Fascia/Fibromyalgia

Question 1

What is fascia? Describe its activity, function, and primary origin.

Answer 1

Definition: Diffuse, irregular fibrous CT holding all tissues together

• Metabolically active -
• Innervated and vascularized
• Has contractile ability
• Critical to wound healing/repair
• Mesodermal origins

Question 2

Pannicular Fascia (Hypodermis) 
What is its location?

Answer 2

Deep to epidermis/dermis

Question 3

Pannicular Fascia (Hypodermis) 
Origin?

Answer 3

Somatic mesoderm

Question 4

Pannicular Fascia (Hypodermis) 
Constructed of what?

Answer 4

Loose/dense irregular CT w/ variable fat contect

Question 5

Pannicular Fascia (Hypodermis) 
Function?

Answer 5

Facilitates movement/immune surveillance, insulate, store fat

Question 6

Pannicular Fascia (Hypodermis) 
What muscles insert into it?

Answer 6

Facial muscles

Question 7

Pannicular Fascia (Hypodermis)
Name in the abdomen? Another name for it elsewhere?

Answer 7

Camper’s Fascia, superficial fascia

Question 8

Investing Fascia

Two other names?

Answer 8

Axial/appendicular fascia, Deep Fascia

Question 9

Investing fascia

Where does it fuse? What does it surround?

Answer 9

Fuses to panniculus peripherally extending out from the body having surrounded epaxial (dorsal deep spinal muscles) and hypaxial muscles (all other muscles)

Question 10

Investing Fascia

Surrounds what structures?

Answer 10

Entire muscle fiber bundle (Epimysium) and intermuscular septa, Bones (periosteum), Tendons (peritendon), Sheaths of neurovascular bundles (e.g. axillary sheath)

Question 11

Epaxial muscles groups are innervated by what nerve bundle?

Answer 11

Dorsal root peripheral nerve

Question 12

Investing fascia are connected to which layers of fascia surrounding muscle?

Answer 12

All of them

Epi, peri, endomysium

Question 13

What attaches the investing fascia to the periosteum?

Answer 13

Sharpey’s fibers

Question 14

What four muscle’s fascia composes the thoracocolumbnar fascia?

Answer 14

Gluteus maximus
Gluteus medius
External oblique
Latissimus dorsi

Question 15

What is a myofascial meridian?

Answer 15

e.g. Superficial back line

Single line of fascia connected from the toes to the eyebrows.

Question 16

Meningeal fascia surrounds what?

Answer 16

CNS

Question 17

Meningeal fascia is composed of what layers?

Answer 17

Dura and leptomeninges (arachnoid, pia mater)

Question 18

Meningeal fascia is derived from what?

Answer 18

Somatic/cephalic mesoderm and neural crest cells (in neuroectoderm; telencephalic meninges)

Question 19

Where does the meningeal fascia terminate?

Answer 19

Peripherally with the epineurium surrounding the peripheral nerves, but it is continuous with the epineurium of the peripheral nerves. No clear boundary.

Question 20

What is visceral fascia derived from?

Answer 20

Splanchnic mesoderm

Question 21

What does visceral fascia surround? What 3 big thoracic cavities are surrounded by visceral fascia (3P’s) and what are the fascia cavity names?

Answer 21

Body cavities -
Pleural - endothoracic fascia
Pericardial
Peritoneal - endoabdominal, transversalis fascia, endopelvic fascia)

Question 22

Near the head, the visceral fascia invests what muscle group and connects them to what structure? What are the two group names?

Answer 22

1. Superior pharyngeal constrictors - fuses them to cranial base - surrounds attachments of superior pharyngeal constrictor muscles
2. Pharyngobasalar, pharyngobuccal

Question 23

The visceral fascia fold over to form what “ligaments” in the thorax and abdomen?

Answer 23

Pulmonary ligaments, broad ligaments of uterus, ligament of Trietz

Question 24

What cells are commonly associated with fascia?

Answer 24

Fibrocytes, Fibroblasts, Myofibroblasts, Macrophages, Mast cells

Question 25

What do fibroblasts secrete? What do these compounds contain?

Answer 25

Synthesize ECM proteins (collagen, elastin, fibronectin) and ground substance (contain GAGs, proteoglycans, hyaluronic acid, glycoproteins)

Question 26

What do fibroblasts respond to and how?

Answer 26

Tension, growth factors (TGF-ß), and inflammatory substances - increase collagen

Question 27

What do fibrocytes do?

Answer 27

Maintain CT

Question 28

What are myofibroblasts?

Answer 28

Differentiated fibroblasts similar to smooth muscle

Question 29

What do myofibroblasts respond to and do?

Answer 29

Respond to TGF-ß; Synthesize/secrete collagen and facilitate wound healing

Question 30

Macrophages are active during what processes in fascia? What is their fxn?

Answer 30

Inflammatory and infectious processes - clean up cellular waste - release TGF-ß1

Question 31

Mast cells secrete what? What macrophage-like function do they have?

Answer 31

Secrete histamine (vasodilate) and heparin (anticoagulate) - secrete proinflammatory cytokines - phagocytosis

Question 32

Collagen and elastin provide what in the ECM of CT?

Answer 32

Tensile strength and recoil

Question 33

Ground substance allow what stresses in CT? What cellular fxn relies on ground substance?

Answer 33

``` Compression and expansion Cell adhesion (GAGs - chondroitin, heparin, hyaluronic acid) ```

Question 34

Pannicular fascia contains what mechanoreceptors and what is their function?

Answer 34

Ruffini - fast adapting proprioception Pacini - fast adapting vibration, proprioception Golgi-Mazzoni - slow adapting muscle tension

Question 35

Contractility of fascia is regulated by what factors?

Answer 35

Innervation and cell to cell communication

Question 36

TGF-ß overproduction can lead to what? How?

Answer 36

Fibrosis - persistent irritation = sustained growth factor supply = too many myofibroblasts = too much collagen = fibrosis

Question 37

During the hemostasis stage of healing, what is the timeline, and what is the main cell involved?

Answer 37

Hemostasis - immediately after injury - platelets and RBCs

Question 38

During the inflammatory stage of healing, what is the timeline, and what is the main cell involved?

Answer 38

Inflammation - days 1-5 - neutrophils and macrophages

Question 39

During the proliferative stage of healing, what is the timeline, and what is the main cell involved?

Answer 39

Proliferation - days 5-21 - lymphocytes, fibroblasts, keratinocytes, endothelial cells

Question 40

During the remodeling stage of healing, what is the timeline, and what are the main cells involved?

Answer 40

3 weeks to 2 years - fibroblasts

Question 41

What is a myofascial trigger point?

Answer 41

Discrete, hypersensitive nodule w/in tight bands of muscle or fascia

Question 42

What is the difference between a latent or active myofascial trigger point? Why do they develop?

Answer 42

Latent does not cause spontaneous pain unless palpated - may restrict movement/cause weakness Active causes pain at rest - most commonly in postural support muscles - They develop as a result of mechanical stress (trauma)

Question 43

49 year old female Pt presents with debilitating fatigue, chronic aches and pains globally in soft tissue, sleep disturbance, tender points, headaches, migraines, and IBS. She has an Hx. of depression. You evaluate her to find at least 11 of 18 associated tender points are present on her body. What is her likely diagnosis?

Answer 43

Fibromyalgia