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MSK > Bones and joints > Flashcards

Bones and joints Flashcards

1
Q

Types of bone and example

A 
Long - femur 
Short - carpals
Flat - scapula 
Sutural - within a suture in cranium 
Irregular - vertebra 
Sesamoid - patella
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2
Q

Structure of short, flat and sesamoid bones

A 
Mainly spongy bone
Bone marrow between trabeculae
Thin layer compact bone (covered in periosteum)
No epiphysis 
No diaphysis
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3
Q

Blood supply of bones before epiphyseal fusion

A

Epiphyseal arteries (only blood supply to epiphysis)
Bends of metaphyseal arteries
Periosteal arteries
Nutrient artery

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4
Q

Blood supply of bones after epiphyseal fusion

A

Anastomoses between epiphyseal and metaphyseal arteries
Periosteal arteries
Nutrient artery

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5
Q

Where do metaphyseal arteries enter bone

A

Metaphysis at site of attachment of capsule

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6
Q

What does the periosteal artery supply

A

Periosteum

Outer 1/3 of cortex

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7
Q

Where does the nutrient artery enter bone

A

Diaphysis via nutrient foramen

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8
Q

How can avascular necrosis be caused

What can it lead to

A 
Fracture
Dislocation
Steroids
Radiation
Decompression sickness (N2)

Leads to secondary osteoarthritis

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9
Q

What properties are joints classified by

A

Structural (tissue between articulating bones)

Functional (amount of movement)

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10
Q

What are the structural joint types

A

Fibrous
Cartilaginous
Synovial

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11
Q

What are the functional joint types

A

Synarthrosis - immovable
Amphiarthrosis - slightly moveable
Diarthrosis - freely moveable

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12
Q

Functions of skeleton

A 
Support
Protection
Movement - attachment site for muscles 
Mineral and growth factor storage (Ca, PO3, insulin like growth factor, transforming growth factors, bone morphogenetic proteins)
Haematopoeisis
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13
Q

Types of fibrous joints

Give a short description of each

A

Suture -restricted to cranium
Syndesmosis - immovable joint with CT between bones
Gomphosis - peg of bone fits into bone socket

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14
Q

What occurs to suture joints on completion of growth

A

Synostosis - fusion of adjacent bones

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15
Q

Examples of syndesmosis joint

A

Inferior tibiofibular joint
Radioulnar interosseus membrane
Posterior sacroiliac joint

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16
Q

Examples of gomphosis joint

A

Teeth

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17
Q

Types of cartilaginous joints

A

Primary cartilaginous joint

Secondary cartilaginous joint

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18
Q

Describe primary cartilaginous joints

A

United by hyaline cartilage

Synarthrosis

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19
Q

Describe secondary cartilaginous joints

A

Articulating bones covered with hyaline cartilage with fibrocartilage between them
Amphiarthrosis

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20
Q

Examples of primary cartilaginous joints

A 
First sternocostal joint 
Xiphisternal joint (end of sternum)
Epiphyseal growth plate
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21
Q

Examples of secondary cartilaginous joints

A

Pubic symphysis
Intervertebral disc
Manubriosternal joint (sternal angle)

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22
Q

Describe synovial joints

A

Diarthrosis

Made up of:
Articular cartilage
Fibrous capsule 
Synovial membrane 
Synovial fluid
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23
Q

What synovial joints don’t have hyaline as the articular cartilage
What do they have instead

A

Acromioclavicular
Sternoclavicular
Temperomandibular

Fibrocartilage

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24
Q

Describe fibrous capsule of synovial joints

A

Collagen
Poor blood supply
Encloses joint except at synovial protrusions
Stabilises joint

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25
Q

Describe synovial membrane of synovial joints

A 
Thin
Highly vascularised
Lines capsule
Covers exposed osseus surfaces, tendon sheaths and bursae
Doesn't cover articular cartilage 
Produces synovial fluid
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26
Q

Describe properties of synovial fluid

A

Clear/pale yellow
Viscous
Slightly alkaline

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27
Q

Composition of synovial fluid

A

Hyaluronic acid
Lubricin
Proteinase
Collagenase

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28
Q

Functions of synovial fluid

A

Reduce friction
Shock absorption
Nutrient and waste transportation

29
Q

Compare bursae and tendon sheaths

A

Bursa - synovial fluid filled sac lined with synovial membrane
Tendon sheath - elongated bursa around tendon

30
Q

Blood supply of articular cartilage of synovial joint

A

Avascular

31
Q

Blood supply of synovial joints

A

Periarticular arterial plexus

This contains many vessels so movement doesn’t cut off blood supply

32
Q

What is hiltons law

A

Nerves supplying joint capsule also supply:
Muscles moving joint
Skin overlying insertion of these muscles

33
Q

What are the types of synovial joints

Give examples for each

A

Planar - sternoclavicular, intercarpal, vertebral facet
Hinge - knee, ankle
Pivot - proximal radioulnar, atlantoaxial
Condyloid/ellipsoidal - MCP, radiocarpal, atlantooccipital
Saddle - CMC
Ball and socket - hip, shoulder

34
Q

Describe planar joint

A

Articulating surfaces are flat/slightly curved

Uni axial

35
Q

Describe hinge joint

A

Convex surface of one bone fits into concave surface of another
Uni axial

36
Q

Describe pivot joint

A

Rounded surface of one bone articulate within a ring formed by:
Concavity of another bone
Fibrous ligament

Uni axial

37
Q

Describe Condyloid joint

A

Oval shaped condyle rests on elliptical cavity of another

Biaxial

38
Q

Describe saddle joint

A

One bone is concavoconvex (saddle) and the other bone resembles legs of rider
Biaxial

39
Q

Describe ball and socket joint

A

Ball like surface of one bone fits into cup-like structure of another
Multi axial

40
Q

Describe cracking synovial joints

A

Bones pulled apart at joint so synovial cavity expands
Synovial volume is constant so partial vacuum produced
Gases dissolved in fluid are pulled out of solution making a popping sound

41
Q

How does aging affect synovial joints

A

Articular cartilage thins
Ligaments shorten
Decreased flexibility
Decreased production of synovial fluid

42
Q

Describe Paget’s disease

A

Increased bone turnover (especially spine and pelvis)
New bone is weaker, less compact and more vascular
Bone pain which is worse lying down

43
Q

What is arthritis

What is the most common type

A

Inflammation and stiffness of a joint

Osteoarthritis

44
Q

Describe rheumatoid arthritis

A

Autoimmune disorder where rheumatoid factor attacks the synovium causing synovial inflammation
Women affect 2-3x more than men

45
Q

X-ray features of RA

A 
Narrow joint space
Periarticular osteopenia (decreased bone mineral density at joint)
Bony erosions near joint 
Subluxation
Gross deformity
46
Q

What does RA mainly affect

A 
MCP joints
Cervical spine
Feet 
Eyes
Skin
Lungs
Heart
BVs
Kidneys 
Blood
47
Q

What local factors affect bone healing

A

Type of injury (soft tissue)
Type of bone (cortical takes longer)
Treatment - reduction, stabilised by plaster, infection

48
Q

What regional factors affect bone healing

A

Blood supply

Muscle cover

49
Q

What systemic features affect bone healing

A

Age
Comorbities - e.g cardiac disease reduces blood supply
Bone pathology
Head injury (heals well)

50
Q

What is malunion

A

Fracture heals but in wrong position

51
Q

Causes of malunion

A

Deformity

Late arthrosis

52
Q

What’s non-Union

A

Fracture doesn’t heal

53
Q

Causes of non-Union

A

Hypertrophic - bones moving

Atrophic - poor bone quality or blood supply

54
Q

Local early fracture complications

A

Neurovascular injury
Compartment syndrome
Avascular necrosis
Infection

55
Q

Systemic early fracture complications

A 
Hypovolaemia 
Fat embolism
Thromboembolism 
Acute respiratory distress syndrome 
Disseminated intravascular coagulation
56
Q

Local late fracture complications

A 
Delayed Union
Non-Union
Malunion 
Myositis ossificans
Refracture
57
Q

Regional late fracture complications

A

Osteoporosis
Osteoarthrosis
Joint stiffness
Overreaction of SNS leading to increased blood supply and chronic regional pain syndrome

58
Q

Predispositions to stress fractures

A

Osteoporosis
Sports
Eating disorders

59
Q

Diagnosis of osteoporosis

A

DEXA scan assesses bone mineral density

60
Q

What are T and Z scores

A

T is number of SD below mean for sex and race matched with young healthy adult population
Z is number of SD below mean for age, sex and race matched with young healthy adult population

61
Q

Risk factors for type 2 osteoporosis

A

Age
Hyperparathyroidism
Ca deficiency
Affects men and women equally

62
Q

What is type 1 osteoporosis

A

Affects post menopausal women

63
Q

Treatment for osteoporosis

A

Bisphosphonates inactivate osteoclasts:
Decrease bone turnover
Increase bone mineralisation

64
Q

What is OA

A

Disorder of synovial joints mostly affecting articular cartilage resulting in decreased joint space
There is sclerosis and formation of osteophytes and bone cysts
There can be mild synovitis

65
Q

Clinical features of OA

A

Pain
Stiffness
Deformity
Joint swelling

66
Q

Treatment for OA

A

Weight loss
Physiotherapy
Analgesia/NSAIDs
Joint injection
Arthroscopy (endoscope inserted into joint - minimally invasive)
Osteotomies
Arthrodesis (induction of joint ossification)
Arthroplasty (surgical restoration of joint function)

67
Q

Local complications of hip replacement

A 
Leg length inequality
Dislocation
Infection
Loosening
Neurovascular damage
68
Q

Systemic complications of hip replacements

A

UTIs
DVT
Pulmonary embolism
Mortality

MSK (87 decks)

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