119 Shoulder trauma Flashcards Preview

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Flashcards in 119 Shoulder trauma Deck (55):
1

What is this?

Hill-Sach's lesion - when the posterior part of the humeral head hits the glenoid head during dislocation causing a cortical depression #

2

What is an apprehension test in Msk?

Placing the humeral head in a position of imminent subluxation or dislocation which makes the pt recognise the familiar pattern of instability and react with anticipated fear.

3

What is classed as a recurrent dislocation?

>3 dislocations

4

Which nerve supplies the biceps brachii, coracobrachialis and brachialis?

Musculocutaneous

5

What area is of skin is supplied by the axillary nerve?

Regimental badge area

6

What is the clinical presentation of damage to the ulnar nerve?

Ulnar claw

7

What is the risk of dislocation of the SC joint in a posterior direction?

Damage to the big vessels posterior to the joint

8

What runs in the bicipital groove?

Long head of biceps tendon

9

Which ligament is the strongest?

  • AC
  • coracoclavicular

 

Coracoclavicular

10

What is the direction of the humeral head during an anterior dislocation?

Antero-inferior

11

What is a Bankart lesion?

Labral tear from the glenoid

12

Which muscle is weakened following damage to the axillary nerve?

Which muscle compensates in this situation?

  • deltoid
  • trapezius compensates

 

13

What is a prefixed brachial plexus?

Contribution of anterior ramus of C4 

14

What does a lesion to the upper parts of the brachial plexus cause?

Erb's palsy

15

What does a lesion to the lower parts of the brachial plexus cause?

Klemperer palsy - results in ulnar claw

16

What can deposits of pyrophosphate from tendons cause if they're shed into the subachromial bursa?

Bursitis with severe pain and shoulder restriction

17

  • What is adhesive capsulitis?
  • When can it develop?

  • Frozen shoulder 
  • Following
    • rotator cuff injuries
    • hemiplagia
    • chest/breast surgery
    • MI

18

What are the differences between young and mature cartilage?

  • young:
    • abundent in cells
    • low ECM
    • no tide mark
    • no zonal morphology

 

19

What does the the tidemark in articular cartilage restrict?

Chondrocytes access to nutrients from the vasculature of the subchondral bone

20

Where does cartilage get its nutrients from?

Synovial fluids from synovial capsule vessels

21

What are the changes which happen in articular cartilage with ageing?

(5 listes)

  1. cell metabolism slows and number decreases
  2. collagen matrix proteins cross-link
  3. reduction in type IX collagen
  4. biochemical changes in aggrecan
  5. degradation products decrease

 

22

What is formed by the modification of hydroxyl using residues in the collagen chains?

Pyridinoline cross-links in mature cartilage

23

What is the role of transglutaminases in mature cartilage?

Enzymatically cross-link martix proteins (between lysine and glutamine)

24

What are the changes to chondroitin sulphate in ageing cartilage?

They become shorter

25

What changes happen to the keratan sulphate as cartilage ages?

Increases in size

26

Name 2 types of matrix proteinases

  • ADAMTS
  • metalloproteinases

 

27

Which 2 minerals are required for MMPs and ADAMTS?

Zinc and/or calcium

28

What are the 4 types of MMPs in cartilage metabolism?

  1. collagenases
  2. gelatinases
  3. stromelysins
  4. membrane bound MMPs

 

 

29

What are the 2 principal matrix proteinases for aggrecan metabolism?

  • ADAMTS4
  • ADAMTS5

30

Why does articular cartilage lack a perchondrium?

Perichondrium contains bvs and nerves - cartilage needs to remain avascular and aneural to be able to function in resisting compressive loads - would occlude vbs.

31

What is the classic first sign of OA in cartilage?

Surface fissures in the articular cartilage + chondrocyte clustering

32

What is the territorial matrix in hyaline cartilage?

The matrix immediately surrounding the cells

33

What is the name of the cavity in which the chondrocytes lie?

Lacunae

34

Where can elastic cartilage be found?

Epiglottis

External ear

External auditory canal

35

Apart from IVD, where else is fibrocartilage found?

Ligament/tendon entheses + anywhere tendon presses against bone

36

What is synovium?

  • Thin membrane in synovial joints which lines the joint capsule
  • 1-3 layers of macrophage and fibroblast-like cells which produce the synovial fluid

 

37

What are Benninghoff arcades?

Collagen fibre organisation in articular cartilage

38

What makes up the 'wet' weight of articular cartilage?

(5 listed)

  • 70% water
  • 20% collagens
  • 7% PGs
  • 2% cells
  • 1% other proteins

 

39

What makes up the 'dry' weight of articular cartilage?

  • 75% collagens
  • 22% PGs
  • 3% other proteins

 

40

What type of collagen is type IX? Function?

FACIT collagen - binds to type II collagen and is important in organisating fibrils

41

What is the function of the N globular domain in type IX collagen?

Anchors type II to the other matrix components

42

Where else in the body does type IX and type II interact?

  • Cornea 
  • vitreous humour of the eye

 

43

Where is type VI collagen found?

In pericellular matrix - forms hine fibrils in lacunae and around cells

44

What is collagen type XI involved with?

Fibril nucleation

45

Name 3 small leucine rich PGs

  • decorin
  • biglycan
  • fibromodulin

 

46

Which chemical groups link GAGs to protein cores in cartilage? 

(2)

  • Hydroxyl groups of serine/threonine
  • Amine groups of asparagine

47

Which groups on the GAGs provide them with polyanionin properties?

  • carboxyl
  • sulphate

48

What is the role of biglycan and where is it found?

  • Small leucine rich PG 
  • found in per-cellular regions 
  • binds GFs near cell surface receptors

 

49

What are canaliculi?

Canals which house long cell processes of the osteocytes which communicate via gap junctions

50

What lies in the spaces between the trabeculae?

Bone marrow

51

What are trabeculae composed of?

Lamallae of bone with lacunae containing osteocytes

52

From which type of cell are osteocytes derived from?

Osteoblasts

53

Which cell type is responsible for resorbing bone?

Osteoclasts

54

What is osteoid?

Uncalcified matrix in developing spongy bone

55

What is a Howship's lacuna?

How is it formed?

  • Lacuna in which the osteoclast lies 
  • result of bone erosion activity of the osteoclast