24 - Review of Connective Tissue Disorders

Question 1

What is the myotendinous junction

Answer 1

Where the muscle and tendon merge together

Question 2

What is tendinitis

Answer 2

Small tears causing local inflammation in a tendon

Question 3

Causes of tendinitis

Answer 3

Overuse
Collagen disorders
Renal dialysis

Question 4

Common sites of tendinitis

Answer 4

Lateral epicondyle
Achilles tendon
Supraspinatus

Question 5

Treatment for tendinitis

Answer 5

Rest, Ice, Compression, Elevation
Analgesia + NSAIDs
Stretching
Surgery if larger

Question 6

What is tendinosis

Answer 6

Chronic tendinitis
Full thickness tears
Causes disorganised collagen

Question 7

What are heterotopic calcified regions

Answer 7

Bone nodule inside the tendon

It can become brittle and fracture

Question 8

What causes the hetereotopic calcified regions in tendinitis

Answer 8

Mesenchymal cells can convert AA –> Prostaglandins
Prostaglandin E2 - causes chondrocyte hypertrophy
Induces osteoblasts
Generates osteogenesis

Question 9

What can be used to prevent calcification in tendinitis

Answer 9

NSAIDs

as they inhibit COX2

Question 10

Phases of tendon healing

Answer 10

1) Inflammation - pain, swelling + redness
Decreased collagen
2) Repair - collagen fibre production, decrease in inflammatory cells
3) Remodelling - Increased strength

Question 11

Examples of tendon healing extrinsicly

Answer 11

Achilles, rotator cuff
Usually quicker
Peripheral fibroblasts

Question 12

Tendon healing intrinsically

Answer 12

Hand flexors

Takes longer as had covered by a tendon sheath

Question 13

What is the enthesis

Answer 13

Where the tendon/ligament/articular capsule is inserted through the periosteum + into the bone

Question 14

Fibrous enthesis

Answer 14

Fibrous tissue extends all the way up to bone

The fibres from tendon insert into the bone via periosteum

Question 15

Fibrocartilaginous enthesis

Answer 15

Small section of fibrocartilage at the attachment site
gradual change
tendon - unmineralised fibrocartilage - mineralised fibrocartilage - bone

Question 16

What is enthesitis

Answer 16

Inflammation of the enthesis

Question 17

Causes of enthesitis

Answer 17

Recurring stress

Autoimmune disease

Question 18

Pathogenesis of enthesitis

Answer 18

As enthesis inserts into porous bone at a location with small transcortical vessels
Mechanical trauma the TCV can become inflamed

Question 19

Features of enthesitis

Answer 19

Vasodilation
efflux of immune cells
Osteoblasts form bone at enthesis

Question 20

Enthesophytes

Answer 20

Originate from the insertion of joint capsule, ligaments or tendons (articular border not involved)

Question 21

Osteophytes

Answer 21

Originate from the border of the articular cartilage

Question 22

Treatment for enthesitis

Answer 22

RICE, NSAIDs
If inflammatory - sulfasalazine, methotrexate, anti-tnf therapy
radiotheray

Question 23

Function of tendon sheath

Answer 23

Protect + nourish tendon

Guide and cushions

Question 24

Where do tendons get their nutrition from

Answer 24

Synovial fluid

Question 25

What is tenosynovitis

Answer 25

Isolated inflammation

Question 26

What causes trigger finger

Answer 26

Enlargement of the tendon within the sheath

Question 27

Treatment for trigger finger

Answer 27

Cut the annular ligament

Question 28

What are S + S of systemic lupus erythematosus

Answer 28

Non-specific fatigue
Fever 
Arthralgia 
Weight changes
Renal nephritic disease
Neuropsych 
Dermatological - small joints of the hands and knees, malar facial rash in butterfly pattern, photosensitivity, alopecia

Question 29

What is the rash like in SLE

Answer 29

Malar facial rash that extends over cheeks and bridge of nose
Immune complexes cause damage to blood vessels and CT

Question 30

What is the hand deformity in SLE

Answer 30

Jaccoud arthropathy

Question 31

SLE ANA pattern

Answer 31

Antinuclear
Anti- jo1
Anti-DNA
Anti-histone

Question 32

SLE treatment

Answer 32

NSAIDs
DMAR - Cyclophosphamide
Corticosteroids
Biologicals