Fascia/Fibromyalgia Flashcards
What is fascia? Describe its activity, function, and primary origin.
Definition: Diffuse, irregular fibrous CT holding all tissues together
- Metabolically active -
- Innervated and vascularized
- Has contractile ability
- Critical to wound healing/repair
- Mesodermal origins
Pannicular Fascia (Hypodermis) What is its location?
Deep to epidermis/dermis
Pannicular Fascia (Hypodermis) Origin?
Somatic mesoderm
Pannicular Fascia (Hypodermis) Constructed of what?
Loose/dense irregular CT w/ variable fat contect
Pannicular Fascia (Hypodermis) Function?
Facilitates movement/immune surveillance, insulate, store fat
Pannicular Fascia (Hypodermis) What muscles insert into it?
Facial muscles
Pannicular Fascia (Hypodermis) Name in the abdomen? Another name for it elsewhere?
Camper’s Fascia, superficial fascia
Investing Fascia
Two other names?
Axial/appendicular fascia, Deep Fascia
Investing fascia
Where does it fuse? What does it surround?
Fuses to panniculus peripherally extending out from the body having surrounded epaxial (dorsal deep spinal muscles) and hypaxial muscles (all other muscles)
Investing Fascia
Surrounds what structures?
Entire muscle fiber bundle (Epimysium) and intermuscular septa, Bones (periosteum), Tendons (peritendon), Sheaths of neurovascular bundles (e.g. axillary sheath)
Epaxial muscles groups are innervated by what nerve bundle?
Dorsal root peripheral nerve
Investing fascia are connected to which layers of fascia surrounding muscle?
All of them
Epi, peri, endomysium
What attaches the investing fascia to the periosteum?
Sharpey’s fibers
What four muscle’s fascia composes the thoracocolumbnar fascia?
Gluteus maximus
Gluteus medius
External oblique
Latissimus dorsi
What is a myofascial meridian?
e.g. Superficial back line
Single line of fascia connected from the toes to the eyebrows.
Meningeal fascia surrounds what?
CNS
Meningeal fascia is composed of what layers?
Dura and leptomeninges (arachnoid, pia mater)
Meningeal fascia is derived from what?
Somatic/cephalic mesoderm and neural crest cells (in neuroectoderm; telencephalic meninges)
Where does the meningeal fascia terminate?
Peripherally with the epineurium surrounding the peripheral nerves, but it is continuous with the epineurium of the peripheral nerves. No clear boundary.
What is visceral fascia derived from?
Splanchnic mesoderm
What does visceral fascia surround? What 3 big thoracic cavities are surrounded by visceral fascia (3P’s) and what are the fascia cavity names?
Body cavities -
Pleural - endothoracic fascia
Pericardial
Peritoneal - endoabdominal, transversalis fascia, endopelvic fascia)
Near the head, the visceral fascia invests what muscle group and connects them to what structure? What are the two group names?
- Superior pharyngeal constrictors - fuses them to cranial base - surrounds attachments of superior pharyngeal constrictor muscles
- Pharyngobasalar, pharyngobuccal
The visceral fascia fold over to form what “ligaments” in the thorax and abdomen?
Pulmonary ligaments, broad ligaments of uterus, ligament of Trietz
What cells are commonly associated with fascia?
Fibrocytes, Fibroblasts, Myofibroblasts, Macrophages, Mast cells
What do fibroblasts secrete? What do these compounds contain?
Synthesize ECM proteins (collagen, elastin, fibronectin) and ground substance (contain GAGs, proteoglycans, hyaluronic acid, glycoproteins)
What do fibroblasts respond to and how?
Tension, growth factors (TGF-ß), and inflammatory substances - increase collagen
What do fibrocytes do?
Maintain CT
What are myofibroblasts?
Differentiated fibroblasts similar to smooth muscle
What do myofibroblasts respond to and do?
Respond to TGF-ß; Synthesize/secrete collagen and facilitate wound healing
Macrophages are active during what processes in fascia? What is their fxn?
Inflammatory and infectious processes - clean up cellular waste - release TGF-ß1
Mast cells secrete what? What macrophage-like function do they have?
Secrete histamine (vasodilate) and heparin (anticoagulate) - secrete proinflammatory cytokines - phagocytosis
Collagen and elastin provide what in the ECM of CT?
Tensile strength and recoil
Ground substance allow what stresses in CT? What cellular fxn relies on ground substance?
Compression and expansion Cell adhesion (GAGs - chondroitin, heparin, hyaluronic acid)
Pannicular fascia contains what mechanoreceptors and what is their function?
Ruffini - fast adapting proprioception
Pacini - fast adapting vibration, proprioception
Golgi-Mazzoni - slow adapting muscle tension
Contractility of fascia is regulated by what factors?
Innervation and cell to cell communication
TGF-ß overproduction can lead to what? How?
Fibrosis - persistent irritation = sustained growth factor supply = too many myofibroblasts = too much collagen = fibrosis
During the hemostasis stage of healing, what is the timeline, and what is the main cell involved?
Hemostasis - immediately after injury - platelets and RBCs
During the inflammatory stage of healing, what is the timeline, and what is the main cell involved?
Inflammation - days 1-5 - neutrophils and macrophages
During the proliferative stage of healing, what is the timeline, and what is the main cell involved?
Proliferation - days 5-21 - lymphocytes, fibroblasts, keratinocytes, endothelial cells
During the remodeling stage of healing, what is the timeline, and what are the main cells involved?
3 weeks to 2 years - fibroblasts
What is a myofascial trigger point?
Discrete, hypersensitive nodule w/in tight bands of muscle or fascia
What is the difference between a latent or active myofascial trigger point? Why do they develop?
Latent does not cause spontaneous pain unless palpated - may restrict movement/cause weakness
Active causes pain at rest - most commonly in postural support muscles
- They develop as a result of mechanical stress (trauma)
49 year old female Pt presents with debilitating fatigue, chronic aches and pains globally in soft tissue, sleep disturbance, tender points, headaches, migraines, and IBS. She has an Hx. of depression. You evaluate her to find at least 11 of 18 associated tender points are present on her body. What is her likely diagnosis?
Fibromyalgia
