9: Arthritis 11- is sport good for your joints?

Question 1

Explain the Heuter Volkmann principle

Answer 1

• Bones growth in childhood responds to compression/ stretching of bone in childhoos
  
  • compression: decreases growth
  • extension: allows growth

Question 2

How do you call this (right) ?

Where is the weight bared?

Answer 2

It is a Varus

• weight is bared at medial condyle

Question 3

What do you call this?

What is weight bared in it?

Answer 3

Valgus

• weight is bared at the lateral side of knee

Question 4

What is the effects of exercise on leg shape?

Answer 4

Not quite known but e.g.

1. Soccer (exercise in general?) in childhood probably leads to varus formation
2. Valgus often seen in catwalk models (and females due to wider hip)

Question 5

Explain the raltionship between leg shape deformity and arthritis

Answer 5

If uneven weight baring

• cartilage erosion –> painful
• arthritis develops at over- stimmulated sites
  
  • Varus= 2x arthritis in knee
  • Valgus = 1.5 x risk of arthritis
• Same thing can be observed in hips (if structural abnormalities in hips: unusual weight baring –>

Question 6

Explain the Wolffs Law of bone formation

Answer 6

1. Bone reacts to load
   
   • if stress put on it: increase in stress increase bone density and lay down
     
     • (e.g. surfers knuckles)
   • Bone mass goes down when it is not used
     
     • Astronautes: loos bone and muscle mass

Question 7

Explain the Developmental Dysplasia of the Hip (DDH)

1. What is it?
2. What are the risk factors?
3. Treatment

Answer 7

• If in childhood/ development head of femur slips out of fosssa–> no force is applied to hip bone –> no propper bone formation (Wolffs Law)

Risk

• female
• breech babies
• ? IU behaviour

Treatment:

• try to relocate: bone will form around
• but : increasese risk of arthritis

Question 8

How can leg shape deformities be treated?

Answer 8

Can be done by Osteotomy (cutting the bone)

Question 9

Explain the treatent of DHS

Answer 9

Via: replacement

Question 10

What is a Cam impingement?

What is it caused by?

Answer 10

By rigerous exercise–> high stress on femoral neck causes increased bone mass formation leading to

• cam impingement (might be a cause of arthritis)
• because it has an impact /stress on cartilage and
• labural tears

Question 11

What is a Pincher Impingement?

Answer 11

Deepening of the hip socket

leading to

• damage to labrum
• degeneration and ossification of laburm (two sided
• damage to cartilage
• –> Arthritis

Question 12

What is the most effective way of treat arthritis?

Answer 12

• Exercise
  
  • exercise is good: cartilage also responds to weight
  • but also depending on loading cycle (e.g. might be fine for 1hr but not 5)
    *

Question 13

Explain the 4 layered structure of hyaline cartilage

Answer 13

1. Superficial layer
   
   • for articulation + reducing friction
   • horizontal collagen fibres
2. Transitional Zone
   
   • oblique collagen fibres
   • starts to resist compression but also shears side to side
3. Deep layer
   
   • Vertical Fibres
   • Resists compression

Tidemark (junction between non-ossefied and ossefied cartilage)

• 4. Calcified cartilage
     * barrier function preventing germs etc. from bone getting into joint

Question 14

What are the long-term problems of an ACL rupture and why?

Answer 14

Long term: arthritis because of

• shift in position of tibia
• change in weight on cartilage in knee –>
• Arthitis