Chapter 5

Question 1

3 joint classifications

Answer 1

fibrous joints (synarthroses-don't move)
amphiarthroses (slightly moveable joints with cartilage components)
synovial joints (highly movable and are called diarthroses)

Question 2

ligaments

Answer 2

if strongly attached to capsule, joint will have less movement (hip)
if not as strong or integral, joint will have more mobility (shoulder)

Question 3

structures that increase stability of a joint

Answer 3

meniscus-knee
acetabular labrum-hip
glenoid labrum-shoulder
They can be external and internal to the joint

Question 4

collagen

Answer 4

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

Question 5

hyaline cartilage contains mostly

Answer 5

type II collagen

Question 6

bones, ligaments and tendons are composed mostly of

Answer 6

type I collagen

Question 7

bursae

Answer 7

• 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

Question 8

purpose of bones

Answer 8

supports the body; provides attachments for muscle; allows movement to occur; protects vital organs (bones of the rib cage and spine)

Question 9

composition of bones

Answer 9

collagen, elastin, ground substance:osteoid

Question 10

long bones contain

Answer 10

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)

Question 11

bone cells

Answer 11

osteocytes- design, maintain
osteoblasts- make new bones
osteoclasts-break down bone

Question 12

bone growth

Answer 12

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)

Question 13

osteoarthritis OA/osteoarthrosis

Answer 13

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;

Question 14

fibrillation

Answer 14

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.

Question 15

Eburnation

Answer 15

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

Question 16

osteophytes

Answer 16

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

Question 17

hyperthyroidism

Answer 17

activates parathyroid; breaks down cortical bone; can develop osteoporosis if not regulated; cartilage is not healthy either

Question 18

OA of the hip

Answer 18

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

Question 19

Trendelenburg gait pattern

Answer 19

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

Question 20

OA of the knee

Answer 20

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”

Question 21

OA of the hands

Answer 21

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

Question 22

heberden’s nodes

Answer 22

found on the distal interphalangeal joints DIP; nodes are composed of cartilage or bone and sometimes become rather tender

Question 23

bouchard’s nodes

Answer 23

found on proximal interphalangeal joints PIP

Question 24

OA of the feet

Answer 24

involves the first metatarsophalangeal joint MTP with resulting hallux valgus deformity (bunions)

Question 25

unicondylar knee resurfacing

Answer 25

a new surgery performed for OA in which only one side of the knee joint is affected by OA

Question 26

modalities for OA

Answer 26

heat, ice, ultrasound, electrical stimulation and massage

Question 27

advice to patients with OA (15)

Answer 27

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

Question 28

spondylosis

Answer 28

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

Question 29

radiculopathy

Answer 29

pain due to compression on the nerve roots

Question 30

myelopathy

Answer 30

muscle weakness due to compression of the spinal cord

Question 31

spondylolysis

Answer 31

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);

Question 32

spondylolisthesis

Answer 32

spondylolysis defect starts to slip anteriorly; may cause a stenosis of the spinal canal resulting on pressure of the nerves; NO LUMBAR EXTENSION

Question 33

retrolisthesis

Answer 33

if the vertebral body moves posteriorly

Question 34

infective (sepsis) arthritis

Answer 34

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.

Question 35

hemophilic arthritis

Answer 35

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

Question 36

lyme disease

Answer 36

from tick

Question 37

gout

Answer 37

crystal arthritis; caused by heredity and environmental factors; inherited gout involves a metabolic inability to process uric acid in the body;

Question 38

hyperuricemia

Answer 38

high level of uric acid in the blood

Question 39

surgical intervention for arthritis

Answer 39

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)

Question 40

osteoporosis

Answer 40

disease in which the bone loses density and strength; main bones affected are spine, pelvis, hip

Question 41

rickets

Answer 41

bone deformation; from malnutrition or lack of vitamin d; loss of matrix and bones become flexible

Question 42

osteomalacia

Answer 42

bones develop in a bad way; causes softening and weakening of the bones; fractures are common

Question 43

legg-calve-perthes disease

Answer 43

pediatric disease; caused by avascular necrosis of the proximal femoral epiphysis (growth plate)

Question 44

avascular necrosis

Answer 44

loss of blood supply and disintegration of the bone

Question 45

slipped capital femoral epiphysis

Answer 45

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