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MSS > Biology of Injury and Healing > Flashcards

Biology of Injury and Healing Flashcards

1
Q

what are 3 tissue types in terms of growth? what are some examples of each?

A

liable (bone)

stable (muscle, tendons, ligament, cartilage)

non-division/ permanent

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2
Q

what are te 3 phases of healing

A
  1. Inflammation
  2. granulation tissue formation
    1. cell proliferation and angiogenesis
    2. fibroblast migration
  3. remodeling
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3
Q

what is the difference in mind set between a question about what you are “most worried about” and what is the “most likely diagnosis”

A

most worried about means something that is possible, but is the most immediately emergent. this is not necessarily the most likely diagnosis.

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4
Q

what are the 3 different kinds of fractures?

A
  • traumatic
    • high force exceeds normal bone strength
  • pathologic
    • normal force exceed damaged bone strength
  • stress
    • repetitive submaximal forced gradually damages bone
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5
Q

What is the process/time line of bony healing?

A
  • Bleeding (seconds to minutes)
  • Clot formation (minutes to hours)
  • Inflammatory stage (hours to days)
  • Repair stage (1-2+ weeks-3+months)
    • osteoclasts and osteoblasts invade blood clot
    • soft callus (2-6 weeks)
    • hard callus (4 to 12+ weeks)
    • callus matures (12-26 weeks)
    • bony gaps bridged (6-12 months)
  • Remodeling stage (1-2 years)
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6
Q

What 2 things should make you think about a bony injury? a;lso what are 3 possible causes?

A

point tenderness on exam, and pain with indirect loading

acute-known injury

stress-overuse injury

pathologic-normal forces to abnormal bone

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7
Q

What is associated with a “locking joint”

A

something flipping in and out of the joint, either a peice of floatin cartilage, or the tendon

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8
Q

what motions lead to pain with a cartilge injury? what is associated with a cartilage injury?

A
  • pain with both active and passive motions (if large enough lesion or involved area stressed)
  • poor healing
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9
Q

what is a joint mice?

A

a loose body of cartilage that is sometimes floating around in the joint space after an injury

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10
Q

describe the stability of a joint during

dislocation

subluxation

laxity

A

dislocation-complete displacement

subluxation-transient, partial displacement (goes out and pops back in)

laxity- normal variant in “joint looseness”

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11
Q

A positive external rotation test often means_______-

A

it is NOT a lateral ankle sprain

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12
Q

what s a squeeze test? what does a positive squeeze test indicate?

A

pressing the fibula and tibia together cause the ends to bow out (or stress the lower part of the syndesmosis ligament) and cause pain.

suggestive of a Maisonneuve (proximal fibula) fracture

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13
Q

what symptoms are associated with a lateral ankle sprain?

A
  • bleeding
  • clot formation
  • inflammation
  • repair
    • fibroblast proliferation
    • neovascularization
  • remodeling
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14
Q

would you use NSAIDs to treat a chronic illness?

A

no! You definitely would use it for acute pain, but chornic pain is often degenerative, not inflammatory so an anti-inflammatory probably wouldn’t do anything

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15
Q

what is another name for a lateral ankle sprain? what rules this out?

A

AFT

positive external rotation test!

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16
Q

what is necessary for proper ligament healing?

A

good blood supply

damage section to be approximated or guided to correct area

relative rest

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17
Q

Cast vs brace?

A
  • Cast
    • greater protection
    • “non-removeable”
  • Brace
    • limits only certain motions
    • removeable
    • adjustable
18
Q

When does pain with eversion occur?

A

occurs with peroneal ankle sprain

19
Q

what are the differences between actue and chronic injury

A
  • Acute
    • “classic injury” (exact time of injury)
    • gets worse with use
    • inflammation
    • treatments-ice
  • Chronic
    • overuse injury
      • vague time of onset of pain
    • pain gets better after warming up (for a while)
    • degeneration
20
Q

what are the 2 different mechanism of shoulder dislocation?

A
  • acute- from sudden imapct of large force exceeding strength of the joint restraints
  • pathologic- from normal forces to weakened or anatomic variant joint/capsular restraints
21
Q

what 5 things are involved in joint stability?

A

muscles (stabilizers)

capsule (ball and cup)

bony architecture

ligaments

intracapsular (negative) pressure

22
Q

where should the humeral head be siting in the body/ on radiograph? what likely occured if it is not there?

A

humeral head should be sitting in the glenoid cavity. if the humeral head is below the cavity it is likely due to an anterior shoulder dislocation

23
Q

what nerve is most likely to be damaged in an anterior shoulder dislocation? how do you ensure that you don’t get sued for damageing the nerve while reducing the fracture?

A
  • axillary nerve (transverses through the quadrangular space) can also be the musculocutaneous nerve
  • check sensation/ ensure the nerve is in tact and document it, before reducing the fracture
24
Q

what is the typical direction of shoulder dislocation? what are the common etiologies?

A

anterior (90%)

  • forced extension, abduction and external rotation of the arm (open arm tackle or fall onto abducted arm)
  • direct blow to posterior shoulder
25
Q

wht alteration alteration of shoulder contour is seen in an anterior dislocation?

A

promiennt acromion

humeral head anterior to acromion and adjacent to coracoid

26
Q

what is a positive apprehension test? feeling of instability with stress (not pain, just the sensation that the should will fall out again)

A
27
Q

WHat are 2 loading tests?

how about shift stress?

A
  • loading-pull out or in
    • compression loading-test joints and structures between surfaces (eg articular cartilage, menisci, labrum)
    • distraction loading-test strucutres surrounding joint (eg capsule and ligament)
    • shit-pull up or down, to test various strcutures
28
Q

what causes the “popeye” sign?

A

tear of the biceps long head! usually the long head, not the short

29
Q

what are 3 things to keep in mind when treating musculotendinous ruptures?

A

impact of absence of muscle

presence of alternative muscles

functional requirements of patient (olympic athelete or body builder)

30
Q

What is capsulitis? what usually causes it? what would hear on history? what would you see on exam?

A
  • capsular thickening often associated with inflammation and scarring
  • idiopathic or post -injury
    • risk factors: injury, diabetes, thyroid disease
  • history: limited range of motion
  • exam
    • decreased ROM
    • gradually tightening endpoint
    • exam otherwise c/w underlying etiology
31
Q

what are the 3 phases of capsulitis and what is seen at each phase?

A

Freeze phase- painful early with decreasing ROM

Frozen phase-non-painful, with stable, decreased ROM

Thawing-non-painful with improving ROM

32
Q

what is the treatment protocol for capsulitis?

A

reasurrence

educate and set u expectations

maintenance of ROM

pain control

33
Q

what are 3 differnet type of 5th metatarsal fractions?

A
  • Avulsion-5th metatarsal base at peroneus brevis insertion
  • Jones-traumatic fracture metaphyseal-diaphysis junction
    • “pseudo-jones”- stress fracture proximal diaphyses
  • dancer’s spinal fracture mid to distal diaphyses
34
Q

how do you find the dorsalis pedis artery/pulse?

A

tell patient to raise big toe. this will raise extensor hallucis longus. the artery will be found just lateral to it

35
Q

what are the 4 sections of a bone?

A

diaphysis-shaft

metaphysis-area between shaft and growht plate

physis-growth plate

epiphyses-end of long bone

36
Q

what is an apophysitis? what is the associated pain pattern?

what are the treatments? and what are possible complications?

A
  • pain and inflammation of ossification centers from repetitive tension
  • pain pattern
    • after activity
    • at the beginning of activity
    • through activity
    • all the time
  • treatments are activity as tolerated, ice and sometime NSAIDs
  • complications would be bony hypertrophy, or fracture (rare)
37
Q

what are 6 common site/conditions associated with apophysitis?

A

Osgood Schlatter: tibial tubercle

Sever’s: calcaneal apophysitis

sinding-larsen-johansson: distal patellar pole

anterior superior iliac spine (ASIS): sartorius

Anterior Inferior iliac spine (AIIS)- rectus femoris

Little leaguer’s elbow (medial epicondyle)

38
Q

word associations!

acute=_____

chronic= __________

A

acute=inflammation

chronic=degernation

39
Q

growth plates are ___________ what is the significance of this?

A

growth plates are inherently weak areas.

so in a person with an open growth plate undergoing repetitive stress (like running) they will damage the growth plate before they damage the tendons or msucles. But the same action in and adult would lead to a tendon injury.

40
Q

describe the repair potential of cartilage. also what motions cause pain with a cartilage injury?

A

poor repair potential

pain with active and passive motions

41
Q

ligaments are associated with _______

muscle and tendon are assocaited with ________-

A

ligaments-stability

muscle and tendon- active joint motion

MSS (26 decks)

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