Chapter 5 Flashcards
3 joint classifications
fibrous joints (synarthroses-don't move) amphiarthroses (slightly moveable joints with cartilage components) synovial joints (highly movable and are called diarthroses)
ligaments
if strongly attached to capsule, joint will have less movement (hip)
if not as strong or integral, joint will have more mobility (shoulder)
structures that increase stability of a joint
meniscus-knee
acetabular labrum-hip
glenoid labrum-shoulder
They can be external and internal to the joint
collagen
component of bone, cartilage, ligaments and tendons
collagen is organized into parallel fibers in tendons and ligaments to give strength to the structure. The capsule has both parallel fibers and a meshwork of CT fibers that provide strength and a little flexibility
hyaline cartilage contains mostly
type II collagen
bones, ligaments and tendons are composed mostly of
type I collagen
bursae
- sacs that are enclosed and have small amount of lubricating fluid in them
- located wherever a tendon passes over bone or muscle, muscle passes over bone, or ligament passes over another structure.
- decreases friction between the 2 surfaces
- can get inflamed and swell-take away irritating stimulus so it can heal
purpose of bones
supports the body; provides attachments for muscle; allows movement to occur; protects vital organs (bones of the rib cage and spine)
composition of bones
collagen, elastin, ground substance:osteoid
long bones contain
haversian canals (run length, carries BV's-bone nutrition) Volkmann's canals (cross channels to connect haversian canals) Lacunae (hold the osteocytes) Trabeculae (thread like channels; strength; in cancellous (spongy) bone)
bone cells
osteocytes- design, maintain
osteoblasts- make new bones
osteoclasts-break down bone
bone growth
endochondral bone growth-through childhood until the epiphyseal plates (growth plates) ossify. (long bones)
intramembranous ossification-throughout life under the influence of muscle stresses, which increase the strength & density of bone (flat bones)
osteoarthritis OA/osteoarthrosis
degenerative joint disease; 2 types-primary and secondary; associated with loss of cartilage in the joint, resulting in reduced joint space between the bone ends of the joint; largely noninflammatory condition;
fibrillation
the absorption of water by the cartilage causes cracks to develop in the surface of the cartilage; these cracks joint together and pieces of cartilage flake off into the joint space; the pieces can cause “locking” or discomfort if they become trapped in the joint line and may result in reduced ROM.
Eburnation
the bone beneath the cartilage becomes shiny and smooth due to rubbing of bone against bone on both ends. The bone ends change shape as a result of the degenerative process with a flattening of the femoral head in the hip and flattening of the tibial condyles in the knee; cysts can develop in the subchondral bone
osteophytes
bony spurs that develop at the margins of the arthritic joint; may interfere with joint motion and in some cases may break off and become lodged inside the joint. Irritation from bone fragments within the joint can cause synovitis
hyperthyroidism
activates parathyroid; breaks down cortical bone; can develop osteoporosis if not regulated; cartilage is not healthy either
OA of the hip
referred pain into the groin and distally along with anterior aspect of the upper leg as far as the knee; muscles involved include the hip flexors, adductors and lateral rotators-all spasm; muscle atrophy and weakness occur in all of the hip muscles but are most apparent in the hip extensors and abductors; develop Trendelenburg gait pattern
Trendelenburg gait pattern
a result of the inability of the hip abductors to maintain a level pelvis over a straight leg in the one-legged standing position; a weakness of the glute medius; hip drops on the opposite side of the problem hip
OA of the knee
muscle spasm frequently occurs in the hamstrings, causing a flexion deformity/contracture of the knee; the quads become atrophied and weak and genu valgus (knock knee) occurs; knee appears very large because quads atrophied and enlargement of the knee because of synovial hypertrophy; knee “gives away”
OA of the hands
develops slowly and usually doesn’t grossly impair function; heberden’s nodes and bouchards nodes; radial or ulnar deviation of the distal phalanges may occur in late stages
heberden’s nodes
found on the distal interphalangeal joints DIP; nodes are composed of cartilage or bone and sometimes become rather tender
bouchard’s nodes
found on proximal interphalangeal joints PIP
OA of the feet
involves the first metatarsophalangeal joint MTP with resulting hallux valgus deformity (bunions)
unicondylar knee resurfacing
a new surgery performed for OA in which only one side of the knee joint is affected by OA
modalities for OA
heat, ice, ultrasound, electrical stimulation and massage
advice to patients with OA (15)
1.use a cane 2.avoid keeping joint in any one position for long periods 3. avoid prolonged standing in one position 4. exercise everyday 5. control weight 6. do NOT place a pillow beneath knees 7. do NOT lift heavy weights (extra stress on joints) 8. keep joints warm 9. use moist heating pad at home 10. if knees swell, elevate legs 15 min 3x a day 11. walk as much as possible 12. pace activity (little and often) 13. avoid sitting for long periods 14. avoid crossing legs 15. follow dr’s prescription meds
spondylosis
degenerative disease affecting the intervertebral discs of the spine; most often in the cervical spine; disc deterioration with cracking of the annulus fibrosis and breakdown of the proteoglycans in the disc that enable the disc to absorb water and remain viable; loss of height; lipping of the vertebral bodies(extra growth of the bone in a lip formation at the margins); can lead to crush or compression fractures; ligamentous thickening
radiculopathy
pain due to compression on the nerve roots
myelopathy
muscle weakness due to compression of the spinal cord
spondylolysis
disease process involving a defect in the pars interarticularis of the vertebra of the lumbar spine; repeated microtrauma to the pars interarticularis that pd a stress fracture; can be genetic and people w/spina bifida occulta have an increased risk; usually in lower lumbar spine (L4/5 or L5/S1);
spondylolisthesis
spondylolysis defect starts to slip anteriorly; may cause a stenosis of the spinal canal resulting on pressure of the nerves; NO LUMBAR EXTENSION
retrolisthesis
if the vertebral body moves posteriorly
infective (sepsis) arthritis
most common in very young or very old, in people who are immunosuppressed or those who abuse drugs; prolonged infection in a joint damages the articular cartilage.
hemophilic arthritis
present in patients with hemophilia that occurs when hemathrosis (bleeding into a joint) is present; presence of blood in the synovial fluid causes a deterioration of the articular cartilage that leads to arthritis in the affected joint
lyme disease
from tick
gout
crystal arthritis; caused by heredity and environmental factors; inherited gout involves a metabolic inability to process uric acid in the body;
hyperuricemia
high level of uric acid in the blood
surgical intervention for arthritis
arthodesis (fuses the joint and prevents motion); hemiarthroplasty (one-sided replacement of a joint; ex-hip would be a replacement of the femoral head and leaving the acetabulum intact); menisectomy (removal of any damaged areas of meniscus and any fragments of meniscus floating within the joint); osteotomy (a cut is made in the bone; performed to realign bones); resection arthoplasty (removal of a joint); total joint arthroplasty (both articulating surfaces of the joint are replaced; could be hip, knee, shoulder)
osteoporosis
disease in which the bone loses density and strength; main bones affected are spine, pelvis, hip
rickets
bone deformation; from malnutrition or lack of vitamin d; loss of matrix and bones become flexible
osteomalacia
bones develop in a bad way; causes softening and weakening of the bones; fractures are common
legg-calve-perthes disease
pediatric disease; caused by avascular necrosis of the proximal femoral epiphysis (growth plate)
avascular necrosis
loss of blood supply and disintegration of the bone
slipped capital femoral epiphysis
similar to legg-calve-perthes disease except that the femoral head slides on the femur at the epiphysis during growth of the bone and the femur becomes laterally rotated
