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LOCO2 > Soft Tissue Conditions > Flashcards

Soft Tissue Conditions Flashcards

1
Q

What is the boundary between skeletal muscle and a tendon called

A

Myotendinous junction

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2
Q

Why do tendons repair poorly

A

Relatively avascular

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3
Q

What is the difference between tendinitis and tendinosis

A

Tendinitis is acute
Tendinosis is chronic

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4
Q

Tendinitis

A

Small tears in a tendon causing localised inflammation

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5
Q

Tendinosis

A

Chronic tendon degeneration in response to chronic injury and failed healing leading to disordered collagen

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6
Q

Tendinitis and tendinosis causes

A

Overuse
Collagen disorders
Renal dialysis

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7
Q

How is renal dialysis linked to tendon problems

A

Kidney failure effect collagen
Pt may be put on steroids

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8
Q

Tendinitis and tendinosis treatment

A

RICE
analgesia + NSAIDs
Stretching
Surgery

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9
Q

What does RICE stand for

A

Rest
Ice
Compression
Elevation

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10
Q

Heterotopic calcification

A

Bone formation in soft tissues
Can occur in tendon injuries

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11
Q

How are COX2 and prostaglandins involved in formation of heterotopic bone

A

COX2 causes chondrocyte differentiation from mesenchymal stem cells
prostaglandins causes chondrocyte hypertrophy

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12
Q

Process of heterotopic bone formation

A

Chondrocyte differentiation -> chondrocyte hypertrophy -> osteoclast recruitment + osteogenesis + angiogenesis

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13
Q

Which type of drugs decreases hypertropic bone formation by >50% and how

A

NSAIDs
Prevent chondrocyte differentiation by inhibiting COX2- 1st step in heterotopic bone formation

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14
Q

Why is calcification of a tendon harmful

A

Tendon more brittle
More prone to rupture

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15
Q

Do exposed or sheathed tendons heal more easily and why

A

Exposed heal more easily - can recruit systemic repair cells, sheathed tendons can only recruit cells within tendon sheath

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16
Q

Which type of tendon healing improved by cast immobilisation

A

Tendon-to-bone healing
Detrimental to flexor tendon healing

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17
Q

Which type of tendon healing is improved by passive motion

A

Flexor tendon healing
Detrimental to tendon-to-bone healing

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18
Q

Difference between extrinsic and intrinsic tendon healing

A

Extrinsic - peripheral fibroblasts - in exposed tendons
Intrinsic - fibroblasts from within tendon - in sheathed tendons

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19
Q

Is immobilisation generally good for tendon healing

A

No - healing usually takes longer + more long term damage

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20
Q

Enthesis

A

site of attachment of tendon, ligament, fascia, or capsule to bone

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21
Q

2 types of enthesis

A

Fibrous
Fibrocartilaginous

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22
Q

Difference between fibrous and Fibrocartilaginous enthesis

A

Fibrous - fibrous tissue extends all the way up to bone
Fibrocartilage - section of fibrocartilage at attachment site

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23
Q

Are fibrous or Fibrocartilaginous enthesis better at dissipating stress

A

Fibrocartilagenous

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24
Q

Sharpey fibres

A

Collagen bundles from a tendon which travel through the periosteum and insert into bone

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25
Q

Which type of enthesis has a more gradual change in material properties

A

Fibrocartilage

26
Q

Ethesitis

A

Inflammation of the enthesis

27
Q

Enthsitis causes

A

Recurring stress
Autoimmune disease

28
Q

Which autoimmune conditions are associated with enthesitis

A

Spondyloarthritides
HLA B27 arthopathies

29
Q

How does mechanical trauma cause pathogenesis of enthesitis

A

Transcortical vessels in bone at enthesis insertion point become infkammed causing influx of immune cells and formation of osteobkasts

30
Q

Why does enthesitis cause bone spur formation and how do bone spurs make enthsitis worse

A

Transcortical vessel inflammation causes oesteoblasts to form bone
Bone spurs rub against and irritate tendons

31
Q

What is the main immune cell in enthesitis

A

Neutrophils

32
Q

Difference between enthesophytes and osteophytes

A

Enthesophytes originate from insertion of joint capsule, ligament, or tendons
Osteophytes originate from border of articular cartilage

33
Q

Are enthesophytes or Osteophytes found at the articular border

A

Osteophytes

34
Q

Enthesitis treatment

A

RICE
NSAIDs
Sulfasalazine, methotrexate - treat associated arthritis
Anti TNF - severe autoimmune enthesitis only
Local radiotherapy
Corticosteroid injections
Hyperosmolar dextrose injections

35
Q

Why is local radiotherapy used in enthesitis

A

Kill heterotrophic chondrocytes

36
Q

How does Hyperosmolar dextrose injections help enthesitis

A

Initiate proliferation of intrinsic fibroblasts increasing the ration of fibroblasts to osteoblasts

37
Q

Ankylosing spondylitis

A

Enthesitis of IVDs and anterior longitudinal ligament

38
Q

Difference in location of tendinitis and enthesitis

A

Tendinitis in belly of tendon
Enthesitis in insertion point of tendon

39
Q

Function of tendon sheath

A

Cushions tendons
Guides tendons
Provides nutrition to tendons - synovial fluid + vincula blood supply

40
Q

Tenosynovitis

A

Inflammation of the synovium around a tendon

41
Q

De Quervains tenosynovitis

A

Fibrosis and narrowing of the tendon sheath caused by tendons and sheath rubbing over radial styloid process

42
Q

Which tendons are involved in de quervains tenosynovitis and where is pain felt

A

EPB + EPL
lateral wrist + 1st dorsal compartment of hand

43
Q

Trigger finger

A

Enlargement of a tendon in the hand within the sheath locking the finger in flex ion

44
Q

What pathology does ficklesteins test test for

A

De quervains tenosynovitis

45
Q

How is ficklesteins test performed and what if a positive result

A

Pt holds hand in fist and doctor moves fist in ulnar deviation
Positive - pain up medial arm

46
Q

Tenosynovitis treatment

A

RICE
splinting
Anti inflammatories
Corticosteroid injections
Surgery

47
Q

How is trigger finger treated surgically

A

Cut annular ligament

48
Q

How is de quervains treated surgically

A

Shave down radial styloid process or cut sheath

49
Q

What type of condition are trigger finger and de quervains

A

Tenosynovitis

50
Q

Systemic lupus erythematosus

A

Multisystem chronic disorder caused by ANA antibodies against intranuclear proteins

51
Q

SLE signs and symptoms

A

Fatigue
Fever
Arthralgia
Weight chages
Migratory asymmetrical pain
Malar facial rash in butterfly pattern
Discoid lesions
Slope is
Renal nephrotic disease
Neuropsychiatric problems
Pulmonary problems
GI problems
Cardiac problems
Haematological problems

52
Q

What type of antibodies cause SLE

A

anti nuclear antibodies

53
Q

What tissues are damaged by immune complexes in SLE

A

Blood vessels
CT

54
Q

SLE pathogenesis

A

DNA released in response to damage -> taken up by APCs -> autoimmune response

55
Q

Jaccoud arthropathy

A

Chronic non erosive joint disorder caused by inflammation of the joint capsule and subsequent fibrotic retraction, causing ulnar deviation of the fingers
Usually caused by lupus

56
Q

What joint condition do 90% of SLE pts develop

A

Arthritis

57
Q

Why is jaccoud arthropathy reducible

A

No bony deformity

58
Q

2 main patterns of ANAs in SLE

A

Homogenous
Speckled

59
Q

SLE treatment

A

Prevent trigger exposure
NSAIDs
DMARDs
Corticosteroid for flares
IV immunoglobulins

60
Q

Potential SLE triggers

A

UV light
Viruses

61
Q

Belimumab MOA for SLE treatment

A

Inhibits BAFF
( BAFF causes B cells to mature and make antibodies)

62
Q

Rituximab MOA for SLE

A

CD20 blocker
(CD20 found on B cells - causes B cells to apoptose)

LOCO2 (26 decks)

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