DR SHRIKANT J. GOREM.S.(ORTHO)

PROFESSOR

DEPT. OF ORTHO.

GMC , LATUR2011

A symptom – not a disease

Multiple parts

Multiple etiological factors

Causes

DiseaseGeneralized , Local, Neighboring

Anatomical siteBones, joints, capsule, ligaments, muscles

Functional

Generalised diseases

The deficienciesIron, Calcium, Vitamins - D, B-Plex

Metabolic diseasesOsteoporosis, diabetes,

Chronic debilitating diseasesBr. Asthma, COPD, malignancies

Behavioral anomaliesAlcoholism, smoking,

Obesity

The deficiencies

IronPallor - Fatigue on exertion

De worming – Iron, Vit-C, B-12

Calcium & Vit-DChalky white worn out teeth

Difficulty in initiation of activity

*Milk *Sunlight

Regional causes

Intra-abdominal pathologies

Amoebic colitis

Renal stones

Pelvic inflammatory diseases

Intra abdominal tumors

Local Causes affecting

Bones

Ligaments

Joints

Muscles

Nerves

Aetiology

Trauma – Stress - Strain

Congenital – Listhesis, bifida

Infection - TB, pyogenic, fungal

Autoimmune RA

Metabolic Osteoporosis ,Br.Asthma,DM

Neoplastic - primary, secondary

Synovial Affections vilonodular, chondromatosis

Degeneration Abnormal loading - organ failure

Mechanics of V-Column

The Design of Various parts of V- Column

Their inter relation (posture)

size-shape-thickness-length-material –

physical & biological properties

V- Column mobile

liable to change its alignment

Factors affecting alignment

Poor Posture

Poor Muscle Tone

Poor Muscle balance

Poor Health - Obesity

Poor Bone Quality - Osteoporosis

Degenerative changes

POSTURE

Poor muscle Tone

Muscle imbalance

Agonist & antagonist balance

dynamic deformity

Concentric joint alignment

Loss of joint stability

Abnormal loading

Stress on ligaments & articular cartilage

Obesity Excessive Fat

Relative weight of bones-muscles –fat

Overloading

Skin fold thickness

Concept of good food

Patient education

Exercise

Poor Bone Quality

Degeneration

Normal physiological loading of joint stimulates hypertrophy & strengthening

of its structures

Excessive or abnormal loading results in wear & tear of joint leading to degeneration

Under load - Disuse atrophy - Relative overload

Degeneration

Structural deformities of spine,

Limb length discrepancy

Repetitive impulsive loading (Professional)

Overloading - obesity , muscle imbalance ,

muscle weakness, bad posture

Osteoporosis - Relative overloading

PathologyViscoelasticity of cartilage &

subchondral bone

Stabilization & shock absorption by timely contraction of muscles during activity.

Pathology Increased intra-articular stress

Hypertrophic repair of cartilage

Thinning & softening of cartilage

Fibrillation- fragmentation

Loss of cartilage - exposure of bone – vascular penetration of cartilage

Pathology Subchondral bone

Micro fractures , osteo-necrosis

Healing with micro callus focal vascular remodeling-

Subchondral sclerosis

Marked stasis of blood flow

Intra osseous hypertension - pain

Bony thickening & enlargement

- osteophytes

Pathology Loss of joint space

Synovial thickening & effusion

Thickening of joint capsule

Muscle wasting

Contractures & deformities

Loss of alignment of vertebral column

Reduction of movements & function

Degenaration Hemi vertebra

POSTURAL CORRECTION

Conclusion

Avoid Abnormal loading by

Regular exercise Maintain physiology

Correct posture Alignment

Correct muscle tone Stability

Balanced diet Deficiencies

Control weight Overloading

Avoid repetitive cyclical loading

Pain free Back