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musculoskeletal > arthritis 11 > Flashcards

arthritis 11 Flashcards

1
Q

describe the role of exercise on bone growth when you are young *

A

long bone has 2 growth centres - 1 at each end

it is the Hueter-Volkman theory - increased compression at the growth plate slows down longitudinal growth, increasing tension at the growth plate speeds up longitudinal growth

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2
Q

describe the use of an 8 growth plate

A

if there is a fracture in growth plate it stops bone growing

put in 8 growth plate - compresses the bone so stops it growing so the other bone can catch up

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3
Q

describe different alignments/misalignments of the leg *

A

normal alignment - hip and ankle match up ie are in a straigh line - so the weight baring occurs evenly across the knee joint

varus - means go towards - all weight is on the medial side of the knee - bowed legs

valgus - all weight on lateral side of the knee - knocked knees

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4
Q

describe the effect of sport on alignment of legs *

A

sport = more bowed/varus legs

most people are slightly varus and sport squashes medial bone = less growth in medial bone = varus legs

by changing the shape of the bone you change the weight through the bone - this effects the mechanics

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5
Q

who gets valgus legs

A

models - have to like walk

women have wide pelvises mean angle of femer coming out of hip is altered

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6
Q

what is the effect of having valgus/varus legs *

A

have causes arthritis on the weight baring part - either get arthritis on outside or inside

there is no cartilige gap - it has been rubbed away

if present really late then the arthritis is disorganised because ligaments are involved

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7
Q

what are the effects of arthritis *

A

pain

loss of function

muscle weakness

loss of cartilage

osteophytes

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8
Q

should you do sport to prevent arthritis *

A

shoudl do a variety - not just 1 that will work a certain part of the bones because the bones will change shape to match

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9
Q

how can you treat valgus/varus legs

A

with osteotomy

cut bone - insert hinge to open/shut joint = change shape of leg - delays/prevents arthritis

can do 3D CT to see what would happen with the surgery

problem is identifying people early enough for this to work

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10
Q

describe Wolff’s law *

A

bone responds to the stress that you put on it

more load = more bone added

if stop using the bone it will dissolve away

problem in astraunauts - the trabeculae thin out

this happens at all ages

eg bone mass in tennis player’s dominant arm is stronger because muscles putting load on arm

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11
Q

describe developmental dysplasia of the hip *

A

effects babies

need the ball of the hip to be in the socket so that the bone grows around it - if the ball has slipped out you dont get this reaction = DDH

if never had hip in joint - the socket stays flat

risk factors:

  • girls - because oestrogen makes ligaments more lax to allow childbirth = more likely for hip to slip out of place
  • babies born breech
  • right hip - that is the one that is pushed against the lumbosacral spine
  • in utero life of the fetus - number of kicks
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12
Q

management of DDH (

A

need to put babies in harness so that the femer is kept in place - hold hip joint out so that via wolff’s law the hip will respond

depend on how carry baby - want legs flexed and abducted

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13
Q

problem with DDH *

A

increase the risk of arthritis because the bone is rubbed away quickly

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14
Q

what are the 3 groups of people that would get arthritis *

A

elderly - overwear

injury - torn structure around the hip eg labrum which leads to damage of the cartilage

young - around 40yrs - because of the shape of the hip based on actibity when young

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15
Q

summarise a standard hip joint *

A

spherical ball

slender neck

cartilage gap

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16
Q

describe a cam impingement *

A

due to a lot of exercise

femoral neck is under a lot of stress - therefore by Wolff law the bone deposits more to cope

therefore you get a lump of bone on side

caused by deep flexion

17
Q

describe pincer impingement *

A

movement based - deep flexion

the socket is deeper

18
Q

what is the problem with a cam impingement *

A

the bump knocks into the labrum everytime you deep flex eg when sitting/squatting

causes the labrum to tear

causes clicking and pain and the cartilage buckles up so quickly wears out = arthritis

19
Q

describe the problem with pincer impingement *

A

causes labrum to tear

cartilage wear out on the opposite side to the pincer as well

20
Q

describe treatment for cam impingement

A

surgery to scrape away the bump - stop it hitting the acetabulum

effective if early, but if already started affecting cartilage it is not

it allows you to preserve the joint

21
Q

problem with joint replacement

A

only last for 20yrs - so if do them young you will have to have a lot of replacement

2nd replacement is less good because the bone left is weaker because it doesnt take as much yield because the metal cap takes all the yeild (wolff’s law) - so the bone dissolves

also becoming a pain reliever - people have it saying they will lose weight and exercise more afterwards but they dont

22
Q

describe exercise and arthritis *

A

treatment for arthritis is exercise - keep load on bone so that they stay strong - wolff’s law

people avoid activity = weaker muscles = more weighht goiung through the joint that is normally taken by the muscles

therefore exercise is good for joint but should do a variety of exercise not extreme exercise in one area because 1 bone will take a lot of weight - need to do counter activities

cartilage also responds to load - so exercise increases cartilage

depends on how long and how consistant the cartilage is - not just the fact that you’re doing exercise

23
Q

describe the structure of a synovial joint *

A

where 2 bones articulate

covered in fibrocatilage or hyaline cartilage

bathed in synovial fluid that is secreted by the synovial membrane

surrounded in articular capsule

24
Q

describe menisci *

A

they are C shaped fibrocartilage

shock absorbers

deepen the socket and give stability

25
Q

what is the role of the cruciate ligaments *

A

stop the knee sliding back and forward

26
Q

what property makes carilage good in joints *

A

it has a low coefficient of friction

27
Q

describe the sructure of cartilage *

A

superficial layer

  • in joint surface
  • fibres are flat to put up with the shearing, sliding action of bone above

middle transitional layer

  • fibres are oblique
  • resist compression
  • resist sliding

deep radial zone

  • fibres completely verticle
  • resist compression

tidemark - go from cartilage that isnt calcified to cartilage that is

calcified cartilage

  • stop blood from the bone entering the joint
  • this stops infection getting into the joint which would destroy the cartilage
28
Q

what provides the cartilage with nutrients *

A

the synovial fluid

29
Q

describe the problem that the joint doesnt have blood for repair *

A

no inflammatory factors or nutrients for repair - when you get damage, you cant really undo it

30
Q

type of injury that would cause an ACL tear *

A

when leg fully extended and foot stuck - rotational injury

31
Q

effect of an ACL tear *

A

the tibia slides forward

tibia and femer shoudl line up

this misalignment leads to arthritis

32
Q

do you have to operate on all ACLs

A

no

problems are:

  • functional - stability in pivoting is reduced
  • cartilage damage - loading in wrong position leading to arthritis
  • back of meniscus tear because take weight when the femer roles back

so people can be ‘copers’ and do loads of physio etc - do normal actibity but modify it if you used to be able to do lots of sports

or get ACL reconstruction

33
Q

how do you treat problems with menisci

A

the inside of the meniscus has a bad blood supply so need to remove

the bits around edges have blood supply so you can repair by suturing

by removing the meniscus you get an increased load on cartilage = arthritis

  • if have meniscus - even distribution of pressure across the knee
  • if removed - 70% reduction in area it loads the cartilage = increased load on cartilage = arthritis
34
Q

describe a partial knee replacement

A

restore the jpoint space so that the knee goes back to the normal place

everything else from original joint is still there

musculoskeletal (12 decks)

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