FMC Test 2 *Periarticular Tissue* Flashcards
What are the three Periarticular Tissues?
Ligaments
Joint Capsule
Tendons
{All these closely surround, connect, and stabilize the joints}
What influence of movement does Periarticular Tissues have? (3)
- They don’t produce active motion
- Ligaments and capsules guide motion, by providing mechanical stability and preventing excessive motion
- Tendons transmit loads
Injures to Peri-Articular tissues may influence: (6)
- Pain
- Impaired ROM
- Impaired Joint mobility and integrity
- Impaired muscle performance
- Impaired balance
- Impaired gait
What are the characteristics of Peri-Articular Tissue?
- Characterized by parallel fibers of collagen known as ‘dense connective tissue’. (Their structure is uniquely due to the tensile loads they’re responsible for, they are composed of fibroblast and abundant extracellular matrix)
What does Dense Connective Tissue compose of? (5)
1) Non-muscular soft tissue
-Joint Capsule Fibrous layer of jt. capsule is considered irregular dense connective tissue, this is well-suited to resist tensile forces because of a large portion of collagen will resist tensile strength from multiple directions
-Fascia
-Ligaments
-Tendons
2) Low Portions of Glycosaminoglycans (GAGs) and elastin
3) Lots of Type 1 Collagen
4) Limited Blood Supply
5) Viscoelastive behavior when load is applied -> This is applicable when you are treating a patient with a stiff joint or adhesions from repairing and/or remodeling
What is Regular Dense Connective Tissue made up of?
Ligaments and Tendons
- Made of up Type 1 regular collagen in a parallel alignment to protect against tensile loads
What is Irregular Dense Connective Tissue made up of?
Joint capsule and Fascia
- Joint capsule is made up of Type 1 dense irregular collagen, which affords its ability to resist loads in multiple directions
What are size dependent variables of the Periarticular tissue?
(referred to as structural properties)
- Composition
- Length
- Cross-sectional area
Larger Structures can tolerate larger forces
Longer structures can stretch further than shorter structures before damage occurs
What are the three layers of the Joint Capsule?
1) The Outermost is dense irregular collagen connective tissue
2) The Middle layer has vascular supply, lymphatic vessel and fat cells
3) The Inner most layer is synovial sites, mast cells and capillaries, which produces the synovial fluid
What does a Joint Capsule compose of? (3)
- The joint Capsule has elastic capabilities at 10-15% strain and protected from injury by reflexive contraction of appropriate muscles
- Fibrous Capsules exhibit local thickenings of parallel bundles of collagen fibers called capsular intrinsic ligaments, and are named by their attachments
- Accessory ligaments are distinct structures, such as Lateral Collateral Ligament (LCL), ligaments may be located inside the joint, such as ACL
What happens if the joint capsule gets injured?
Injury to the joint capsule can result in joint laxity due to injury of the connective tissue and decreased synovium. Synovial fluid adds to joint stability
What happens if the synovium or synovial fluid in a joint capsule is altered?
If the synovium or synovial fluid are altered in any way, “Too much” or “Too little”, this can lead to joint instability
Do joint capsules have the capability to heal?
-What is the key in treating joint capsule correctly?
-What is the key with joint capsule injury?
Yes, due to its vascular supply, the joint can regain stability from capsular healing
- The key is treating the joint capsule correctly, through appropriate immobilization and dynamic stability training.
- The key with joint capsular injury is to prevent scar tissue to obtain better function, along with managing joint effusion and loading
What is the Load Deformation Curve/Physical Stress Theory?
A framework for all viscoelastic tissues in the body, where an appropriate load on a tissue will keep it healthy, whereas not enough of load will lead to atrophy, and too much load can lead to injury and death of tissue.
What is the Ligament Anatomy? What is it composed of?
Dense Connective Tissue: Described as opaque, white band, or cord-like. Contains collagen, fibroblast, and extracellular matrix and some elastin
- Type 1 Collagen: (Dominate)
-In Mature Ligaments
-In Mature scars - Type 3 Collagen: (Pre-dominate)
-In very young / or in proliferative stage of healing after injury- More elastic in immature scars
Sensory Innervation
- Contribute to proprioception and pain
What are the Roles of Ligaments? (3)
1) Provide passive guidance to the joint, especially at the anatomical limits of motion
2) Provide joint stabilization, especially when mechanoreceptors are activated
3) Provide proprioceptive feedback
They feedback information through the CNS to the periarticular tissues, affecting muscular function by providing muscular dynamic stabilization to the joint
{Ligaments are part of passive restraining systems of joints. When moving through ROM, ligaments provide sensory feedback through mechanoreceptors in the joint}
How does vascular supply and nerve innervation to ligaments differ from other tissues?
Ligaments are not as richly endowed with blood vessels or nerves compared to other tissues.
-Ligaments have ligament specific blood and nerve supply that is important for normal function
- Insertions of the bone are more innervated than the mid-substance of the ligaments
- Innervation follows pattern of vasculature
What is Grade 1 in Ligament Injury?
Microscopic tearing without producing joint laxity, and associated with pain
What is Grade 2 in Ligament Injury?
Tearing of some ligament fibers with moderate laxity, increased production of pain.
What is Grade 3 in Ligament Injury?
Complete rupture of the ligament with profound instability and laxity, typically no symptoms but marked laxity.
What are the three conditions needed for ligaments to heal or remodel?
- Torn ligament ends must be in contact with each other
- Progressive, controlled stress must be applied to the healing tissues to orient scar tissue formation
- Ligament must be protected against excessive forces during remodeling
How do you know if a ligament needs surgical intervention?
This depends on the degree of injury and involvement of supporting tissues
- Is the any dynamic stability?
Ligaments not managed correctly or untreated ligament tears are biomechanically inferior and are generally not healed even at 40 weeks after injury
Do all ligaments heal the same?
No, not all ligaments heal at the same rate or the same degree.
What is the difference between Intra-articular and Extra-articular ligament healing?
Intra-Articular ligaments: When injured, the intra-articular environment interfaces with the formation of fibrin clot, which in turn disrupts the healing process.
These ligaments do NOT heal spontaneously and WILL require surgery to heal, especially in high performance athletes.
Extra-Articular ligaments: Can heal with conservative management, depending on the extent of the injury, surgery may be indicated.
