that have metastasized to the bone? Please view all slides that
apply. SLIDES 73-78.
8. Examples of trophy formed from uric acid crystal deposits. Please view all
slides that apply. SLIDES 125-127
9. Examples of a disease that causes excessive resorption of spongy bone and
accelerated formation of softened bone. Describe the 3 phases of this
disease. SLIDES 90-93. PAGET’S DISEASE HAS AN INITIAL
OSTEOLYTIC PHASE FOLLOWED BY A MIDDLE PHASE WITH
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Hthsci 2231 Lab 13
Hths 2231
Laboratory 13
Alterations in
Musculoskeletal
OSTEOSCLEROSIS AND OSTEOLYSIS. OSTEOSCLEROSIS OCCURS IN
THE FINAL STAGE
10. A condition primarily found in older women involving a loss of bone mass.
SLIDES 104-107
11. Examples of non-inflammatory and inflammatory joint disease. How are
these disease differentiated? SLIDES 116-121
Inflammatory
Etiology
Joint fluid
Rheumatoid Arthritis
Yes
Systemic autoimmune
damage to connective
tissue in joints.
Inflammatory exudates
Osteoarthritis
No
Degeneration and loss
of cartilage
Few cells and
proteoglycan fragments
from cartilage
breakdown
12. Examples of bone infection. What is the most common organism involved in
bone infection? SLIDES 120-135. STAPHYLOCOCCUS AUREUS IS THE
MOST COMMON ORGANISM CAUSING AN OSTEOMYELITIS
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Hthsci 2231 Lab 13
Hths 2231
Laboratory 13
Alterations in
Musculoskeletal
ANSWERS TO CASE STUDIES
Case #1
Mr. Jones, his wife, and their child Sally were involved in an automobile
accident. Each of them suffered broken bones, scrapes and bruises.
Look at slides 1-4 and match the x-ray with the correct patient.
Slide 1a - MRS. JONES
Slide 1b - SALLY
Slide 1c - MR. JONES
Mr Jones - Transverse tibial fracture
Mrs. Jones - Pott’s fracture
Sally Jones. - Colles’ fracture
Case #2
An 18-year-old man presents with a six-month history of progressive
pain in his left distal thigh. He had some moderate swelling about his
knee. His pain was worse at night. He did not have pain with ambulation.
Radiographs demonstrated a lesion of the distal femur.
See slide 2a. This radiograph demonstrates a lesion in the metaphyseal
region of the distal femur.
See slide 2b. This bone scan demonstrates a “hot spot” of increased
uptake in the distal left femur.
a. What is the diagnosis? OSTEOSARCOMA IN THE METAPHYSEAL
REGION
b. In whom and at what sites is this lesion most common? THERE IS A
SLIGHT MALE PREDOMINANCE, WITH PEAK INCIDENCE FROM
TEENAGE TO YOUNG ADULTHOOD. THE MOST COMMON SITES
ARE IN LONG BONES, PARTICULARLY AROUND THE KNEE
Case #3
A 29 year-old woman complains to her physician that she hasn’t felt well
since having the flu several months ago. She is extremely tired but
often doesn’t sleep well at night. She complains of generalized aching
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Hthsci 2231 Lab 13
Hths 2231
Laboratory 13
Alterations in
Musculoskeletal
and pain. She has experienced frequent migraines and is often
incapacitated for days. Her bowel movements are irregular and
fluctuate between constipation and diarrhea.
Physical exam revealed pain to the touch at the base of the neck,
muscles in upper back, upper muscles of the buttocks, knee joints, and
sides of the elbows.
(See slide 3).
Laboratory tests are unremarkable with normal chemistry, CBC, and
thyroid function. ESR is within the normal range. ANA, RA, and mono
tests are negative.
What condition do you suspect FIBROMYALGIA.
DIAGNOSIS OF FIBROMYALGIA IS BASED ON HAVING ALL 3
OF THE FOLLOWING MAJOR CRITERION:
1. Generalized aches or stiffness of at least three anatomical
sites for at least three months
2. Six or more typical, reproducible tender points. (See slide 3)
3. Exclusion of other disorders that can cause similar symptoms .
Four or more of the minor criteria must also be present for
diagnosis. These include:
1. Generalized fatigue
2. Chronic headache
3. Sleep disturbance
4. Neurological and psychological complaints
5. Joint swelling
6. Numbing or tingling sensations
7. Irritable bowel syndrome
8. Variation of symptoms in relation to activity, stress, and
weather changes
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Hthsci 2231 Lab 13
Hths 2231
Laboratory 13
Alterations in
Musculoskeletal
Case #4
A 35-year-old man complains of lower back pain, fatigue, and decreasing
range of movement. Physical exam shows severely restricted forward
flexion, rotation, and lateral flexion.
See slide 4a.
A radiograph of the spine shows fusion of vertebrate.
See slide 4b.
Laboratory Tests are remarkable for an elevated ESR, and elevated
alkaline phosphatase. Serum analysis for HLA-B27 is positive.
Your diagnosis is? ANKYLOSING SPONDYLITIS
Case #5
A 65-year-old man complains of pain in his left elbow and right great
toe. He has a history of kidney stones. Lab results show normal CBC
and chemistry values other than an elevated uric acid.
See slide 5 for a radiograph of the great toe.
Your diagnosis? GOUT
What causes the pain he is experiencing? PAIN IS CAUSED BY
NODULES THAT FORM FROM URIC ACID CRYSTAL DEPOSITS
Case #6
A 70 year-old woman fell and broke her hip. Her daughter accompanies
her to the emergency room. See slide 6 for a radiograph of her
opposite hip. What is the most likely cause of her broken hip?
OSTEOPOROSIS.
Recommend a treatment regimen to improve her condition.
TREATMENT REGIMEN WOULD INCLUDE AN IMPROVED DIET
WITH CA AND VITAMIN D SUPPLEMENTS. PHYSICAL THERAPY
AND AN EXERCISE REGIMEN AS HER HIP HEALS. DRUG
THERAPY TO DECREASE BONE RESORBTION
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Hthsci 2231 Lab 13
Hths 2231
Laboratory 13
Alterations in
Musculoskeletal
Can you recommend preventative measures for her daughter? HER
DAUGHTER SHOULD INCORPORATE CALCIUM AND VITAMIN D
IN HER DIET AND MAINTAIN A GOOD EXERCISE PROGRAM
Case #7
A 46-year-old man presents with progressive pain and swelling of his
right hip region. The swelling is worse than the pain. On physical
examination, he is mildly obese and it is difficult to assess the right hip
region.
Slide 7a
A bone scan showed a large area of increased uptake (a "hot
spot") in the right pelvic wing (seen here on the left).
Slide 7b
A radiograph of the pelvis demonstrates an ill-defined mass
eroding the right pelvic wing and extending into soft tissue. Note
the fluffy calcifications within the mass.
Slide 7c
A pelvic CT scan reveals an ill-defined mass eroding the right
pelvic wing and extending into soft tissue. Note the calcifications
within the mass.
A resection was performed. It was noted that the lesion had invaded
the spongy bone.
What type of tumor do you suspect? THIS IS A
CHONDROSARCOMA. THE TUMOR WAS CAUGHT EARLY
ENOUGH THAT RESECTION WAS POSSIBLE
Case #8
A 58-year-old woman has suffered from arthritis with pain and swelling
of her hands and feet that is aggravated by movement. Over the past
decade she has noted increasing deformity of her hands and feet,
making it difficult to walk and to perform simple daily activities such as
buttoning a blouse or even combing her hair. She has no history of any
trauma. Radiographs show ankylosis of the carpals (immobility) with
http://chpweb.weber.edu/hthsci/labpages/
Hthsci 2231 Lab 13
Hths 2231
Laboratory 13
Alterations in
Musculoskeletal
residual evidence of MP joint erosion and decreased bone mass of the
metacarpals and carpals. Physical examination reveals firm, non-tender,
less than 1 cm nodules over the elbows.
Slide 8a
Left hand of patient.
Slide 8b
Radiograph of hand shows joint narrowing with marginal erosions
and osteoporosis,
Slide 8c
Synovial fluid shows mononuclear cells with numerous
lymphocytes and some scattered plasma cells.
Laboratory results are remarkable for elevated ESR, and positive RA.
Your diagnosis is? RHEUMATOID ARTHRITIS
Why are there numerous cells in the synovial exudates? THIS IS AN
AUTOIMMUNE INFLAMMATORY PROCESS WITH
CHARACTERISTIC CELLULAR SYNOVIAL FLUID
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Hthsci 2231 Lab 13