24 - Review of Connective Tissue Disorders Flashcards
What is the myotendinous junction
Where the muscle and tendon merge together
What is tendinitis
Small tears causing local inflammation in a tendon
Causes of tendinitis
Overuse
Collagen disorders
Renal dialysis
Common sites of tendinitis
Lateral epicondyle
Achilles tendon
Supraspinatus
Treatment for tendinitis
Rest, Ice, Compression, Elevation
Analgesia + NSAIDs
Stretching
Surgery if larger
What is tendinosis
Chronic tendinitis
Full thickness tears
Causes disorganised collagen
What are heterotopic calcified regions
Bone nodule inside the tendon
It can become brittle and fracture
What causes the hetereotopic calcified regions in tendinitis
Mesenchymal cells can convert AA –> Prostaglandins
Prostaglandin E2 - causes chondrocyte hypertrophy
Induces osteoblasts
Generates osteogenesis
What can be used to prevent calcification in tendinitis
NSAIDs
as they inhibit COX2
Phases of tendon healing
1) Inflammation - pain, swelling + redness
Decreased collagen
2) Repair - collagen fibre production, decrease in inflammatory cells
3) Remodelling - Increased strength
Examples of tendon healing extrinsicly
Achilles, rotator cuff
Usually quicker
Peripheral fibroblasts
Tendon healing intrinsically
Hand flexors
Takes longer as had covered by a tendon sheath
What is the enthesis
Where the tendon/ligament/articular capsule is inserted through the periosteum + into the bone
Fibrous enthesis
Fibrous tissue extends all the way up to bone
The fibres from tendon insert into the bone via periosteum
Fibrocartilaginous enthesis
Small section of fibrocartilage at the attachment site
gradual change
tendon - unmineralised fibrocartilage - mineralised fibrocartilage - bone
What is enthesitis
Inflammation of the enthesis
Causes of enthesitis
Recurring stress
Autoimmune disease
Pathogenesis of enthesitis
As enthesis inserts into porous bone at a location with small transcortical vessels
Mechanical trauma the TCV can become inflamed
Features of enthesitis
Vasodilation
efflux of immune cells
Osteoblasts form bone at enthesis
Enthesophytes
Originate from the insertion of joint capsule, ligaments or tendons (articular border not involved)
Osteophytes
Originate from the border of the articular cartilage
Treatment for enthesitis
RICE, NSAIDs
If inflammatory - sulfasalazine, methotrexate, anti-tnf therapy
radiotheray
Function of tendon sheath
Protect + nourish tendon
Guide and cushions
Where do tendons get their nutrition from
Synovial fluid
What is tenosynovitis
Isolated inflammation
What causes trigger finger
Enlargement of the tendon within the sheath
Treatment for trigger finger
Cut the annular ligament
What are S + S of systemic lupus erythematosus
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
What is the rash like in SLE
Malar facial rash that extends over cheeks and bridge of nose
Immune complexes cause damage to blood vessels and CT
What is the hand deformity in SLE
Jaccoud arthropathy
SLE ANA pattern
Antinuclear
Anti- jo1
Anti-DNA
Anti-histone
SLE treatment
NSAIDs
DMAR - Cyclophosphamide
Corticosteroids
Biologicals
