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Musculoskeletal > Growth, Injury and Repair > Flashcards

Growth, Injury and Repair Flashcards

1
Q

What is a tendon?

A

Longitudinal arrangement of cells (mostly tenocytes) and fibres (collagen type 1 triple helix)

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2
Q

What is the structure of a tendon?

A

Collagen bundles covered by endotenon
Fascicles covered by paratenon
Tendon covered by epitenon

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3
Q

In what layers is the blood supply to a tendon found?

A

Paratenon

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4
Q

What types of injuries can occur to a tendon?

A 
Degeneration 
Inflammatory 
Enthesiopathy 
Traction apphysitis 
Avulsion +/- bone fragment 
Tear- intrasubstance (rupture) 
Tear- musculotendinous junction 
Laceration/incision  
Crush/ischameia/attrition 
Nodules
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5
Q

What is a common area of tendon degeneration?

A

Achilles tendon

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6
Q

What is de Quervain’s stenosing tenovaginitis?

A

Inflammation of tendons of EPB and APL passing through common tendon sheath at radial aspect of wrist

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7
Q

What are the symptoms and signs of de Quervain’s?

A 
Swollen 
Tender 
Hot 
Red 
Positive Finklestein's test
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8
Q

What is enthesiopathy?

A

Inflammation at insertion to bone of muscle, tendon or ligament

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9
Q

What is an example of traction atophysitis?

A

Osgood Schlatter’s disease

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10
Q

What is Osgood Schlatter’s disease?

A

Insertion of patellar tendon into anterior tibial tuberosity

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11
Q

What group are commonly affected Osgood Schlatter’s disease?

A

Adolescent active boys

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12
Q

What is mallet finger?

A

Insertion of extensor tendon into dorsum of base of distal phalanx of finger, causing forced flexion of extended finger

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13
Q

What is the treatment for avulsion?

A

Conservative (Limited application, retraction tendon)

Operative (Reattachment tendon, bone fixation)

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14
Q

Why does avulsion occur?

A

Load exceeding failure strength while muscle contracting

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15
Q

How does intrasubstance rupture?

A

Load exceeds failure strength

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16
Q

What are common mechanisms of rupture?

A

Pushing off with weight bearing forefoot whilst extending knee joint
Unexpected dorsiflexion of ankle
Violent dorsiflexion of plantar flexed foot

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17
Q

What are the clinical signs of a ruptured achilles tendon?

A 
Positive Simmonds (squeeze) test 
Palpable tender gap
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18
Q

What is the treatment for a rupture?

A

Conservative (Mobilise, Splint/cast)

Operative

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19
Q

What are common areas for laceration to occur?

A

Finger flexors (FDS and FDP)

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20
Q

What are ligaments?

A

Dense bands of collagenous tissue anchored to a bone at either end

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21
Q

How are ligaments different from tendons?

A

Lower percentage of collagen
Higher percentage of proteoglycans and water
Less organised collagen fibres
Rounder fibroblasts

22
Q

What are the healing phases of a ligament?

A

Haemorrhage
Proliferative phase
Remodelling

23
Q

What occurs during the haemorrhage phase of ligament healing?

A

Blood clot reabsorbed
Replaced with a heavy cellular infiltrate
Hypertrophic vascular response

24
Q

What occurs during the proliferative phase of ligament healing?

A

Production of scar tissue

Disorganised collagenous connective tissue

25
Q

What occurs during the remodelling phase of ligament healing?

A

Matrix becomes more ligament like

Major differences in composition, architecture and function persist

26
Q

What is a peripheral nerve?

A

The part of the spinal nerve distal to the nerve roots

27
Q

What is the structure of a peripheral nerve?

A

Axons covered with endoneurium and grouped into fascicles, covered in perineurium and grouped to form nerves which are covered in epineurium

28
Q

What type of compression injuries can occur to nerves?

A

Entrapment
Carpal Tunnel syndrome
Sciatica
Morton’s neuroma

29
Q

What kind of traumatic injuries can occur to nerves?

A 
Direct (blow, laceration) 
Indirect (avulsion, traction) 
Neurapraxia 
Axonotmesis 
Neurotmesis
30
Q

What is neurapraxia?

A

Nerve in continuity
Stretched or bruised
Reversible conduction block, local ischaemia and demyelination

31
Q

What is axonotmesis?

A

Endoneurium intact but disruption of axons, more severe injury
Stretched, crushed or direct blow
Wallerian degeneration follows

32
Q

What is neurotmesis?

A

Complete nerve division
Laceration or avulsion
No recovery unless repaired
Endoneural tubes disrupted sp high chance of ‘miswiring’ during regeneration

33
Q

What is a closed nerve injury?

A

Associated with nerve injuries in continuity with possible spontaneous recovery

34
Q

What is an open nerve injury?

A

Frequently related to nerve division
Treated with early surgery
Distal portion of nerve undergoes Wallerian degeneration

35
Q

What are the sensory clinical features of nerve injuries?

A

Dysaethesiae (anaesthetic, paraesthetic, hypo/hyper aesthetic)

36
Q

What are the motor clinical features of nerve injuries?

A

Paresis or paralysis +/- wasting

Dry skin

37
Q

What other clinical features may be present with nerve injuries?

A

Reflexes absent or diminished

38
Q

What is Tinel’s sign?

A

Tap over site of nerve and paraesthesia will be felt as far as distally as regeneration has progressed

39
Q

What surgical options are available for nerve repair?

A

Direct repair

Nerve grafting

40
Q

What is the “rule of three” for nerve repair?

A

Immediate surgery within 3 days for clean and sharp injuries
Early surgery within 3 weeks for blunt/contusion injuries
Delayed surgery 3 months after injury for closed injuries

41
Q

What are the clinical signs of an upper motor neurone injury?

A 
Decreased strength  
Increased tone
Increased deep tendon reflexes 
Clonus present 
Babinski's sign present 
Absent atrophy
42
Q

What are the clinical signs of a lower motor motor neurone injury?

A 
Decreased strength 
Decreased tone 
Decreased deep tendon reflexes 
Clonus absent 
Babinski's sign absent 
Present atrophy
43
Q

What is a bone fracture?

A

Break in structural continuity of bone, may be a crack, break, split, crumpling or buckle

44
Q

Why do bones fail?

A

High energy transfer in normal bones
Repetitive stress in normal bones
Low energy transfer in a normal bones

45
Q

What are the stages of fracture repair?

A

Inflammation
Soft callus
Hard callus
Bone remodelling

46
Q

What occurs during the inflammation stage of fracture repair?

A 
Haematoma and fibrin clot 
Platelets, PMNs, Neutrophils, Monocytes 
Fibroblasts 
Mesenchymal and osteoprogenitor cells 
Angiogenesis
47
Q

What is the time frame for the soft callus phase of fracture repair?

A

Begins when pain and swelling subside

Lasts until bony fragments are united by cartilage or fibrous tissue

48
Q

What occurs during the hard callus stage of fracture repair?

A

Conversion of cartilage to woven bone

Increasing rigidity

49
Q

What occurs during the bone remodelling stage of fracture repair?

A

Conversion of woven bone to lamellar bone
Medullary canal is reconstituted
Bone responds to loading characteristics Wolff’s law

50
Q

What is delayed union?

A

Failure to heal in expected time

51
Q

What are some of the caused of delayed union?

A 
High energy injury 
Distraction (increased osteogenic jumping) 
Instability 
Infection 
Steroids 
Immune suppressants 
Smoking 
Warfarin 
NSAID 
Ciprofloxacin
52
Q

What alternative management methods should be considered for delayed healing?

A

Different fixation
Dynamisation
Bone grafting

Musculoskeletal (27 decks)

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