Adult MSK injury

Question 1

What drugs are associated with tendinopathies?

Answer 1

Fluoroquinolones, corticosteroids, statins, estrogen, NSAIDs

Question 2

What are intrinsic risk factors for sports injuries?

Answer 2

Systemic illness (DM2, HTN), previous injury, genetics, obesity, weakness, biomechanical abnormalities

Question 3

What is the role of tendons?

Answer 3

Tendons transmit force from muscle to bone and act as a buffer by absorbing external forces to limit muscle damage

Question 4

What makes up the majority of the dry mass of tendons?

Answer 4

Type I collagen and elastin

Question 5

What is the weakest point of the musculotendinous unit?

Answer 5

The myotendinous junction

Question 6

What is the myotendinous junction?

Answer 6

A site in the musculotendinous unit where tendinous collagen fibrils are inserted into deep recesses formed by myocyte processes, allowing the tension generated by intracellular contractile proteins of muscle fibers to be transmitted to the collagen fibrils.

Question 7

What is found on histology in tendonpathy?

Answer 7

Disordered, haphazard, healing with an absence of inflammatory cells, a poor healing response, noninflammatory intratendinous collagen degeneration, fiber disorientation and thinning, hypercellularity, scattered vascular ingrowth, and increased interfibrillar glycosaminoglycans

Question 8

What are the three stages of tendon healing?

Answer 8

Inflammation, remodeling, and maturation

Question 9

What ages are rotator cuff tendinopathies most common at?

Answer 9

Middle age (less common in childhood)

Question 10

Where does achilles tendinopathy usually occur?

Answer 10

Midportion of tendon and at insertion on the calcaneous

Question 11

What are the three grades of muscle strain?

Answer 11

Grade I: microscopic tear

Grade II: macroscopic partial tear

Grade III: complete tear

Question 12

What types of muscles are more likely to be strained?

Answer 12

Muscles that cross two joints

Question 13

What is the most common type of sprain?

Answer 13

Inversion ankle sprains

Question 14

What ligaments can be involved in inversion ankle sprains?

Answer 14

Anterior talofibular ligament (most common), calcaneofibular ligament, or posterior talofibular ligament

Question 15

What are the three stages of tissue healing?

Answer 15

Stage I - inflammatory phase (0-10 days after injury)

Stage II - proliferative phase (2-21 days after injury)

Stage III - remodeling phase (12 days-1 year after injury)

Question 16

What are the components of stage I of tissue healing?

Answer 16

RBC/WBC infiltrate, initiation of angiogenesis, removal of necrotic material

Question 17

What are the components of stage II of tissue healing?

Answer 17

Infiltration of specialized cells, production of type III collagen

Question 18

What are the components of stage III of tissue healing?

Answer 18

Consolidation phase, maturation phase

Question 19

Patients with achilles tendinopathy have tendon pain that is worst with:

a) sitting
b) running
c) walking
d) lying down

Answer 19

b) running

Question 20

Which of the following muscles is most likely to suffer a muscle strain?

a) gastrocnemius
b) vastus medialis
c) short head of biceps femoris
d) tricepsbrachii

Answer 20

a) gastrocnemius

Question 21

Rehabilitation after an ankle sprain is important because

a) most people do not exercise so at least they should have strengthening exercise for the ankle
b) exercise will maximize healing of the sprained ligament
c) it will decrease chance of experiencing another sprain at the same ankle
d) tendons are usually injured with an ankle sprain and need to be strengthened before returning to fitness and sport activities

Answer 21

c) it will decrease chance of experiencing another sprain at the same ankle

Question 22

What does this histology show?

Answer 22

Tendinopathy (of the achilles)

Question 23

What is the treatment for an ankle sprain?

Answer 23

RICE, immobilization/taping/bracing, rehab