MSK growth and repair Flashcards
(102 cards)
1
Q
What is a ligament
A
Dense band of collagenous tissue spanning a joint
Connects bone to bone
Gives joint stability
Multiple at joint
2
Q
What is the structure of a ligament?
A
Type 1 collagen fibres Contain fibroblasts for communication Contain sensory fibres (proprioception/stretch) Have surface vesells Are crimped allow for stretching
3
Q
When does a ligament rupture occur?
A
When force exceeds strength of ligament
Either expected or unexpected
4
Q
What are the types of ligament rupture?
A
Can be complete or incomplete
5
Q
What are the side effects of a ligament rupture?
A
Pain
Stability loss
Proprioception loss in joint
6
Q
How does the haemorrhage caused by ligament rupture heal?
A
Blood clot that is reabsorbed
The replaced with heavy cellular infiltrate
Has hypertrophic vascular response
7
Q
What happens to the scar tissue produced by a ligament healing?
A
The disorganised connective tissue matrix becomes more ligament light
Although still has major differences in composition and function
8
Q
How do you treat a ligament injury?
A
Conservative or operative
Conservative if parital, no instability or cannot have surgery
Operate on sportsmen If multiple (and therefore compulsary) Joint instability
9
Q
What are the layers to a tendon?
A
Collagen bundles covered by endotenon
Make up fascicles covered by paratenon
Make up tendon covered by epitenon
10
Q
Where are teh blood vessels in a tendon located?
A
In paratenon
11
Q
How are tendons connected to their sheath?
A
By vinicula
12
Q
What do the tendon sheaths contain?
A
A synovial lining + fluid for lubrication
13
Q
What is the function of a tendon?
A
Flexible and very strong tension to allow for movement
14
Q
What does immobility lead to?
A
Reduced water content
Reduced glycosaminoglycan concentration
Reduced strength
15
Q
What are the types of tendon injury?
A
degeneration inflammation enthesiopathy traction apophysitis avulsion bone fragment * tear - intrasubstance (rupture) * tear - musculotendinous junction laceration/ incision crush / ischaemia / attrition nodules
16
Q
What is tendon degeneration?
A
Intrasubstance mucoid degneration
May be swollen, painful tender
Maybe asymptomatic
17
Q
What are the symptoms of tendon inflammation?
A
Swollen Tender Hot Red Positive Finklestein test
18
Q
What tendons are likely to become inflamed?
A
EPB
APL
Tendons through common tendon sheath at radial aspect of wrist
19
Q
What is enthesiopathy?
A
Inflmmation at insertion to bone
20
Q
Where is enthesiopathy likely to take place in a muscle?
A
The muscle origin rather than tendon insertion
Lateral humeral epicondylitis is a common example
21
Q
What is traction apophysitis?
A
Where excessive pull by a large tenson causes damage to unfused apophysis
Recurrent load leading to inflammation
22
Q
Who is likely to get traction apophysitis?
A
Adolescent active boys
23
Q
What are some examples of traction apophysitis?
A
Osgood-Schlatter’s disease
Sever’s disease
Sinding Larsen’s disease
24
Q
What is avulsion?
A
Where a structure is forcibly detached from it’s nomral point of insertion
I.e bone/ligament detachment leaving a fragment
25
How do you treat avulsion
Conservative - limited application
| Operative - reattachment /fixation
26
What is an intrasubstance tendon rupture?
Where the tendon ruptures
| Happens when load exceeds failure strength
27
What are the signs in an achilles tendon rupture?
Positive simmonds test (squeeze test)
| Palpable tendon gap
28
What is a musculotendinous junction tear?
Where the joint between the tendon and its muscle tears
| Often partial
29
How do you treat tendon ruptures?
```
Conservative - splint/cast
Mobilise
Operative - ends cannot be opposed
High risk of rereupture
High activity
```
30
How do you treat lacerations of tendons?
Repair surgically and quickly
| More common in young adults and men
31
What is the structure of a nerve?
Axons, coated in endoneurium, bundled into fascicles which are bundled into form a nerve
Fasciles covered in Perineurium
Epinerium for nerve
32
What is the speed of an Aa neurone?
60-100m/s
33
What is the function of an Aa neurone?
Large motor axons
| Muscle stretch + tension seconsry axons
34
What is the speed of Ab neurones?
30-60m/s
35
What is the function of an Ab neurone?
Touch
Pressure
Vibration
Prioprioception
36
What is the function of an Ay neurone?
Gamma efferent motor neruones
37
What is the speed of an Ay neurone?
15-30m/s
38
What is the function of an Ad neurone?
Sharp pain
Light touch
Temperature
39
What is the speed of an Ad neurone?
10-15m/s
40
What is the function of a B neurone?
Sympathetic preganglionic motor neurones
41
What is the speed of a B neurone?
3-10m/s
42
What is the speed of a C neurone?
<1.5m/s
43
What is the function of a C neurone?
Dull, sching or burning pain
| Temperature sensation
44
What are teh types of periheral nerve injury?
Compression
| Trauma (direct or indirect)
45
What are some examples of compression injuries?
Entrapment
"Classical conditions"
Carpal tuinnel syndrome (median nerve at wrist)
Sciatic (spinal root by intervertebral disc)
Mortons neuroma (digital nerve in 2nd/3rd webspace of foot)
46
What are the three types of trauma injury?
Neurapraxia
Axontmesis
Neurotmesis
47
What is neurpraxia?
A reversible conduction block caused by stretching or bruising
There is local ischaemia and demyelination
Good prognosis
48
What is axonotmesis?
Disruption of axons but endoneurium intact
| Often due to being stretched, crushed or direct blow
49
What is the prognosis of axontmesis?
Okay - sensory often recover better than motor
| May not go back to normal
50
What follows axonotmesis?
Wallerian degeneration
51
What is neurotmesis?
A complete nerve division, often caused by laceration or avulsion
Endoneural tubes disrupted
52
What is the prognosis of neurotmesis?
No recovery unless repaired (graft/suture)
Even under repair "miswiring" common
Prognosis poor
53
What is a closed nerve injury?
Associated with nerve injuries in continuity (neuroprains/axontmesis)
Spontaneous recover possible
54
When is surgery indicated in a closed nerve injury?
After 3 months if no recovery identified
55
What is an open nerve injury?
Frequently nerve division (often knife etc)
| Distal portion dies (wallerian degneration)
56
How do you treat an open nerve injury?
Early surgery
57
What are the clinical features of a nerve injury?
Dsysaethesia (in sensory neurones)
In motor - paresis/paralysis + wasting
Dry skin due to no sweat gands
Reflexes - diminished or absent
58
How do nerve injuries heal?
Distal nerve dies under wallerian degeneration
Myelin sheath degrades
Proximal axonal budding occurs after 4 days
Regeneration at 1mm/day
Pain is first modality to return
59
What is the prognosis for recovery from a nerve injury?
Dependant on if pure or mixed
| How distal the lesion is (further the better)
60
What is Tinels sign?
Tap over site of nerve
| Paraesthesia felt as distially as nerve recovered
61
When would you do a direct nerve repair?
In laceration
No loss of nerve tissue
Bundle repair
62
When would you use a nerve graft?
In nerve loss
Or late repair
Use sural nerve often
63
What is the rule of 3?
Immediate surgery within 3 days for sharp/clean injuries
Early surgery within 3 weeks for blunt injuries
Delayed (3 months) surgery for closed injury
64
What are the differences between cortical and cancellous bone?
Cortical bone found in diabpysis of bone
Resists bending + torsion
Circumfrentially laid
Less biologically active
Cancellous
Found in metaphysis of bone, resists compression
Site of longitudinal growth
Biologically active
65
What is the diaphysis?
The shaft of a bone
66
What is the metaphysis and epipphysis?
Metamysis is flare at end of shaft
| Epiphysis is on the joint side of physis
67
Where is the medullary canal found?
In the central cavity of the bone
68
What is a fracture?
Break in continuity of bone
| Could be crack, break, split, crumpling or buckle
69
What can lead to a fracture (the bone failing)?
High energy transfer in normal bones
Repetive stress in normal bones (stress #)
Low energy in abnormal bones (osteoporosis, ostemalacia etc)
70
What happens to the bone in a fracture?
```
Mechanical + structural failure of bone
Disruption of blood supply
Regenerative process (no scar)
```
71
What are the four stages to fracture repair?
Inflammation
Soft callous stage
Hard callous stage
Bone remodelling
72
What happens in the inflammation stage of fracture healing?
```
Begins immediately after #
Forms haematoma and fibrin clot
Lots of blood cells and by products f cell death
Angiogensis starts if hypoxic
Osteogenic induction of cells
```
73
How might we help the inflammation stage of fracture healing?
NSAIDs
| Treat aemotoma in open fractures with surgery
74
What is the soft callus stage of fracture healing?
Begins when pain/swelling subside
Lasts until bony fragments united by fibrous tissue/cartilage
Some stability of fracture
Continued increase in vascularity
75
How might we assits the soft callus stage of fracture healing?
Replace cartilage with demineralised bone matrix
| Use bone graft
76
What is the hard callus stage of fracture healing?
Conversion of cartilage to woven bone
Typical in long bone fracture -
Increased rigidity although obvious callus
77
What is the bone remodelling stage of fracture healing?
Conversion of woven bone into lamellar bone
Medullary canal reconstituted
Bone responds to loading characteristics
78
What ca cause delayed union?
```
High energy union
Distraction (increased osteogenic jumping)
Instability
Infection
Steroids
Immune suppresants
Smoking
Warfarin
NSAIDs
Ciprofloxacin
```
79
What is non-union?
Failure for fracture to heal
80
What can cause non-union?
```
failure calcification of fibrocartilage
instability
-excessive osteoclasis
abundant callus formation
pain + tenderness
persistent fracture line
sclerosis
```
81
What is an open fracture?
Direct communication between external environent and fracture
82
Why are open fractures significant?
Increased infection rate
Soft tissue complications common
Higher energy injury
Long term morbidity
83
What are the types of open fracture?
type 1 - clean and simple, <1cm
Type 2 - wound 1cm+ with soft tissue damage, simple fracture pattern
Type 3 - extensive soft tissue damage, complex fracture pattern
84
What are the features of a type 3 open fracture?
High energy
wound 10cm + often
Extensive soft tissue damage
85
What are the subtypes of type 3 open fracture?
A - adequate periosteal coverage (not grossly contaminated)
B - tisse loss requiring soft-tissue coverage procedure (graft etc) - extensive muscle damage
C- vascular injury needing repair - neurovascular complication
86
What are the tibial fracture patterns?
Transverse/short oblique tibial fractures with fibular fractures
Tibial fractures with communication with fibular fractures
Segmental tibial fractures
Fracutes with bone loss (either extrusion or debridement)
87
What are soft tissue injury patterns in a tibial fracture?
skin loss that tension free closure not possible
Degloving
Injury to muscles requiring excision via wound extensions
Injury to 1+ major arteries in leg
88
How do you manage a complex open fracture?
Full advance trauma life support assesment + treatment
Tetanus + antibiotic prophylaxis
Repeated neurovascular status examination
Wounds only handled to remove gross contamination
89
What are the indications for surgery?
```
Polytraumatise patient
Marine/farmyard environment
Gross contamination
Neurovascular compromise
Compartment syndrome
```
90
When debriding and fixing (surgery) what is looked for?
```
4 Cs
Colour
Contraction
Consistency
Capacity to bleed
```
91
Who deals with skin coverage issues?
Plastic surgeons
| Grafting
92
When is amputation considered?
Insensate limb/foot
Irretrivable soft tissue or bony damage
Other life threatening issues
dual constultant decision
93
What is a dislocation?
Complete joint disruption
94
What is subluxation?
Partial dislocation (not fully outside joint)
95
How do you diagnose dislocation?
Clinically + radiological
| Associated injuries - neurovasculat damage, soft tissue/msk damage
96
How do you treat dislocation
Relocation
| Surgery if required
97
What dislocations can occur at the shoulder?
Anterior - squared off
| Posterior - locked in internal rotation
98
What dislocations can happen at the elbow
Posterior - olecranon prominent posteriorly
99
What dislocations can happen at the hip?
Posterior - Leg short, flexed
Internal rotation
Adduction
100
What dislocations can occur at the knee?
Anteroposteriorly
| Loss of normal contour, extended
101
What dislocations happen at ankle?
Lateral most common - externally rotated
| Prominent medial malleolus
102
What locations occur at subtalar joint?
Lateral most common - displaced calcis (heel)
