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Loco > Connective tissue conditions > Flashcards

Connective tissue conditions Flashcards

1
Q

What cell is responsible for the repair of skeletal muscle?

A

Satellite cells

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2
Q

What is tendonitis and how is it caused?

A

Small tears causing localised inflammation in a tendon

Causes: overuse, collagen disorders, renal dialysis

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3
Q

How should tendonitis be treated?

A

RICE
Analgesics + NSAIDS
stretching
surgery

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4
Q

Where in the Achilles tendon does tendonitis usually occur?

A

Belly of the tendon

~2-6 cm above insertion point

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5
Q

What is heterotopic calcification/ossification? How often does it occur in tendon injuries? How can this be treated?

A

Formation of bone outside the skeleton (i.e. in soft tissue)
~30% of tendon injuries cause heterotopic ossification

NSAIDs such as indomethacin, aspirin and ibuprofen can prevent the ossification (not necessarily heal ossification that has already occurred)

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6
Q

State whether cast immobilisation and passive motion are beneficial or detrimental for:

a) tendon-to-bone healing
b) flexor tendon healing

A

a) tendon-to-bone healing
- cast immobilisation is beneficial
- passive movement is detrimental

b) flexor tendon healing
- cast immobilisation is detrimental
- passive movement is beneficial

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7
Q

Which tendons heal via extrinsic and intrinsic methods?

A
  1. Extrinsic (peripheral fibroblasts):
    - Achilles
    - Rotator cuff
    - Tendons without a tendon sheath
  2. Intrinsic (fibroblasts from tendon):
    - Hand flexors
    - any tendon with a sheath
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8
Q

What are the different phases of tendon healing? How long does tendon healing take and why?

A

Phase 1: INFLAMMATION

  • pain, swelling, redness
  • reduced collagen synthesis and increased inflammatory cells

Phase 2: PROLIFERATION/REPAIR

  • collagen fibre production
  • reduced collagen fibre organisation and reduced inflammatory cells

Phase 3: MATURATION/REMODELLING

  • proper collagen fibre alignment
  • increased tissue strength

Can take up to 1 year to heal fully - as tendons are relatively avascular

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9
Q

What are the two different types of enthesis?

A
  1. Fibrosus
    - tendon/ligament not kinked by joint movement (long distance from insertion
    - extends all the way up to bone
    - aligned collagen fibres are going to insert and integrate on the outer edge
    - tendon joins directly to bone
  2. Fibrocartilaginous
    - tendon/ligament is kinked by joint movement (close insertion)
    - small section of fibrocartilage at attachment site
    - tendon transitions through fibrocartilage before reaching the bone
    - -> ensures that any bending of tendon/ligament is spread gently away from bone
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10
Q

What are Sharpey’s fibres?

A

insertion of tendons into periosteal layer of bone

look like trees in longitudinal section and circles in cross-section

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11
Q

What is enthesitis? How is it caused?

A

Inflammation of the enthesis (i.e. any point of attachment for tendon/ligament)
Causes:
1. recurring stress
2. autoimmune disease (i.e. spondyloarthritides, associated with HLA-B27 arthropathies)

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12
Q

What is the pathogenesis of enthesitis?

A
  1. mechanical injury
    - stress-sensing at entheseal junction
  2. vasodilatation
    - transcortical vessels become inflamed
  3. Inflammation
    - cells (neutrophils) efflux through transcortical vessels
    - enthesitis occurs
  4. new bone formation
    - mesenchymal proliferation and osteoblast differentiation
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13
Q

What is the main difference between tendonitis and enthesitis?

A 
Tendonitis = inflammation in belly of tendon
Enthesitis = inflammation at insertion point of tendon
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14
Q

Where do enthesophytes and ostephytes originate from?

A

Enthesophytes = from the insertion of joint capsule, ligaments or tendons; the articular border of cartilage is not involved

Osteophytes = originate from the border of articular cartilage

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15
Q

How should enthesitis be treated?

A

Mechanical: RICE and NSAIDs

Inflammatory: usually part of treatment of an asspocated polyarthritis

  • sulfasalazine, MTX
  • anti-TNFalpha therapy
  • local radiotherapy
  • corticosteroid injections
  • injection of hyperosmolar dextrose
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16
Q

Why are injections of hyperosmolar dextrose used sometimes as treatment for enthesitis?

A

it is an irritant - causes proliferation of intrinsic fibroblasts
this speeds up the repair of the tendon before it becomes ossified

17
Q

What are the main forms of tenosynovitis?

A
  1. De Quervain’s syndrome:
    - fibrosis and narrowing of tendon sheath
    - caused by tendons and sheath rubbing over radial styloid process
    - inflammation of the tendon sheath of the first dorsal compartment
  2. Trigger syndrome:
    - enlargement of tendon within the sheath
    - section of tendon/nodule outside the tendon gets stuck (finger is stuck in position)
18
Q

What treatment options are there for De Quervain’s and Trigger syndrome?

A

RICE, splinting, anti-inflammatories, corticosteroid injections
Surgery:
Trigger finger: cut the annular ligament
DeQuervain’s: shave down the radial styloid process

19
Q

What is a characteristic clinical feature of tendinopathies/enthesitis?

A

Pain on resisted movement

20
Q

What tendons are involved in DeQuervain’s syndrome?

A

Extensor pollicus longus
Abductor pollicus longus
Extensor pollicus brevis

21
Q

What are the differential diagnoses for carpal tunnel syndrome?

A

cervical radiculopathy
diabetic neuropathy
MS

22
Q

Thenar eminence wasting is a sign of carpal tunnel syndrome, what other condition is it a sign of?

A

Pancoast tumour

  • tumour in apex of lung
  • can compress T1
23
Q

What causes Dupuytren’s contracture?

A

Fibrosis of palmar aponeurosis

24
Q

What causes the following types of pain at the elbow:

  1. referred pain
  2. peri-articular pain
  3. articular pain
A
  1. due to issue in the neck of shoulder
  2. epicondylitis or bursitis
  3. trauma or osteoarthritis
25
Q

What is tennis elbow? How is it diagnosed and treated?

A

Also called lateral epicondylitis
affects the extensor muscles which attach to the lateral epicondyle

Diagnosis :
pt ‘cocks’ wrist back against resistance, if there is pain or tenderness then this indicates lateral epicondylitis

Treatment:
rest, topical NSAIDs, massage, injections, therapy

26
Q

What could cause swellings and rashes over the extensor surface of the elbows?

A 
olecranon bursitis
rheumatoid nodule 
gout tophus
psoriatic plaque 
vasculitis rash
27
Q

What are the potential causes of pain in the shoulder?

A 
rotator cuff tendonitis
bicipital tendonitis
frozen shoulder 
subacromial bursitis 
degenerative arthritis (Acromioclavicular joint)
28
Q

What are the causes of these referred pain patterns in the arm?

  1. posterior arm/shoulder
  2. anterior arm/shoulder
  3. deltoid to elbow
A
  1. neck pain
  2. acromioclavicular joint pain
  3. true shoulder pain
29
Q

What muscle is most likely to be the cause of shoulder impingement/tendinopathy and why?

A

Supraspinatus

because of how the muscle inserts –> passes under clavicle and acromion to insert onto the greater tubercle of humerus

30
Q

What is the main clinical sign of rotator cuff tendonitis and how is it treated?

A

Sign: painful arc on active abduction, pain on resisted abduction

Treatment: physiotherapy, steroid injections, surgery

31
Q

What causes the following types of pain at the hip:

  1. referred pain
  2. peri-articular pain
  3. articular pain
A
  1. pelvis, spine/SIJs, meralgia paraesthetica (paraesthesia of outer thigh)
  2. trochanteric bursitis, ischial bursitis, adductor tendinopathy, bone disease
  3. OA, inflammatory arthritis, irritable hip
32
Q

What are potential causes of pain in the foot?

A

Plantar fasciitis
March fracture
Morton’s neuroma

Loco (19 decks)

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