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Year 3 MSK (JK) > MSK - growth, injury and repair > Flashcards

MSK - growth, injury and repair Flashcards

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1
Q

Give a brief description of a ligament

A

dense bands of collagenous tissue which are anchored to bone at each end and allow joint stability

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2
Q

Type of collagen fibres in ligaments

A

1

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3
Q

5 components of the structure of a ligament

A 
type 1 collagen 
vessels at the surface 
fibroblasts
sensory fibres 
crimping to allow stretch
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4
Q

4 differences in ligaments compared to tendons

A

less % of collagen and less organised
higher % of proteoglycans and water
rounder fibroblasts

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5
Q

When does ligament rupture occur?

A

when forces exceed the strength of ligament

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6
Q

3 phases of ligament healing

A

haemorrhage
proliferative phase
remodelling

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7
Q

Describe the haemorrhage stage of ligament healing

A

blood clot
replaced with heavy cellular infiltrate
hypertrophic vascular response

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8
Q

describe proliferative phase of ligament healing

A

scar tissue

disorganised collagenous connective tissue

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9
Q

describe the remodelling of ligament healing

A

matrix becomes more ligament like

major differences persist

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10
Q

Treatment of ligament rupture and reasons for this

A

conservative if partial/no instability/poor candidate
operative –> replace or augmentation
–> expectation ie sportsman, instable or compulsory/multiple

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11
Q

Where is cortical bone found in a bone?

A

diaphysis

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12
Q

what does cortical bone resist?

A

bending and tension

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13
Q

How is cortical bone laid down?

A

circumferentially

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14
Q

Is cortical or cancellous bone more biologically active?

A

cancellous

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15
Q

Where in a bone is cancellous bone found?

A

metaphysis

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16
Q

What does cancellous bone resist?

A

compression

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17
Q

sign for a fracture

A

#

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18
Q

3 reasons why bones fail

A

high energy transfer in normal bones
repetitive stress in normal bones –> stress fracture
low energy transfer in abnormal bones eg osteoporosis

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19
Q

4 stages of fracture regeneration

A

inflammation
soft callus
hard callus
bone remodelling

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20
Q

Inflammation in fracture healing brief description

A

occurs immediately after with a haematoma and fibrin clot

platelets, PMN, neutrophils, MO, monocytes

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21
Q

What are the by products of cell death in stage 1 of fracture healing?

A

lysosomal enzymes

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22
Q

Where are mesenchymal and osteoprogenitor cells derived?

A

transformed endothelial cells from medullary canal and or periosteum

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23
Q

Requirement for angiogenesis and macrophages producing angiogenic factors

A

low oxygen gradient

hypoxic conditions

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24
Q

How may we affect the inflammation phase of fracture healing?

A

NSAIDs
loss haematoma - open fractures and surgery
extensive tissue damage - poor blood supply

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25
4 growth factors in buffy coat platelet concentrates
IGF VEGF TGF-B PDGF
26
When does soft callus of fracture healing begin and end?
when pain and swelling subside | bony fragments united by collagen/fibrous tissue
27
angulation
abnormal bend
28
How might we affect soft callus phase?
replace cartilage | jump straight to bone - graft
29
Is autogenous cancellous bone graft osteoinductive or conductive?
both
30
Is allograft bone osteoconductive or inductive?
osteoconductive
31
Risk of allograft bone
disease transmission
32
Brief description of hard callus
cartilage --> woven bone | endochondral and membranous bone formation
33
Bone remodelling
woven bone --> lamellar bone
34
What law does bone remodelling follow?
wolff's
35
Best way to express instability
magnitude of strain - % change of initial dimension
36
What happens if strain is too low?
mechanical induction of tissue differentiation fails
37
What happens if strain is too high?
healing process does not progress to bone formation
38
10 things which can lead to delayed union
``` instability NSAIDs warfarin ciprofloxacin smoking steroids high energy injury distraction infection immune suppressants ```
39
6 reasons for non union
``` failure of calcification fibrocartilage instability --> increased osteoclasis pain and tenderness abundant callus formation sclerosis persistent fracture line ```
40
3 alternatives if healing delayed
different fixation bone graft dynamization
41
Fibres named when tendon inserts into bone
sharpeys fibres
42
Arrangement of tenocytes
longitudinal
43
collagen type in tendon
1
44
State which each of these is covered by a- collagen bundles b - fascicles c - tendon
``` a = endotendon b = paratenon c = epitenon ```
45
How are tendon connected to sheath in flexor tendon in palm?
vincula
46
Thickenings of tendon sheath form?
annular pathways - pulleys
47
function of tendon sheath
flexible and very strong in tension
48
What does immobility do to water content and glycosaminoglycan concentration and strength?
reduce
49
Name 10 tendon injuries
``` degeneration nodules inflammation laceration/incision avulsion +/- bone fragment enthesiopathy ischaemia traction apophysitis tear - intrasubstance/rupture tear - musculotendinous junction ```
50
Tendon degeneration
mucoid degeneration swollen, pain, tender or no symptoms precursor to rupture
51
positive test in de Quervains stenosing tenovaginitis
finklestein
52
Where does enthesiopathy occur? eg..
muscle origin | common extensor origin at lateral humeral epicondyle - tennis elbow
53
traction apohpysitis example and explain
Osgood schatters disease insertion of patellar tendon into anterior tibial tuberosity active adolescent boys recurrent load and inflammation
54
When does avulsion occur
failure at insertion when load > fail strength when muscle contracting
55
Mallet finger
insertion of extensor tendon - fixed flexion
56
Treatment of mallet finger
conservative = limited application, retraction tendon | surgery - reattach tendon through bone or fixation of bone fragment
57
When does intrasubstance rupture occur?
load > failure strength | ruptured achilles tendon
58
3 mechanisms of achilles rupture and explain
pushing off with weightbearing forefoot when extending knee joint eg jumping unexpected dorsiflexion of ankle - slip into hole violent dorsiflexion of plantarflexed foot eg fall from height
59
2 findings of achilles tendon rupture
positive Simmonds squeeze test | palpable tender gap
60
example of musculotendinous junction tear
medial head of gastrocnemius at musculotendinous junction with achilles tendon
61
treatment of musculotendinous junction tear
conservative - where ends can be opposed mobilise of splint - healing will occur operative -high risk of rerupture, high activity and ends cannot be opposed
62
Finger flexor laceration
common in young adult males - need surgery early
63
motor unit
anterior horn cell in gray matter of spinal cord, motor axon and muscle fibres
64
sensory unit
cell bodies in posterior root ganglia
65
how do spinal nerves exit spinal cord?
intervertebral foramen
66
what are these coated with? a - axons b - fascicles c - nerve
a - endoneurium b - perineurium c - epineurium
67
entrapment of nerve example
mortons neuroma - digital nerve in 2nd or 3rd web space of forefoot
68
classical nerve compression - 2 examples
sciatica | carpal tunnel syndrome
69
briefly describe neurapraxia
nerve in continuity and good prognosis stretched or bruised reversible conduction block
70
briefly describe axonotmesis
endoneurium intact but axons disrupted stretched, crushed or direct blow prognosis fair
71
sensory or motor more likely to recover?
sensory
72
Name for degeneration which follows axonotmesis?
wallerian
73
briefly describe neurotmesis
complete nerve division and no recovery unless repaired or graft endoneural tube disruption
74
closed nerve injuries
neuropraxis and axonotmesis | spontaneous recovery possible - surgery after 3 months
75
axonal growth rate
1-3mm/day
76
example of closed nerve injury
brachial plexus injury | radial nerve humeral fracture
77
open nerve injury
eg knife, early surgery and distal proportion undergoes Wallerian degeneration 2/3 weeks after injury
78
sensory features of nerve injury
dysaesthesia - anaesthetic, hypo and hyper aesthetic, paraesthesia
79
motor features of nerve injury
paresis or paralysis and muscle weakness | dry skin
80
Why dry skin due to motor disruption?
loss of tactile adherence since sudomotor nerve fibres not stimulating sweat glands in skin
81
Healing of nerve injury - brief explanation
slow and starts with initial death of axons distal to injury | proximal axonal budding, 1mm/day
82
What returns first after nerve injury?
pain
83
3 things prognosis of nerve injury depends
how distal lesion is - proximal worse nerve is pure ie sensory mixed nerve mixed
84
What sign can monitor nerve injury recovery and explain
Tinels | tap over nerve and paraesthesia felt as distally as regeneration
85
How is nerve injury assessed and recovery monitored?
electrophysiology nerve conduction studies
86
direct nerve repair
laceration - no loss of nerve tissue | microscope - bundle repair and growth factors
87
Nerve grafting done when?
nerve loss and late repair (retraction) | sural nerve
88
rule of 3 - surgical timing in traumatic peripheral nerve injury
immediate surgery in 3 days - clean and sharp injury 3 weeks - blunt/contusion delayed - closed injuries

Year 3 MSK (JK) (30 decks)

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