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phase 2 limbs & back > Week 2 > Flashcards

Week 2 Flashcards

1
Q

Which type of joint is the elbow?

A

Hinge synovial joint

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2
Q

3 elbow joints?

A

Humeroulnar joint
Humeroradial joint
Proximal radioulnar joint

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3
Q

Elbow movements?

A

Flexion and extension
Pronation and supination

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4
Q

How is the elbow stable?

A

Trochlea
Olecranon
Both snugly fit their bones

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5
Q

Where are radius and ulna anatomically, what parts of the elbow do they articulate with?

A

Radius: lateral, articulates with the capitulum
Ulna: medial, articulates with trochlea

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6
Q

Medial/lateral epicondyles function?

A

Muscle attachment

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7
Q

Which forearm bone is longer?

A

Ulna

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8
Q

Two proximal processes of ulna?

A

Olecranon: larger posterior elbow prominence
Coronoid: smaller, anterior

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9
Q

Notch at proximal ulna?

A

Trochlear notch: articulates with humerus

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10
Q

Distal parts of ulna?

A

Head: articulates with radius
Styloid process: wrist ligaments

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11
Q

Why is ulna not part of wrist joint?

A

Articular disc (fibrocartilaginous ligament) prevents articulation with carpal bones

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12
Q

Which side is the radius on?

A

Thumb

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13
Q

What is at proximal radius?

A

Head: articulates with capitulum of humerus and radial notch of ulna
Radial tuberosity: medial, biceps attach here

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14
Q

What is at distal radius? What does it articulate with?

A

Articulates with ulnar head and proximal carpal bones
Styloid process laterally
Ulnar notch medially

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15
Q

What is the humeroulnar joint? Where? Reinforced by? Movements? Which processes limit movement past 180 degrees?

A

Trochlea of humerus and trochlear notch of ulna
Medial
Reinforced by ulnar collateral ligament
Flexion/extension
Ulnar processes

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16
Q

What is the humeroradial joint? Where? Reinforced by?

A

Capitulum of humerus, radial head
Lateral
Reinforced by radial collateral ligament
Supination/pronation
Moves passively in flexion/extension

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17
Q

Difference between humeroradial and humeroulnar joint?

A

Humeroradial joint more circular so can rotate for pronation/supination

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18
Q

Where do biceps brachii heads attach?

A

Scapula

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19
Q

Long vs short head of biceps brachii?

A

Long: attaches to tubercle superior to glenoid cavity. Runs superior to humeral head through intertubercular groove, more lateral
Short: attaches to coracoid process of scapula, more medial

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20
Q

Where do biceps brachii muscle bellies lie over? What ligament holds the long head in place?

A

Coracobrachialis/brachialis
Transverse humeral ligament

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21
Q

Where do both biceps brachii heads converge to?

A

Coverge to single tendon
Insert on radial tuberosity of radius at medial aspect of radius

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22
Q

What does the biceps brachii give off? What does it allow?

A

Gives off bicipital aponeurosis: flat sheet of connective tissue
Attaches biceps indirectly to posterior border of ulna

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23
Q

Biceps brachii actions?

A

Flexion at shoulder and elbow
Supinates radioulnar joint (fixed elbow)
Short head flexes shoulder
Long head holds humerus against glenoid cavity (stabilising function)

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24
Q

Biceps innervation?

A

Musculocutaneous nerve

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25
Q

Coracobrachialis attachment AND insertion?

A

Coracoid process - A
Medial humerus - I

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26
Q

Coracobrachilis actions?

A

Shoulder flexion
Weak adduction

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27
Q

Brachialis attachments?

A

Anterior distal humerus
Coronoid process of ulna

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28
Q

Brachialis action?

A

Flexes elbow

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29
Q

Coracobrachialis/brachialis innervation?

A

Musculocutaneous nerve

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30
Q

Triceps brachii attachments?

A

Long head: infraglenoid tubercle of scapula
Lateral head: superior, posterior humerus
Medial head: posterior humerus, distal to groove for radial nerve

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31
Q

Which triceps heads fuse? What do they form?

A

Long and lateral fuse
Deep to them is medial
Form common tendon: inserts into superior olecranon of ulna and deep fascia

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32
Q

Triceps actions?

A

Extends elbow
Long head steadies humerus

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33
Q

Triceps innervation?

A

Radial nerve

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34
Q

Anconeus attachments?

A

Lateral epicondyle of humerus
Posterior olecranon of ulna

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35
Q

Anconeus actions?

A

Elbow extension
Pronation

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36
Q

Tendon composition and function?

A

Dense, regularly arranged tissue attaching muscle to bone

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37
Q

Tendon composition and function?

A

Dense, regularly arranged tissue attaching muscle to bone
Closely packed parallel arrangement in direction of force

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38
Q

3 components of tendon?

A

tendon
bone insertion
muscle-tendon junction

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39
Q

Composition of tendon?

A

Dense connective tissue: parallel fibres of collagen
Sparsely vascularised
20% cellular = fibroblasts
80% extracellular = 70% water and 30% collagen I, ground substance, elastin, Collagen III

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40
Q

What is a tendinopathy?

A

Painful conditions arising around tendons in respinse to overuse. Complex and multifactorial

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41
Q

Tendinopathy risk factors?

A

Systemic disease e.g. diabetes/obesity
Family history
Age
Overuse
Medication - FLUROQUINOLONES, HRT
Statins

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42
Q

Which tendons can develop tendinopathy?

A

Rotator cuff tendons
Gluteal tendons
Common flexor/extensor in elbow
Patellar tendon
Achilles tendon

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43
Q

2 types of processes in tendon healing?

A

Extrinsic and instrinsic

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44
Q

3 phases of tendon healing and time frames?

A

Inflammation - 0-7 days
Repair - 3-60 days
Remodelling - 28-180 days

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45
Q

Which cytokines direct tendon healing?

A

Platelet derived growth factor: chemotaxis
Transforming growth factor b: collagen type

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46
Q

Where do inflammatory cells migrate from in tendon healing?

A

Epitendinous tissues (sheath, periosteum, soft tissues)
Epitendon and endotendon

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47
Q

What happens in the inflammatory phase of tendon healing?

A

Inflammatory cells migrate
Defect rapidly filled with granulation tissue, haematoma and tissue debris
Matrix proteins laid down as scaffolding for matrix synthesis

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48
Q

What happens in the repair phase of tendon healing?

A

Fibroblasts migrate to zone of injury and begin to synthesise collagen by day 5
Initially type III collagen produced which is laid down in a random orientation
4th week: intrinsic fibroblasts proliferate, synthesisie and reabsorb collagen = form TENDON CALLUS
Type I collagen starts being produced
Vascular ingrowth via collagen scaffolding

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49
Q

What happens in the remodelling phase of tendon healing?

A

Final stability acquired due to normal use of tendon physiologically
Cross linking of collagen fibrils increases tensile strength

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50
Q

Effect of early controlled mobilisation of tendon tear in rehab?

A

Reduce scar adhesions
Facilitate healing by stimulating remodelling

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51
Q

What are scar adhesions?

A

Dead fibrotic tissue adhering to alive tissues limiting range of movement

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52
Q

What happens if there is excessive loading of damaged tendon?

A

Disrupts repair tissue

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53
Q

Optimal healing of tendons requires…

A

Surgical apposition and mechanical stabilisation
Minimal soft tissue damage

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54
Q

What happens to tendon pathologically in tendonopathy

A

Type III collagen present instead of type I
Neovessels present
More tenoxytes present

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55
Q

Reasons for tendinopathy to develop>

A

Overuse aka mechanical stress
Drugs: fluroquinolones, statins
Genetics
Inflammation
Environmental e.g. smoking, diabetes
Apoptisis e.g. cell death

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56
Q

Static body components in shoulder?

A

Scapula: acromion, coracoid process, glenoid
Clavicle
Humerus
Capsule/ligaments
Labrum/cartilage

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57
Q

Dynamic body parts in shoulder?

A

Rotator cuff muscles
Long head of biceps
Scapular stabilisers

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58
Q

Test for supraspinatus function?

A

Flex arms at 30 degrees in front of you, then make a movement as if pouring out a can
Push down on arms, if they cant resist the force then supraspinatus tear

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59
Q

Test for subscapularis function?

A

Put hands behind back with palms facing out, if cant lift off back then subscapularis tear

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60
Q

Test for infraspinatus/ teres minor function?

A

Arms tucked in, ask to laterally rotate and push their arms, if cant do it then tear/injury

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61
Q

Tests for rotator cuff muscles for range of movement?

A

Supra = forward abduction
Infra/teres = external rotation
Subscap = thumb behind back

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62
Q

Test for subacromial shoulder pain?

A

None

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63
Q

Causes of rotator cuff tears?

A

Age >65
Tendinopathy to tear
Osteophytes
Trauma, acute
Genetic

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64
Q

Non operative rotator cuff tear treatment?

A

Phyiotherapy
Injection steroid/local for pain

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65
Q

Operative rotator cuff tear treatment?

A

Repair tendon to bone
Open surgery/arthrscopic (keyhole)

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66
Q

Novel rotator cuff tear treatment?

A

Glyceryl nitrate patches
CYtokine therapies

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67
Q

Arthroscopic vs open surgery?

A

Arthroscopic: less invasive, faster recovery, visualise whole joint
Open: more invasive, good long term results

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68
Q

Adult vs embro ecm to cell ratio?

A

Adult: 80% ECM, 20% cells
Embryo: 20% ECM, 80% cells

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69
Q

What is basal lamina?

A

Layer of extracellular matrix secreted by epithelium, where epithlium sits

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70
Q

How are mechanical stresses transmitted in epithelial tissue?

A

Transmitted from cell-cell by cytoskeletal filaments achored to cell-matrix and cell-cell adhesion sites

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71
Q

How is mechanical stress beared in connective tissue?

A

Extracellular matrix directly bears stress

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72
Q

Where does skeletal strength stem from?

A

Extracellular matrix

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73
Q

ECM functions?

A
  • provides scaffold for tissue development
  • provides mechanical basis for cell attachment/movement
  • transmits force e.g. tendon, bone
  • withstands compression in cartilage and IVD
  • provides survival signalling molecules
  • reservoir for growth factors
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74
Q

ECM composition?

A

50% water
proteins
glycosaminoglycans
glycoproteins
proteoglycans

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75
Q

Function of water in ECM?

A

Absorbs compressive forces

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76
Q

What are glycoproteins?

A

Proteins with carbohydrate side chains

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77
Q

Examples of glycoprotein side chains?

A

Sugars (glucose, galactose)
Amino sugars (n-acetylglucosamine)
Acidic sugars (sialic acid)

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78
Q

How are sugar side chains attached to glycoproteins and where?

A

Glycosylation in golgi by glycosyltransferase

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79
Q

Proteoglycan composition?

A

Heavily glycosylated protein with GAG side chain

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80
Q

Example of GAG side chain?

A

Chondroitin sulfate

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81
Q

Function of acid group in proteoglycan?

A

Provides negative charge that attracts water and allows protection against compressive forces

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82
Q

How many types of collagen are there?

A

30

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83
Q

Function of parallel collagen fibres in tendons?

A

Allows tension and recoil for functional ability

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84
Q

Composition of collagen in skin and cornea?

A

Skin: criss cross
Cornea: running in different directions

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85
Q

What is fibrosis?

A

Uncontrolled deposition of collagen

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86
Q

Functions of collagen? Different ways they form?

A

Fibril forming: tensile strength e.g. bone, cartilage
Endostatin-producing: cell migration/signalling regulation
Anchoring fibrils: cell to matrix interactions
Transmembrane: cell to matrix interactions
Bead forming: elasticity

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87
Q

What is a rare disease defined as?

A

1 in 10k people have it

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88
Q

Where are fibril forming collagens found?

A

Collagen 1 to 5

89
Q

Where is type I collagen foound, what happens when mutated?

A

Bone, skin, tendons, ligaments, cornea
90% of bodies collagen
Severe bone defects, fractures

90
Q

How much of prtein mass is collagen?

A

30%

91
Q

Composition of collagen in matrix?

A

Gly-X-Y
3 polypeptide chains in triple helix
Glycine sits in centre of triple helix

92
Q

Main 3 amino acids in collagen?

A

Glycine
Proline
Hydroxyproline

93
Q

Which 3 chains is collagen composed of?

A

3 polypeptide chains
Each chain is polyproline helix
Glycine - X-Y repeating chain, glycine at centre as it is a small protein

94
Q

What determines the function of collagen?

A

Its structure

95
Q

Steps in collagen maturation?

A
  • Pro-alpha chain synthesised
  • prolines and lysines hydroxylated by hydroxylase enzymes
  • glycosylation of hydroxylysines
  • self assembly of 3 alpha chains
  • procollagen triple-helix formation
  • no modification can happen after triple helix formed
  • secretory vesicle to golgi apparatus
  • propetides are cleaved (non collagenous domains at n and c terminal) off by enzymes
  • triple helix self assembly to fibril
  • aggregation of collagen fibrils to collagen fibre
96
Q

How are non collagen domains cleaved?

A

Proteinases - c and n proteinases cleave propeptides

97
Q

BMP1 fucntion?

A

C-proteinase

98
Q

ADAMTS family function?

A

N-proteinase

99
Q

Lysyl oxidase function?

A

Stabilises collagen fibrils by forming covalent cross links

100
Q

How long is collagens half life?

A

Very long, no collagen turnover in adults in healthy state

101
Q

What do most collagen mutations usually affect?

A

Glycine

102
Q

What is osteogenesis imperfecta? Type of mutation? Affects what?

A

Brittle bone disease
Autosomal recessive and dominant
Collagen type I affected
Bones can become bent

103
Q

What is collagen type I composition?

A

COLA1A1 makes up alpha chain 1
COL1A2 makes up alpha chain 2
Heterotrimeric protomer
Fibrillar
Each collagen chain is 2 a1 and one 12
a1a1a2

104
Q

What is mitated in most OI cases?

A

Col1a1 or COL1a2

105
Q

Which type of mutation is classic OI?

A

Autosomal dominant

106
Q

Silience type I of OI?

A

Mild non-deforming
COLA1/2 mutation
Autosomal dominant

107
Q

Silience type II of OI?

A

Perinatal letal
COLA1/2 mutation
Autosomal dominant

108
Q

Silience type III of OI?

A

Severely deforming
COLA1/2 mutation
Autosomal dominant

109
Q

Silience type IV of OI?

A

Moderately deforming
COLA1/2 mutation
Autosomal dominant

110
Q

Type I OI?

A

Less severe
Non symptomatic at birth
Early onset osteoperosis
Few fractures
Null mutations
Reduced collagen

111
Q

What are null mutations?

A

Non functional copy of gene produced as a result of mutation
E.g. only 50% of collagen will be functional

112
Q

3 types of mutations causing OI?

A

Stop codon mutation
Promoter mutation
mRNA instability
All result in less collagen production

113
Q

HSP47 function?

A

Coats procollagen molecules
Help collagen secretion

114
Q

What happens in more severe OI? mUTATION type? Effects?

A

80% of severe is glycine missense mutations
Dominant negative mutation
Effects modification due to a folding delay
Not due to levels of collagen, quality of proteins decreases
Triple helix folding stops when glycine is mutated
Overmodification occurs = protein gets bigger so doesnt properly function

115
Q

How exactly does severe OI happen?

A

Disruption of GLY-X-Y sequence slows rate of folding
Overmodifcation of chains occurs

116
Q

Where does forearm rotation happen?

A

Forearm bones are radioulnar joints
Radius rotates over surface of ulna
Around axis of radius head to styloid process
Independent of shoulder and elbow

117
Q

Pronation or supination more powerful?

A

Supination

118
Q

Range of movement of forearm rotation?

A

140-150 degrees
Looks like more as humerus rotates and pectoral girdle moves

119
Q

What is pronation exactly?

A

Palm turned posteriorly
Proximal radius lateral to ulna
Distal radius medial to ulna

120
Q

What exactly is supination?

A

Palm turned anteriorly
Movement reversed
Radius lateral to and parallel with ulna

121
Q

What is the superior radioulnar joint associated with? Continuous with?

A

Elbow
Joint capsule and synovial membrane continuous with that of elbow joint

122
Q

Which type of joint is the superior radioulnar joint? Between?

A

Pivot joint - uniaxial
Between head of radius and osseofibrous ring

123
Q

What is the osseofibrous ring?

A

Radial notch of ulna and annular ligament

124
Q

What holds the superior radioulnar joint in place?

A

Radial annular ligament
Strong fibres encircling head of radius

125
Q

Which type of joint is the inferior radoulnar joint?

A

Pivot synovial joint
Between head of ulna and ulnar notch of radius

126
Q

What is inferior radioulnar joint held together by?

A

Articular disc
Interosseus membrane

127
Q

Where does the radial collateral ligament extend from and blend with? Which side of the joint is it found?

A

Extends from lateral epicondyle
Blends with annular ligament of radius
Laterally

128
Q

Where does the ulnar collateral ligament originate from and attach to?

A

Originates from medial epicondyle
Attaches to coronoid process and olecranon of ulna

129
Q

What is the interosseus membrane?

A

Thin fibrous sheet of tissue seperating radius and ulna

130
Q

What happens to interossues membrane when pronation to supination occurs?

A

Fibres changed from relaxed to tense in neutral position
Relax again when supination occurs

131
Q

What does the interosseus membrane form?

A

Radio-ulnar syndesmosis
Fibrous joint between R and u

132
Q

Functions of interosseus membrane?

A

Divides forear into anterior and posterior
Site of attachment for forearm muscles

133
Q

What injury are pre school children susceptible to? Treatment?

A

Incomplete dislocation of radial head
Radial head moves distally out
If jerked by UL when forearm pronated
Tears distal attachment of annular ligament
Manipulating forearm into supination when elbow is flexed

134
Q

2 supinator muscles?

A

Biceps brachii
Supinator

135
Q

Where does biceps brachii attach?

A

Radial tuberosity

136
Q

Supinator origin and insertion?

A

Deep muscle
2 heads of origin
Deep head: supinator crest of ulna
Superficial head: lateral epicondyle of humerus
Inserts on lateral proximal radius

137
Q

Pronator muscles?

A

Pronator teres
Pronator quadratus

138
Q

Pronator teres origin and insertion? Which nerve passes between the 2 heads?

A

Origin = 2 heads
Superficial: med epicondyle of humerus
Deep: medial aspect of coronoid process of ulna
Median nerve passes between 2 heads
Insertion: crosses forearm and attaches to middle of radius shaft

139
Q

Pronator quadratus origin and insertion?

A

Deep muscle across distal 1/4 of R AND U
Origin: distal shaft of ulna
Insertion: distal shaft of radius

140
Q

What is the cubital fossa?

A

Important transition between arm and foraem

141
Q

What is the triangular depression of the cubital fossa bound by?

A

Brachioradialis laterally
Pronator teres medially

142
Q

What does the brachial artery split into and where?

A

Radial and ulnar arteries
In cubital fossa

143
Q

What nerves run through cubital fossa?

A

Radial nerve laterally under brachioradialis
Median nerve

144
Q

2 layers of forearm muscles?

A

Superficial and deep

145
Q

Superficial muscles of forearm?

A

Long muscles
Humerus to hand: act on elbow and wrist
Humerus to digits: act on elbow, wrist and digits

146
Q

Deep muscles of forearm?

A

Arise from forearm bones and pass to digits
Cross and act on wrist and digit joints

147
Q

Opponens meaning?

A

Rotates bone around long axis

148
Q

Radialis vs ulnaris meaning?

A

Radialis - closer to radius
Ulnaris - closer to ulna

149
Q

Profundus vs superficialis?

A

Profundus - deep
Superficialis - closer to surface

150
Q

Interosseus meaning?

A

Between bones

151
Q

Palmaris meaning?

A

Into palmar aponeurosis

152
Q

Carpi, digitorum, digiti minimi, indicis and pollicis meaning?

A

Carpi - attachment to wrist
Digitorum - attachment into fingers
Pollicis - thumb
Digiti minimi - little finger
Indicis - index funger

153
Q

Longus vs brevis?

A

Longus - longer
Brevis - shorter

154
Q

Superficial anterior forearm muscles?

A

Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris
Flexor digitorum superficialis

155
Q

Deep anterior forearm muscles?

A

Flexor pollicus longus
Flexor digitorum profundus
Pronator quadratus

156
Q

Superficial posterior forarm muscles?

A

Extensor carpi brevis
Extensor digitorum
Extensor digiti minimi
Extensor carpi ulnaris
Brachioradialis
Extensor carpi radialis longus
Anconeus

157
Q

Deep posterior forearm muscles?

A

Extensor indicis
Extensor pollici longus
Extensor pollicus brevis
Abductor pollicus longus

158
Q

What would be the safest way to health according to hippocrates?

A

Give every individual the right amount of nourishment and exercise
Not too little not too much

159
Q

Health benefits of exercise?

A

Reduction in mortality after heart attack
Reduces cancer, hypertension, obesity, osteoperosis (impact exercise), stroke, diabetes
Reduces falls in elderly and cognition
Improve depression, self esteem, pregnancy outcomes
Reduces absenteeism from work

160
Q

Risks in sport?

A

Nature of sport = death
Sudden death suring exercise
Risk of injury

161
Q

Most causes of accidental death?

A

Road and home accidents

162
Q

How many sport fatalities per year? Most high risk sports?

A

160 fatalities per year
Height, water and speed e.g. air sports, watersports, motor sports

163
Q

Most injuries in sport?

A

Football

164
Q

Most and least injured sites of body due to sport?

A

Lower leg, upper limb most
Upper leg and chest least

165
Q

Traumatic sports injuries?

A

Fractures/dislocation
Muscle, ligament, tendon injuries
Head/spinal injuries
Chest/abdominal injuries

166
Q

Factors contirbuting to overload during sport?

A

Increased participation
Increased intensity/duration of training
Intrinsic and extrinsic factors

167
Q

Intrinsic factors causing overload?

A

Anatomical
Muscle imbalance

168
Q

Extrinsic factors causing overload?

A

Training errors
Poor technique
Incorrect equipment
Poor conditions e.g. rain

169
Q

What happens when an area of the body has overload in sport?

A

Tissue injury
Inflammation
Pain
Healing OR continued activity = tissue ijury again

170
Q

How to heal tissue injury?

A

Rest
Rehabilitation

171
Q

Causes of bone injury?

A

Direct e.g. tackle
Indirect e.g. fall or twisting

172
Q

Closed vs open fracture?

A

Closed - doesnt poke through skin
Open - pokes through skin

173
Q

Classifications of fractures?

A

Transverse: horizontal to bone
Oblique
Spiral
Communited: multiple fractures
Avulsion: pieve of bone attached to tendon/ligament torn away

174
Q

Clinical features of bone injuries?

A

Pain
Tenderness
Localised bruising
Swelling
Deformity
Movement restricted

175
Q

Management of bone injuries?

A

Anatomical/functional realignment
Reduction
Plastercast
Surgery

176
Q

Complications of bone injuries?

A

Infection
Acute compartment syndrome
Nerve or blood vessel injury
DVT/pulmonary embolism
Delayed union/non union/ malunion

177
Q

When is infection more likely to happen in bone injury? Treatment?

A

Open fractures
Prophylactic antibiotics

178
Q

What is acute compartment syndrome? Symptoms? Treatment

A

Secondary swelling in muscle compartment with non-distensible fascial sheath
Severe pain, pain on movement, numbness, absent pulses
Fasciotomy (fascia cut to relieve swelling)

179
Q

Where might a DVT happen due to bone injury? Treatmeny?

A

Lower limb
Early movement

180
Q

Problems with bone injuries?

A

Immobilisation
Growth plate fractures in kids
Soft tissue damage
Periosteal injury

181
Q

Why might immobilisation happen due to bone injury? Prevention?

A

Prolonged immobilisation results in muscle wasting and joint stiffness
Limit by early muscle contraction, limited movement braces and internal fixation

182
Q

Where can growth plate fractures happen? Problem?

A

Distal radius at wrist
Elbow
Distal femur
Tibia
Fibula
Interrupts bony growth

183
Q

When can periosteal injury occur?

A

Tibia hit by ball or stick in hockey

184
Q

Articular cartilage function?

A

Lines ends of long bones
Absorbs shock and compressive forces and permites frictionless joint movement

185
Q

When can articular cartilage be injured? Common sites?

A

Shearing forces e.g. dislocation
Talus, femoral condyles, patella, humerus

186
Q

What are articular cartilage injuries associated with? What does X-RAY show? When are they suspected?

A

Soft tissue injury e.g. acl tear
X-ray normal at first
Suspect if sprain remains painful/swollen longer than expected

187
Q

How to diagnose articular cartilage injury? How to confirm and heal? What may they predispose to? How to improve healing, why would you do this?

A

MRI
Arthroscopy to confirm adn remove loose fragments
Predispose to premature osteoarthritis
Perforation, alteration of joint loading and cell transplantation to improve healing as they usually dont heal fully

188
Q

Dislocation vs subluxation?

A

Dislocation: trauma produces complete dissociation of articulating surfaces
Subluxation: some contact of articulating surface remains

189
Q

What does stability of joint depend on, example?

A

On anatomy
Hip stable due to deep ball and socket compared to shoulder

190
Q

Consequence of dislocation/subluxation?

A

Dmaages surrounding joint capsule and ligaments

191
Q

Complications of dislocation/subluxation? How to exclude fracture?

A

Blood vessel/nerve damage e.g. axillary nerve in shoulder, brachial artery at elbow
x-ray

192
Q

Treatment for dislocation/subluxation?

A

Reduction
Muscle relaxants
Protection
Early mobilisation
Rebuild muscle strength

193
Q

Bone reduction meaning?

A

bone is fixed after fracture

194
Q

3 grades of ligament injury?

A

1: fibres stretched but normal range on stressing
2: more fibres involved, laxity on stressing but definite end point
3: complete tear, excessive laxity, no end point, may be pain free as nerve fibres torn

195
Q

Initial management of ligament injury?

A

Reduce bleeding and swelling

196
Q

Grade 1 and 2 ligament injury treatment?

A

Promote tissue healing
prevent joint stiffness
protect agaonst further damage
strengthen muscle

197
Q

grade 3 ligament injury treatment?

A

conservative: medial collateral of knee or lateral collateral of ankle
surgical: direct repair ot reconstruction e.g. acl

198
Q

When do muscle injuries occur? when common? most commonly affected?

A

when demands exceed muscle capacity
common when cross 2 joints, or sudden accellaration/decelleration
affects hamstrings, quadriceps, gastrocnemius

199
Q

3 grades of muscle injury?

A

1: few fibres, localised pain, no loss of strength
2: significant no of fibres, swelling, pain on contraction, reduced strength, limitation of movement
3: complete tear, common at musculotendinous junction

200
Q

muscle tear management?

A

first aid to reduce bleeding, swelling, inflammation
electrotherapy
soft tissue therapy
stretching
strengthening

201
Q

predisposing factors to muscle injury?

A

inadequate warmup
insufficent joint range of motion
excessive muscle tightness
fatigue/overuse/inadequate recovery
muscle imbalance
previous injury
poor technique

202
Q

quadriceps rupture cause? usually affects where?

A

direct impact against contracted muscle
sudden vigourous contraction
normally rectus femoris close to quadriceps tendon

203
Q

hamstring rupture cause?

A

overload and forceful contraction

204
Q

hamstring rupture syntoms?

A

sudden intense pain
muscle spasm
tenderness and swelling
palpable gap

205
Q

hamstring rupture treatment?

A

NSAIDs
electrotherapy
strength/strecthing exercises
surgery for athletes

206
Q

How do muscle contusions/bruises occur? What happens? Common where?

A

Direct blow from opponent or contact from equipment
Contact sports e.g. football, rugby, hockey
Local damage with bledding
Quadriceps common

207
Q

Management of contusions? Avoid?

A

Manage bleeding swelling, electrotherapy, strecthing, strengthening
Avoid heat, alcohol, vigourous massage

208
Q

When does myositis ossificans occur? What is it? cOMMON when? diagnosis? treatment?

A

Bone grows when it isnt meant to
When haemotoma calcifies
Common in severe contusions
Diagnose on X-RAY after 10-14 days
Resolves spontaneously, recovery slow

209
Q

Where do tendon injuries occur? 2 types of tendon rupture? Common sites?

A

Occur at point of least blood supply e.g. achilles tendon at musculotendinous junction/2cm above insertion into calcaenum
Complete/partial occurs without warning, common in older athletes
Achilles and supraspinatus common

210
Q

Where does achilles tendon run? When does tendinopathy occur? symptoms?

A

From calf muscle (gastrocnemius) to calceneum
Chronic repetitive overload injury
Common with sudden increase in activity or change in technique
Pain esp uphill, swelling, tenderness, crepitus on ankle movement (grating sound)

211
Q

Where does achilles tendon run? When does tendinopathy occur? symptoms?

A

From calf muscle (gastrocnemius) to calceneum
Chronic repetitive overload injury
Common with sudden increase in activity or change in technique
Pain esp uphill, swelling, tenderness, crepitus on ankle movement (grating sound)

212
Q

Where does achilles tendon run? When does tendinopathy occur? symptoms?

A

From calf muscle (gastrocnemius) to calceneum
Chronic repetitive overload injury
Common with sudden increase in activity or change in technique
Pain esp uphill, swelling, tenderness, crepitus on ankle movement (grating sound)

212
Q

Where does achilles tendon run? When does tendinopathy occur? symptoms?

A

From calf muscle (gastrocnemius) to calceneum
Chronic repetitive overload injury
Common with sudden increase in activity or change in technique
Pain esp uphill, swelling, tenderness, crepitus on ankle movement (grating sound)

213
Q

Achilles tendinopathy prevention? Treatment? Complications?

A

Warm up/strecthing, no heel tabs, heel wedge
rest, no hills, heel wedge, NSAID, immobilisation, surgery, no steroid injections
chronic tendinopathy, rupture, achilles bursitis

214
Q

What are busae? where are they? how do injuries occur? management?

A

fluid filled sacs between tendon and bone
reduce friction
hip, knees, feet, shoulder, elbow
overuse is cause, can be traumatic
ice, compression, NSAIDS, aspiration

215
Q

nerve injuries cause? symptoms?

A

direct blow - ulnar nerve at elbow, peroneal at neck of fibula
tingling, numbness, pain
unusual in athletes

216
Q

what is neuropraxia? treatment?

A

paralysis and weakness of muscles innervated with nerve, sensory loss
support in brace until resolution

217
Q

skin injury management?

A

stop bleeding
prevent infection
immobilise if over joint
check for tetanus

phase 2 limbs & back (5 decks)

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