Soft Tissue Conditions Flashcards by Bel Luscombe

What is the boundary between skeletal muscle and a tendon called

Myotendinous junction

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Why do tendons repair poorly

Relatively avascular

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What is the difference between tendinitis and tendinosis

Tendinitis is acute
Tendinosis is chronic

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Tendinitis

Small tears in a tendon causing localised inflammation

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Tendinosis

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

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Tendinitis and tendinosis causes

Overuse
Collagen disorders
Renal dialysis

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How is renal dialysis linked to tendon problems

Kidney failure effect collagen
Pt may be put on steroids

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Tendinitis and tendinosis treatment

RICE
analgesia + NSAIDs
Stretching
Surgery

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What does RICE stand for

Rest
Ice
Compression
Elevation

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Heterotopic calcification

Bone formation in soft tissues
Can occur in tendon injuries

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How are COX2 and prostaglandins involved in formation of heterotopic bone

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

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Process of heterotopic bone formation

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

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

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

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Why is calcification of a tendon harmful

Tendon more brittle
More prone to rupture

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Do exposed or sheathed tendons heal more easily and why

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

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Which type of tendon healing improved by cast immobilisation

Tendon-to-bone healing
Detrimental to flexor tendon healing

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Which type of tendon healing is improved by passive motion

Flexor tendon healing
Detrimental to tendon-to-bone healing

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Difference between extrinsic and intrinsic tendon healing

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

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Is immobilisation generally good for tendon healing

No - healing usually takes longer + more long term damage

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Enthesis

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

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2 types of enthesis

Fibrous
Fibrocartilaginous

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Difference between fibrous and Fibrocartilaginous enthesis

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

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Are fibrous or Fibrocartilaginous enthesis better at dissipating stress

Fibrocartilagenous

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Sharpey fibres

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

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

Fibrocartilage

Ethesitis

Inflammation of the enthesis

Enthsitis causes

Recurring stress Autoimmune disease

Which autoimmune conditions are associated with enthesitis

Spondyloarthritides HLA B27 arthopathies

How does mechanical trauma cause pathogenesis of enthesitis

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

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

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

What is the main immune cell in enthesitis

Neutrophils

Difference between enthesophytes and osteophytes

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

Are enthesophytes or Osteophytes found at the articular border

Osteophytes

Enthesitis treatment

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

Why is local radiotherapy used in enthesitis

Kill heterotrophic chondrocytes

How does Hyperosmolar dextrose injections help enthesitis

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

Ankylosing spondylitis

Enthesitis of IVDs and anterior longitudinal ligament

Difference in location of tendinitis and enthesitis

Tendinitis in belly of tendon Enthesitis in insertion point of tendon

Function of tendon sheath

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

Tenosynovitis

Inflammation of the synovium around a tendon

De Quervains tenosynovitis

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

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

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

Trigger finger

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

What pathology does ficklesteins test test for

De quervains tenosynovitis

How is ficklesteins test performed and what if a positive result

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

Tenosynovitis treatment

RICE splinting Anti inflammatories Corticosteroid injections Surgery

How is trigger finger treated surgically

Cut annular ligament

How is de quervains treated surgically

Shave down radial styloid process or cut sheath

What type of condition are trigger finger and de quervains

Tenosynovitis

Systemic lupus erythematosus

Multisystem chronic disorder caused by ANA antibodies against intranuclear proteins

SLE signs and symptoms

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

What type of antibodies cause SLE

anti nuclear antibodies

What tissues are damaged by immune complexes in SLE

Blood vessels CT

SLE pathogenesis

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

Jaccoud arthropathy

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

What joint condition do 90% of SLE pts develop

Arthritis

Why is jaccoud arthropathy reducible

No bony deformity

2 main patterns of ANAs in SLE

Homogenous Speckled

SLE treatment

Prevent trigger exposure NSAIDs DMARDs Corticosteroid for flares IV immunoglobulins

Potential SLE triggers

UV light Viruses

Belimumab MOA for SLE treatment

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

Rituximab MOA for SLE

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