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MSK > Musculoskeletal Growth/Injury and Repair > Flashcards

Musculoskeletal Growth/Injury and Repair Flashcards

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1
Q

What is a ligament?

A

Dense bands of collagenous tissue which span a joint, being anchored to bone at either end

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2
Q

Ligament structure

A 
Type I collagen fibres 
Fibroblasts (communicate)
Sensory fibres
- proprioception 
- stretch 
- sensory 
Vessels (surface)
Crimping allow stretch
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3
Q

Compared to tendons, the composition of ligaments have….

A

Lower % of collagen
Higher % of proteoglycans and water
Less organised collagen fibres
Rounder fibroblasts

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4
Q

What happens to cause a ligament rupture?

A

Forces exceed strength of ligament

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5
Q

Stages of healing a ligament injury

A
  1. haemorrhage (blood clot)
  2. Proliferative phase (production of scar tissue)
  3. remodelling (matrix becomes more ligament like)
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6
Q

Treatment of ligament injuries

A 
Conservative if
- partial injury 
- no instability
- poor candidate 
Operative if
- instability
- expectation (sportsmen) 
- compulsory (multiple)
Repair
Augmentation 
Replacement
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7
Q

What does the muscle/tendinous composite unit consist of?

A

Muscle origin from bone
Muscle belly
Musculotendinous junction
Tendon (+/- sesamoid bone, +/- tendon sheath)
Tendinous insertion into bone (sharpeys fibres)

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8
Q

What arrangement do the cells of tendons have?

A

Longitudinal arrangement of cells (tenocytes)

Fibres (collagen type I - triple helix)

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9
Q

Function of tendons

A

Flexible and very strong in tension

Movement

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10
Q

What is an enthesiopathy?

A

Inflammation at insertion to the bone

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11
Q

What condition is enthesiopathy at a ligament?

A

Plantar fasciitis

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12
Q

Another name for lateral humeral epicondylitis

A

Tennis elbow

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13
Q

What does mallet finger present with?

A

Forced flexion of extended finger

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14
Q

Pathology of mallet finger

A

Tear of extensor tendon into dorsum of base of distal pharynx of finger

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15
Q

What test is done for an achilles tendon tear?

A

Simmonds squeeze test - palpable tender gap

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16
Q

Possible mechanisms of tendon rupture/tear

A

Pushing off weight bearing forefoot whilst extending the knee joint e.g. sprint starts or jumping movements (53%)

Unexpected dorsiflexion of ankle e.g. slipping into a hole (17%)

Violent dorsiflexion of plantar flexed foot e.g. fall from a height (10%)

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17
Q

Treatment of tendon rupture/tear

A

Mobilise (partial rupture)
Splint/cast
Operative

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18
Q

What combines to form a spinal nerve?

A

Anterior and posterior roots

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19
Q

What are peripheral nerves?

A

The part of a spinal nerve distal to the nerve roots

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20
Q

Function of C fibres

A

Dull, aching, burning pain
temp
sensation

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21
Q

What is carpal tunnel syndrome?

A

Compression of the medial nerve at the wrist

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22
Q

What is sciatica?

A

Compression of the spinal root by intervertebral disc

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23
Q

What is mortons neuroma?

A

Compression of digital nerve in 2nd or 3rd webspace in forefoot

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24
Q

Pathology of neurapraxia

A

Nerve In continuity, stretched or bruised

Reversible conduction block - local ischaemia and demyelination

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25
Presentation of neurapraxia
Local ischaemia | Local demyelination
26
Prognosis of neurapraxia
Good - weeks or months
27
Pathology of axonotmesis
``` Endometrium intact (tube in continuity) but disruption of axons - more severe injury Extremely stretched or crushed or direct blow ```
28
Presentation of axonotmesis
Wallerian degeneration
29
Prognosis of axonotmesis
Sensory recovery often better than motor | Often not normal but enough to recognise pain, hot and cold, sharp and blunt
30
Pathology of neurotmesis
Complete nerve division Laceration or avulsion Endoneural tubes disrupted
31
Prognosis of neurotmesis
poor no recovery unless repaired (direct suturing or grafting) endonueral tubes disrupted so high chance of "miswiring" during regeneration
32
Can peripheral nerves regenerate?
yes
33
What nerve injuries are closed fractures related to?
Nerve injuries in continuity e.g. neuropraxis, axonotmesis
34
Treatment of nerve injury after closed fracture
Spontaenous recovery is possible | Surgery indicated after 3 months (if no recovery is indicated after clinical or EMG)
35
Examples of nerve injuries in closed fractures
Brachial plexus injuries | Radial nerve humeral fracture
36
What nerve injuries are open fractures related to?
Nerve division e.g. neuromeric injuries by knife/glass
37
Treatment of nerve injury by open fracture
early surgery
38
in open nerve fractures, how long is it after the injury when the distal portion of the nerve undergoes Wallerian injury?
up to 2-3 weeks after the injury
39
presentation of nerve injuries
``` dysaesthesia - anaesthetic (numb) - hypo and hyper aesthetic - paraesthetic (pins and needles) Paresis or paralysis +/- wasting dry skin diminished or absent reflexes ```
40
Definition of dysesthesia
Disordered sensation
41
Definition of paresis
Weakness
42
Why would a nerve injury cause dry skin?
Loss of tactile adherence since sudomotor nerve fibres not stimulating sweat glands in the skin
43
How does nerve injury healing work?
Initial death of axons distal to site of injury, then Wallerian degeneration, then degradation of myelin sheath 1. proximal axonal budding occurs thereafter 4 days 2. regeneration proceeds at a rate of approx. 1mm/day in humans or 3-5mm per day in children
44
What is the first modality to return in nerve injury?
Pain
45
What does the prognosis of nerve injury healing depend on?
Wether the nerve is - pure = only sensory or only motor - mixed - both sensory and motor component in same nerve How distal the lesion is - proximal worse
46
What sign can monitor the recovery of nerve injuries?
Tinels sign
47
The Rule of 3 - surgical timing in a traumatic peripheral nerve injury
Clean and sharp injuries = immediate surgery within 3 days Blunt/contusion injuries = early surgery within 3 weeks Closed injuries = delayed 3 months after injury
48
Presentation of UMN lesion
``` Decreased strength increased tone increased deep tendon reflexes Clonus present Babinskis sign present Atrophy absent ```
49
Presentation of LMN lesion
``` Strength decreased Tone decreased Decreased deep tendon reflexes Clonus absent Babinskis sign absent Atrophy present ```
50
Definition of a fracture
Break in the structural continuity of bone
51
How can a fracture happen?
``` High energy transfer in normal bones Repetitive stress in normal bones - stress fracture Low energy transfer in normal bones - osteoporosis - osteomalacia - metastatic tumour ```
52
4 stages of fracture healing
1. inflammation 2. soft callus 3. hard callus 4. bone remodelling
53
When does inflammation start after a fracture?
Immediately
54
When does the soft callus occur after a fracture?
When the pain and the swelling subside
55
What is the hard callus formation?
Conversion of cartilage to woven bone
56
What is bone remodelling?
Conversion of woven bone to lamellar bone
57
Causes of delayed union of bone fracture
``` high energy injury distraction (increased osteogenic jumping) instability infection steroids immunosuppressants smoking warfarin NSAIDs Ciprofloxacin ```
58
What is a significant risk factor for avascular necrosis?
Previous Chemotherapy
59
What is avascular necrosis?
Death of bone tissue secondary to the loss of blood supply - leading to bone destruction and loss of joint function
60
Causes of AVN of hip
Alcohol excess Chemotherapy Long term steriod use Trauma
61
Presentation of AVN of hip
Asymptomatic initially | Pain in joint
62
Investigations of AVN of hip
MRI - 1st line | Xray (may be normal initially, osteopenia and microfractures may be seen early on

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