HOK 8 Flashcards
1
Q
art. humeri - What is the ball (convex!)?
A
Head of humerus (Caput humeri).
2
Q
art. humeri - What is the socket (concave!)?
A
Glenoid fossa of scapula (Fossa glenoidalis scapulae).
3
Q
art. humeri - What are the possible movements?
A
Flexion / Extension
Adduction / Abduction
Circumduction
Rotation
4
Q
What are the main ligaments of art. humeri and which movements do they inhibit?
A
Lig. glenohumerale superior:
- External rotation and inferior translation of the humeral head.
Lig. glenohumerale medius:
- Abduction, external rotation and anterior translation of the humeral head.
Lig. glenohumerale inferior:
- Abduction, external rotation and superior and anterior translation of the humeral head
Lig. coracohumeral:
- Anterior fibres: retroflexion
- Posterior: anteflexion
- Both divisions limit inferior and posterior translation of the humeral head.
- Helps to support the weight of the resting arm against gravity.
Lig. transversum humeri
- This ligament serves to keep the tendon of the long head of the biceps in the bicipital groove.
5
Q
art. humeri - What is the ROM in all directions?
A
Flexion = 0° to 150°-170°
Extension = 0° to 40°
Adduction = 0 to 20°-40°
Abduction = 0° to 180° Movements past 90° often referred to as elevation
Internal rotation = 95° (Arm behind back)
External rotation = 60°
6
Q
What does CPP stand for, what does it mean and what is it important for?
A
Close-packed position.
- Ligaments and capsule under maximum tension.
- Stability
- Important as you can fixate the joint in order to move an adjacent joint.
7
Q
What is the CPP of the art. humeri
A
Maximum abduction, external rotation and horizontal extension.
8
Q
What does MLPP stand for, what does it mean and what is it important for?
A
Maximum loose-packed position.
- Ligaments and capsule in maximum relaxation.
- Allows for great mobility.
- Important position for examinations and treating the joint (non-specific traction and translation techniques)
9
Q
What is the MLPP of the art. humeri?
A
60° flexion / abduction
30° external rotation
10
Q
What is the capsular pattern of the art. humeri?
A
Exorotation > abduction > endorotation.
11
Q
art. humeri - What is the direction of the normal?
traction in the direction of the joint normal
A
Lateral / ventral / slightly cranial.
12
Q
What is the direction of translation of the humerus in the following movements:
Anteflexion
Abduction
Exorotation
A
Anteflexion - Spinning.
Abduction - Rolling cranial and sliding caudal.
Exorotation - Rolling dorsally and sliding ventrally.
13
Q
What is the ‘Capsular pattern’ describing?
A
Order of movement limitations in a joint typical to inflammation of the entire joint capsule (arthritis).
14
Q
Define Osteokinematics?
A
The movements of bones.
15
Q
Define Arthrokinematics?
A
Refers to the movement of joint surfaces.
16
Q
What is the Convex/Concave rule?
A
- When changing the angle of the convex (=roll), translation takes place in the opposite direction (=slide)
- When changing the angle of the concave (=swing), translation takes place in the same direction (=glide).
17
Q
What is the direction of translation of the tibia when the knee flexes?
A
The direction of translation is dorsal because the tibia is the PM here and swings + slides (translation) towards dorsal.
18
Q
art. sternoclavicularis - What is the ball (convex)?
A
Ball differs for each direction:
Protraction/retraction = extremitas sternalis
Elevation/depression = incisura clavicularis
19
Q
art. sternoclavicularis - What is the socket (concave)?
A
Socket differs for each direction:
Protraction/retraction = extremitas sternale clavicula
Elevation/depression = incisura claviculare sternum
20
Q
art. sternoclavicularis - What are the possible movements?
A
Elevation/Depression
Protraction/Retraction
Axial rotation (spin)
21
Q
art. sternoclavicularis - What is the ROM in all directions?
A
Elevation = 40° Depression = 10° Protraction = 30° Retraction = 25° Axial rotation (spin) = ???
22
Q
What are the main ligaments of of the SC joint and which movements do they inhibit?
A
Lig. sternoclaviculare posterior: Protraction
Lig. sternoclaviculare anterior: Retraction
Lig. costoclaviculare: elevation/protraction/retraction
Interclavicular ligament: depression
23
Q
art. sternoclavicularis - What is the direction of the normal (traction direction!)
A
Lateral, Cranial (and somewhat Dorsal)
24
Q
What is the CPP and MLPP in the SC joint?
A
There’s is no CPP and MLPP.
25
What is the capsular pattern of the SC joint?
Max. ROM and pain
26
What type of arthrokinematic movement takes place in an axial rotation of the clavicle?
Spinning/rotating movement
27
What is the direction of translation of the clavicle in the following movements:
- Elevation
- Protraction
Elevation: Caudal, somewhat lateral
Protraction: Ventral
Note: in the reversed movement, the direction of translation is also reversed!
28
What are the stabilising ligaments of the AC joint?
```
Stabilising ligaments
Lig. acromioclaviculare
Lig. coracoclaviculare
Lig. conoideum
Lig. trapezoideum
```
29
What is the normal of the AC joint?
Cranial/Ventral/Medial from the acromium.
30
What is the capsular pattern of the AC joint?
Maximum range of movements and pain.
31
AC does not have an actual ball/socket. We therefore assume that the scapula is concave.
What is the direction of translation of the scapula in a protraction?
Ventrolateral.
32
Name the 3 groups which describe 'painful shoulders'
1. Stiff and Painful.
2. Weak and Painful.
3. Unstable and Painful.
33
Name the 3 diagnosis groups as described by the Dutch College of General Practitioners (2019).
1. SAPS.
2. GH joint complaints.
3. Other shoulder complaints.
34
What complaints would a SubAcromial Pain Syndrome (SAPS) patient likely suffer from?
Pain, most often unilateral, localised around the acromion and/or upper arm that worsens during elevation
of the arm (pain and/or ROM restriction of abduction).
35
Name 4 pathologies included in SAPS..
Tendinopathy (possibly calcifying)
Subacromial bursitis
RC rupture (partial/full)
Biceps rupture (long head).
36
When performing a 'painful arc' within which degrees will pain be most likely felt?
60° to 120°.
37
What are the clinical symptoms of SAPS?
Pain (deltoid region)
Painful arc (in abduction)
Pain with elevation
Pain/weakness in exorotation against resistance
38
Name 3 risk factors for developing SAPS.
Age >50
Diabetes
Working with the shoulder above 90°
39
Name 3 possible sources of nociception in SAPS.
Tendon (RC/biceps)?
Tendon pathology?
(also WK3 ‘tendinopathy’)
Bursa?
40
Name 3 signs of scapular dyskinesis.
(1) abnormal static scapular position and/or dynamic scapular motion characterised
by medial border prominence
(2) Inferior angle prominence and/or early scapular elevation or shrugging on arm elevation
(3) rapid downward rotation during arm lowering
41
Name some potential causes of scapular dyskinesia.
```
Neurological
Joint abnormality (e.g. GH-instab.)
Bone (e.g. thoracic kyphosis)
Stiffness (e.g. TROMD - Total ROM deficit)
Muscle weakness/-activation
Kinetic chain
```
42
Name some SAPS general and work-related prognostic factors..
General:
Long lasting existence of complaints before the first consult
Intense pain on the foreground
Additional neck pain
Somatisation/SOLK (somatic unexplainable
bodily complaints)
Poor general health
```
Work related:
Unemployment
(High) physical loads
Few options to make own decisions
Difficult tasks
```
43
What shoulder problems are listed in the GH joint complaints category?
Frozen shoulder (Capsular).
Osteoarthritis.
Rheumatoid arthritis.
...
44
What shoulder problems are listed in the "Other" complaints category?
AC/SC-complaints.
GH-instability.
Cervicogenic.
45
At what age is it most common for a frozen shoulder to occur?
40-60 y/o.
| If their age is above 60 years old then osteoarthritis is a like cause.
46
What symptoms suggest a Frozen shoulder?
Pain
| Progressive restraining of active & passive ROM, especially exorotation & abduction.
47
What pathology shares a lot of symptoms with a frozen shoulder?
GH-osteoarthritis.
48
What is proteolysis and which protein causes it?
```
Proteolysis is the breakdown of proteins into smaller polypeptides or amino acids.
Matrix metallopeptidase (MMP).
*Not relevant to HOK*????
```
49
Name the Risk factor for a frozen shoulder?
```
Diabetes (low grade inflammation - white blood cells disabled)
- 5x higher change on FS
- 13,4% of the diabetici gets FS
- 30% of the people with FS has DM
Frozen shoulder in the family
Hypothyroidism
Genetic
Etnicity
```
50
What is Hypothyroidism?
Is a disorder of the endocrine system in which the thyroid gland does not produce enough thyroid hormone.
This causes the metabolism to slow down and therefore the suffer gains more weight.
It can cause a number of health problems, such as obesity, JOINT PAIN, infertility and heart disease.
51
Name and describe the stages of a Frozen shoulder?
Freezing: 2-9 months (Pain > Stiffness).
Frozen: 4-12 months (Pain = Stiffness).
Thawing: 5-24 months (Pain < Stiffness).
52
Name the layers of capsule, their structure and function?
> Membrane fibrosa - Dense irregular - Protects and stabilises the joint.
> Sub-intima - Loose connective tissue - produces synovial fluid.
> Intima.
53
Frozen shoulder pathophysiology.
Do the following increase or decrease in a FS patient?
> Swelling & contraction capsule (no adhesions)
> Intra-articulair volume.
> Vascularisation.
> Proliferation fibroblasts & myofibroblasts.
> Pro-inflammatoire cytokines (IL & TNF).
> Neuropeptids.
Swelling & contraction capsule (no adhesions) ↑
- ventral/caudal
Intra-articulair volume ↓
- 15-35cc → 5-6cc
Vascularisation ↑
Proliferation fibroblasts & myofibroblasts ↑
Pro-inflammatoire cytokines (IL & TNF) ↑
Neuropeptids (Substance p) ↑
54
Why does the likely hood of getting osteoarthritis increase after having a Frozen shoulder?
When you have a frozen shoulder the amount of movement you can make is greatly reduced. For the cartilage to remain healthy its needs movement in the synovial joint (sponge effect, picking up nutrients by absorbing fluid). Without movement is degrades and can cause inflammation.
55
What is Metabolic syndrome and what is the biggest risk factor for developing it?
Metabolic syndrome is a cluster of biological changes including lipid abnormalities, elevated blood insulin levels and an immune response (increased pro-inflammatory cytokines) leading to a chronic low grade inflammatory state.
Being a BRAVO patient.
56
What is muscle guarding and why is it relevant?
Muscles are limiting the movement.
Muscles can be held in a position of readiness to act much like when the body experiences the stress response (better known as the “fight or flight” syndrome.
57
What is the effect of anaesthesia on Muscle guarding?
Increase ROM
abduction 55° - 110°
| Increase ROM
exorotation 15° - 40°
58
AC luxation - What type of tissue is found in ligaments?
| What is the recovery time of ligaments?
Dense irregular
| Long recovery time.
59
What 3 ligaments are at risk of rupturing during an AC luxation?
lig. acromioclavicular
lig. trapezoideum
lig. coronoideum
60
Describe the three stages of Tossy classification.
Type I is a sprain injury of the AC ligament; there is no complete tear and both AC and CC ligaments are intact.
Type II is a tear of the AC ligament but not of the CC ligaments.
A type III injury involves tears of both the AC and CC ligaments.
61
Describe the six stages of the Rockwood classification?
Type 1:
AC ligament sprain
AC joint intact, CC ligaments intact
Deltoid, Trapezius intact
```
Type 2:
AC Joint disruption
Slight vertical separation of ACJ
CC ligament sprain, CC distance wide
Deltoid, Trapezius intact
```
```
Type 3:
AC ligament disruption
AC joint dislocated
CC ligaments torn
CC distance 25 to 100 % > than normal side
Deltoid, Trapezius may be detached
```
Type 4:
AC ligament disruption
AC joint dislocated
Clavicle displaced posteriorly into Trapezius
CC ligaments completely torn
Deltoid, Trapezius detached from distal clavicle
Type 5:
AC ligament disruption
AC joint dislocated
CC ligaments completely torn
CC distance 100 to 300 % > than normal side
Deltoid, Trapezius detached from distal half clavicle
```
Type 6:
AC ligament disruption
AC joint dislocated
CC ligaments completely torn
Clavicle in subcoracoid position
Deltoid, Trapezius detached from distal half clavicle.
```
62
Which grades of Rockwood usually require surgery?
5 and 6.
63
AC–luxation – connective tissue recovery.
| List the steps..
Damage -> Macrophages -> Fibroblasts -> Type 3 collagen -> Type 1 collagen.
64
What does Immobilisation mean for the following structures?
- Bone
- Capsule
- Tendon
- Ligament
- Muscle
- Cartilage
Bone: Osteoclasts more active, bone density goes down. - More calcium in the blood.
Capsule:
- Fibroblasts less active = less collagen.
- Less elastin = lower ROM.
Tendon:
- Tenoblast = build up tendon.
- Ligament = ....
Muscles: Hypotrophy
- Myosin and actin broken down, less sarcomeres.
Cartilage:
- Chondroblasts build up PG's, GAG's and collagen.
- Inactivity stops production. Cannot get the 'sponge effect', causing blisters.
65
Glenohumeral-humeral instability symptoms?
```
Pain
Insecure feeling (no control)
Fatigue in the shoulder
Shifting
Radiating pain
```
66
Name and decide the three area's on the Stanmore classification?
```
1. Traumatic structural
• significant trauma
• often a Bankart’s defect
• usually unilateral
• no abnormal muscle patterning
```
```
2. Atraumatic
• no trauma
• structural damage to the articular surfaces
• capsular dysfunction
• no abnormal muscle patterning
• not uncommonly bilateral
```
3. Habitual non-structural (muscle patterning)
• no trauma
• no structural damage to the articular surfaces
• capsular dysfunction
• abnormal muscle patterning
• often bilateral
There is an arrow coming from type one that suggests less trauma.
There is an arrow coming from type three that suggests less muscle patterning.
67
Which Pathology causes a Loose capsule?
Marfan's syndrome.
68
What is a SLAP lesion?
An injury to the glenoid labrum (fibrocartilaginous rim attached around the margin of the glenoid cavity). SLAP is an acronym for "superior labral tear from anterior to posterior"
69
What is a Bankart lesion?
An injury of the anterior (inferior) glenoid labrum of the shoulder due to anterior shoulder dislocation.
When this happens, a pocket at the front of the glenoid forms that allows the humeral head to dislocate into it.
70
What type of tissue are tendons and ligaments?
Dense regular.
| They can support high loads, but the recovery takes longer than dense irregular tissues (e.g. capsules)
71
art. genus -
1. What is the ball (convex!)?
2. What is the socket (concave!)?
1. Medial en lateral condyle
| 2. Tibial plateau
72
art. genus - What are the movement possibilities of the knee?
Flexion/extension + endo- & exorotation
73
art. genus - What is the ROM in all directions?
Flexion: 120-150 degrees + (hyper)extension: 5-10 degrees
Endorotation: 10 degrees + Exorotation: 30-40 degrees
74
art. genus - Which ligaments/structures inhibit the following movements?
1. Flexion
2. Extension
3. Endorotation
4. Exorotation
5. Abduction (Valgus)
6. Adduction (Varus)
7. Pivot shift ventral
8. Pivot shift dorsal.
1. Posterior cruciate ligament.
2. Medio/laterodorsal structures / Posterior cruciate ligament / Anterior cruciate ligament.
3. Laterodorsal structures / Posterior cruciate ligament / Posterior cruciate ligament.
4. Medio/laterodorsal structures / Lateral collateral ligament / Medial cruciate ligament.
5. Medial cruciate ligament / mediodorsal structures / Lateral collateral ligament / Posterior cruciate ligament.
6. Lateral collateral ligament / laterodorsal structures Anterior cruciate ligament / Posterior cruciate ligament.
7. Anterior cruciate ligament.
8. Posterior cruciate ligament.
75
art. genus -
1. What is the CPP?
2. What is the MLPP?
1. Maximum hyperextension
| 2. ±30° flexion
76
art. genus - What is the capsular pattern of art. genus?
Flexion >> extension; in end-stage osteoarthritis rotations is limited.
77
art. genus - What is the direction of the normal?
Proximal
78
art. genus - What is the direction of translation of the tibia in a flexion of 0-90°?
Dorsal, proximal
79
art. talocrurale -
1. What is the ball (convex!)?
2. What is the socket (concave!)?
1. Talus
| 2. Fibula + tibia (=cruris)
80
art. talocrurale - What are the possible movements?
Dorsal flexion + Plantar flexion
81
art. talocrurale - What is the ROM in all directions?
DF: 20-30° PF: 30-50 °
82
art. talocrurale - Which ligaments/structures inhibit the following movements?
1. Dorsal flexion.
2. Plantar flexion.
1.
- Tibiofibular ant. + post
- Dorsal part Lateral collateral ligament.
- Dorsal part Medial collateral ligament.
2.
- Ventral part Lateral Collateral Ligament.
- Ventral part Medial collateral ligament.
83
art. talocrurale -
1. What is the CPP?
2. What is the MLPP?
1. Maximum dorsal flexion
| 2. ±10° plantar flexion
84
art. talocrurale - What is the capsular pattern?
Plantar flexion > dorsal flexion
85
art. talocrurale - What is the direction of the normal?
Distal somewhat ventral
86
art. talocrurale - What is the direction of translation of the talus during plantar flexion?
Ventral somewhat proximal
87
Which position do knees and hips reach if a person’s feet are in...
1. Pes valgus
2. Pes varus
1. Endorotation tibia
Valgus position knee
Endorotation femur
Hips in adduction position
2. Exorotation tibia
Varus position knee
Exorotation femur
Hips in a abduction position
88
Name the lateral collateral ligaments of the ankle?
```
From dorsal to ventral:
Lig. Talofibulare posterior
Lig. Calcaneofibulare
Lig. Talofibulare anterior
= lig. collaterale radiale
```
89
Name the medial collateral ligaments of the ankle?
```
From ventral to dorsal:
Lig. Tibiotalare anterior
Lig. Tibionavicularis
Lig. Tibiocalcaneo
Lig. Tibiotalare posterior
= Lig. Deltoideum/ lig. collaterale mediale
```
90
```
How does the shape of your feet effect your posture?
A: Normal feet
B: Pes valgus
C: Pes planus (flat foot)
D: Pes varus
```
A: Normal
B: Extra lordosis back + hanging back thoracic spine
C: Sagged, shoulders hunched forward, head forward (beyond the centre of gravity)
D: Not much lordosis, very flat back!
91
art. subtalare -
| What are the possible movements and the ROM?
Inversion: adduction/supination/plantar flexion (0-20°)
Eversion: abduction/pronation/dorsal flexion (0-10°)
92
art. subtalare -
| Which ligaments inhibit which movements?
Inversion: LCL + tibiofibulare ant. and post.
Eversion: LCM + tibiofibulare ant. and post.
93
art. subtalare -
1. What is the ball (convex!)?
2. What is the socket (concave!)?
1. Facies articularis posterior of calcaneus
| 2. Facies articularis posterior of talus
94
art. subtalare -
1. What is the CPP?
2. What is the MLPP?
1. Max. inversion
| 2. Middle position inversion and eversion
95
art. subtalare -
1. What is the capsular pattern?
2. What is the direction of the normal?
1. Inversion
| 2. Plantar, proximal
96
Under what conditions can a myofibroblast be found in the connective tissue?
In which case are these cells extremely active in the shoulder region? (Latin)
- When MMP (metallomatrix protein) breaks down proteins e.g like in Frozen shoulder pathology.
- Capsulitis adhaesiva
97
Which structures can be distinguished in a capsule and indicate the specific function of each of the layers?
- Membrana fibrosa (outer layer, irregular tissue).
| - Membrana sinovialis: includes subintima (connective tissue) and intima (epithelial tissue)
98
What is the function of a myofibroblast?
Contraction of wounds
99
Correct or incorrect...
| Do the cells in a tendon belong to the fibroblasts?
-Tenoblasts (check this)
100
Correct or incorrect...
| The fibre that is common in tendon tissue is elastin?
-False. It is collagen
101
Correct or incorrect...
The myofascial power transfer is not the same as myotendinous power transfer.
The latter takes place through all different connective tissue structures.
..
102
Correct or incorrect...
The muscle strength contains passive and active components. The active component is the crossbridge between actin and myosin.
True
103
Correct or incorrect...
| The tendon belongs to the passive force component of the muscle. And is called the parallel elastic component.
False. Parallel elastic component (PEC) refers to connective tissue, not tendons.
104
Correct or incorrect...
| With an extended muscle, a lot of energy is stored in the PEC and SEC.
False. PEC (connective tissue) cannot contract, thus it should not be able to store energy (check this answer)
105
Correct or incorrect...
| With a concentric contraction a lot of energy is stored in the serially elastic component.
Correct
106
Correct or incorrect...
| The tendon consists of parallel oriented collagen fibers. This is also called dense regular connective tissue.
Correct.
107
Correct or incorrect...
| A tenoblast produces collagen and proteoglycans and a small amount of elastin.
Correct. Dense regular fibres run in the same direction
108
Correct or incorrect...
| Epitenon forms a resistance-lowering layer between tendon and environment.
False. The outer layer is called Paratenon.
109
Correct or incorrect...
| Paratnon consists largely of dense irregular connective tissue.
..
110
Correct or incorrect...
| The tendon has good blood flow, but the tenoblast does not aborb as much oxygen .
..
111
Correct or incorrect...
| With a myotendinous transition, endo and perimysium pass into tendon collagen.
..
112
Correct or incorrect...
| An extension reaction of the tendon of 6% causes an inflammatory reaction.
..
113
Correct or incorrect...
| With an extension of tendon material of 7 to 8 percent fissuras, gaps and ruptures may be formed.
..
114
Correct or incorrect?
| The purpose of the golgitendon reflex is to protect the tendon tissue.
False. It prevents muscle tissue from elongating too much.
115
Correct or incorrect?
| A tendon requires active recovery to properly arrange the elastin fibers.
..
116
Correct or incorrect?
| Eccentric muscles have more problems with DOMS. This also indicates damage to the stretched tissue.
..
117
Frozen shoulder is one of the shoulder disorders.
| Which cells are located in the synovialis membrane that maintain the loose connective tissue?
Chondrocytes.
118
The NHG divides the shoulder complaints into three groups.
| To which group shoulder complaints does the frozen shoulder belong?
Group 2, Glenohumeral
119
Which pathology appears to have a high odds ratio with Frozen shoulder?
Diabetes
120
To explain how a tendon reacts to overload, the tendon continuum is described.
Which stage in the tendon is difficult to return to normal tendon tissue?
Degenerative tendon.
121
With a rotator cuff tendon rupture, the rupture is expected at the site of compression.
Which position did people expect to find the tendon rupture?
Subacromial, anterior / inferior.
122
What does the abbreviation GIRD stand for (is used to explain shoulder complaints)?
Glenohumeral internal rotation deficit.
123
Name two non-work-related prognostic factors for SAPS.
1. Poor general health.
| 2. Neck pain
124
The NHG classifies the shoulder complaints into three main groups.
To which group does gleno-humoral instability belong?
Group 3
125
With which other shoulder condition is osteoarthritis strongly similar too in symptoms?
Frozen shoulder
126
What is the name of the phase of a frozen shoulder in which the pain is severe and the stiffness of the capsule increases
Freezing
127
What is the name of the endothelial layer of the capsule?
Intima
128
```
With a tossy type there is a degree of luxation of the clavicle.
Which ligament (s) has / have been completely ruptured with a Tossy type 2?
```
Lig. acromioclavicular
129
After an luxation of the shoulder, people often choose temporary immobilisation?
Describe the effect of temporary immobilisation on the cells in the ligament?
Specify the name of the cell and the effect of immobilisation on this cell.
Type 3 collagen isn't "remodelled" into type 1 collagen.
The cell is fibroblasts that makes it is called.
The tissue type you want is dense regular but with immobilisation its dense irregular.
130
The Stanmore classification describes the cause of shoulder instability.
What is meant by Polar TYPE 2 of the Stanmore classification?
2. Atraumatic and structural instability
131
What is the name of the fracture (complication of and luxation of the shoulder), in which the humeral head has a fracture.
Hill-Sachs fracture + Bankart lesion.
132
Which two terms besides tendinopathy were also used for a painful tendon in the past?.
Tendinosis and tendonitis.
133
The tendon consists of different structures. Below is a description of one of the structures. What structure is meant by this?
This loose-connective connective tissue sometimes lies around the tendon (so not around every tendon).
Paratenon.
134
With a continuous overload of the tendon, the normal tendon will first pass into a phase called reactive tendinopathy.
What is the name of the final transition phase in the continuum?
Degenerative
135
In dysrepair tendinopathy does the composition of the matrix change.
Indicate which fibre is mainly deposited in the matrix?
Collagen type 3
136
Which nerve fibers transmit the chronic pain of the tendon?
C-fibre.
137
What is the effect of antibiotics on collagen?
1. Makes fibroblasts stop producing the correct collagen 2. 2. Breaks down collagen (collagenolysis).
3. Lower proliferation of fibroblast.
Makes cells less active.
138
Name the structures of a tendon (largest to smallest).
Tendon, (Lymphatic and blood), Epitenon, Fascicle, Endotenon, (Tenoblast), Collagen bundle, Collagen fibril.
139
Why is diffusion difficult in tendons?
Density of the fibres why it takes so much time.
140
What proteins are collagen fibres active in making?
Tenoblasts are active in making collagen fibres and PG’s.
141
What type of cells can become Tenoblast's when needed and where are they found?
Mesenchyme cells,
| In loose connective tissue.
142
What percentage of patients take half a year to recover?
50% of patients.
143
What type of tissue are tendons made up of?
Tendons = Dense regular.
144
What type of tissue surrounds a tendon?
Loose connective tissue.
145
What are the names of the three layers surrounding a tendon.
Endotenon
Epitenon
Peri-tenon.
146
What are you likely to feel if you completely rupture a tendon?
There are lots of proprioceptors and nociceptors in tendon, however if you completely rupture the tendon then you won't feel any pain.
147
Tendons are very well vascularised but it still takes a long time to heal. Why is this?
The type of tissue its made up of is Dense regular, which takes a long time to form.
148
What is Protein degradation?
The breaking down of collagen and PG’s e.t.c
149
With regard to protein degradation, why is it important to have sufficient rest between workouts?
What is likely to happen without sufficient rest?
In the first 24hrs there is more degradation than synthesis.
Without rest only type 3 collagen will be produced, leading to injury or disrepair.
150
Why are NSAids and antibiotics bad for tendons?
They signal to tenoblast's that they must rest, as swell as breaking down collagen.
151
Why can Tendon store more energy at a younger age?
The collagen is stronger.
152
What are the characteristics of a reactive tendinopathy?
Reaction on acute overload (stretch/compression)
Proliferation in cell and matrix
Thickness increases (not in ‘normal adaptation’)
Proteoglycanes + water increase
No inflammation
Collagen and Neurovasculare remain the same.
153
What are the characteristics of tendon disrepair?
```
Reaction on continuous overload
Breaking down matrix ↑
Proteoglycans ↑
Separation collagen – disorganisation matrix
Thickness ↑
Collagen ↑
Vascularisation/innervation (↑)
Neoinnervation of efferent (sympathic) nerves
(not afferent).
```
154
What are the characteristics of degenerative tendon?
```
Reaction on ageing / continuous overload / medication / cell death (inner-side tendon)
Thickness ↑
Collagen ↓
Degradation product matrix ↑
Vascularisation/innervation (efferent) ↑
Risk of rupture!
(*97% degeneration before rupture)
```
155
Which pain response is related to peripheral sensitisation?
Hyperalgesia
156
Name three components which facilitate pain.
- Formatio reticularis.
- Substance P.
- Cognitive emotional sensitisation
157
In chronic pain, what does modification mean?
-Disruption of how pain is interpreted by the brain. It is related to hyperalgesia.
158
Which receptors are activated in the Wind-up theory?
-NMDA receptors.
159
What is the main cause of experiencing pain?
-The plasticity of the brain
160
Which structure of the brain stores pain experiences?
-Limbic system
161
Name two brain structures which contribute to pain inhibition.
- PAG (Pariaqueductal Grey)
| - NRM (Nucleus Raphe Magnus)
162
Mr. de Vos is constantly thinking about the pain he experiences. His thoughts cause him chronic pain. What type of pain is being described?
-Nociplastic pain
163
Mention 3 non-nociceptive factors
- Thoughts.
- Emotions.
- Behaviour
164
Name 2 types of non-nociceptive pain
- Neuropathic.
| - Psychogenic.
165
Name 2 types of nociceptive pain.
- Visceral.
| - Somatic.
166
Which brain area is responsible for nociceptive information?
Post-Central Gyrus (also called PSSC, Primary Somatosensory Cortex)
167
Which hormone takes an important role in blood pressure regulation?
Aldosterone
168
What is the main difference between Peripheral and Central sensitisation?
Peripheral sensitisation is about localised pain, mediated by inflammatory cytokines.
Central sensitisation causes chronic pain (substance P on the spinal cord). WDR neurons spread nociceptive information to larger areas and glutamate blocks NMDA receptors, reducing inhibition of pain.
169
Where is pain experience stored?
Limbic system
170
Which hormone is produced on the pituitary gland as part of the HPA-AS?
ACTH (Adrenocorticotropic hormone)
171
Name 3 structures which inhibit pain.
NRM (Nucleus Raphe Magnus), PAG (Pariaqueductal Grey) and GABA
