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Med Yr2 > Joint pain > Flashcards

Joint pain Flashcards

1
Q

Fibrous joint examples: sutures

A
  • Sutures: found exclusively in the skull, bone plates held together by sharpey fibres
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2
Q

fibrous joint examples: syndesmosis

A
  • Syndesmosis: two adjacent bones are linked by a strong fibre/ligament
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3
Q

Fibrous joint examples: Gomphoses

A
  • Gomphoses: the roots of the teeth (the pegs) fit into their sockets in the mandible and maxilla and are the only examples of this type of joint.
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4
Q

Cartilaginous joints:: synchondroses (primary) (3)
- Definition
- Lifespan (2)

A
  • Advancing centres of ossification separated by hyaline cartilage
  • Most are temporary (e.g. epiphyseal growth plates) and fuse in adulthood
  • Some persist, e.g. costal cartilages, which allow some flexibility
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5
Q

Cartilaginous joints: symphyses (secondary) (3)
- Definition
- Role (2)

A
  • Fibro-cartilage pads between a.c. of adjacent bones
  • Allows slight movement (e.g intervertebral discs and symphysis pubis)
  • Some symphyses fuse during growth (e.g. sacral and coccygeal discs)
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6
Q

Synovial joints:
- Definition
- Cavity role
- variation

A
  • Articulating bones separated by synovial cavity filled with synovial fluid
  • Cavity gives synovial joints a wide range of movement
  • Different types allow movement in varying planes
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7
Q

Different types of synovial joint: (6)
P (G)
P
H
S
E
B

A
  • Plane (gliding)
  • Pivot
  • Hinge
  • Saddle
  • Ellipsoid
  • Ball and socket
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8
Q

Synovial joint component tissues: Joint capsule
Outer fibrous capsule
- Location
- Structure
- Innervation

A
  • Blends with periosteum and tendons
  • Composed of dense irregular connective tissue
  • Highly innervated
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9
Q

Synovial joint component tissue: joint capsule: Inner synovial membrane (synovium)
- Location
- Role

A
  • Lines joint cavity bar articulations
  • Produces constituents of synovial fluid
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10
Q

Synovium (inner synovial membrane):
- Layers (2)

A
  • Supporting layer or stroma (sub-intima)
  • Lining of synovial cells in contact with synovial fluid (intimal cells)
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11
Q

synovium (inner synovial membrane):
synovial cell type A

A
  • Derived from bone marrow
  • Secretory and phagocytic functions
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12
Q

Synovium (inner synovial membrane):
synovial cell type B

A
  • Type of fibroblast
  • Role in synthesis of hyaluronic acid
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13
Q

Articular cartilage:
- Contains
- Cell type

A
  • Contains cells, fibres and matrix arranged in zones
  • Cells are chondrocytes; density varies with age and morphology varies in each zone
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14
Q

Articular cartilage:
- Fibre composition
- Matrix composition

A
  • Fibres are collagen; mostly type II, small amounts of types VI, IX and XI
  • Matrix composed mostly of large aggregated proteoglycans (aggrecan) and some smaller PGs (decorin and biglycan)
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15
Q

Subchondral bone:
- Structure
- Variation in children
- Use as a marker

A
  • Cortical bone plate supported by trabecular bone
  • In children, perforated by blood vessels where it provides route for nutrient exchange
  • Shows biochemical and structural changes in some joint diseases
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16
Q

Ligaments:
- Defintion
- Structure
- Structural benefits

A
  • Regions of fibrous capsule thicken to form ligaments
  • Composed of dense regular CT comprising parallel collagen fibres (mainly type I)
  • This gives ligaments great tensile strength along their length
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17
Q

Menisci: (2)

A
  • Discs or pads of fibrocartilage
  • Located within capsule, they provide extra strength and support
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18
Q

Bursae: (2)

A
  • Often found where tendon passes over bone
  • Modified bursae form tendon sheaths around tendons
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19
Q

Synovial fluid: (2)

A
  • Fills joint cavity and bursae
  • Important role in lubrication and cartilage nutrition
20
Q

Mechanical function of synovial joints:
- Role
- Shape of articulating surfaces ….
- General rule

A
  • Synovial joints allow movement whilst providing stability
  • Shape of articulating surfaces influences type and range of movement
  • Increased mobility associated with reduced stability
21
Q

Improving stability of synovial joints: (2)

A
  • Bones enlarge at ends to provide large contact area
  • Deformable cartilage and menisci also increase contact area
22
Q

Effects of shear forces on synovial joints:

A

Causes friction leading to:
- Loss of energy
- Increase in temperature
- Wear and tear at bearing surface

23
Q

Role of joint lubrication:
- Role
- Lubrication types (2)
- Mixed

A
  • Reduces the damaging effects of friction
  • Fluid-film and boundary
  • In some circumstances, both types operate together (mixed lubrication)
24
Q

Lubrication failure: (2)

A
  • Can lead to increased friction and fibrillation of cartilage surface
  • Roughened, fibrillated surface results in increased friction and wear/cartilage damage
25
Q

Effects of mechanical loading:
- General effect
- Repetitive cyclic loading ……
- High levels of mechanical loading ….

A
  • Causes fluid changes in cartilage, sustained compression squeezes fluid out, reducing cartilage thickness and ability to equalise stress
  • Repetitive cyclic loading can cause proteoglycan loss at cartilage surface and distortion of collagen network
  • High levels of mechanical loading can damage cartilage surface and kill chondrocytes
26
Q

Osteoarthritis: cartilage surface changes (3)

A
  • Fibrillation
  • Erosion
  • Cracks
27
Q

Osteoarthritis: other cartilage changes (5)

A
  • Cartilage softening
  • Chondrocyte necrosis
  • Regeneration
  • Cell cluster
  • Cell proliferation
28
Q

Osteoarthritis: changes in the bone (4)
j
M
S
E

A
  • Joint space narrowing
  • Marginal osteophytes
  • Sclerosis
  • Eburnation
29
Q

Osteoarthritis: changes in synovium (2)

A
  • Mild to moderate inflammation
  • Neovascularization
30
Q

Osteoarthritis: clinical signs (7)
S
M
J
T
W
C
I

A
  • Swelling
  • muscle wasting
  • Joint effusions
  • Tenderness
  • Warmth
  • Crepitus
  • Instability
31
Q

Osteoarthritis: symptoms (5)

A
  • Onset is slow and insidious
  • Use-related pain
  • Joint stiffness and inactivity
  • Reduced range of joint motion
  • Functional limitation
32
Q

Causes of knee pain in OA:

A
  • Cartilage damage
  • Bone remodelling
  • Meniscal tears
  • Ligament injuries
  • Synovium
33
Q

Trabecular bone (spongy):

A
  • 15% of bone
  • Endo skeleton
  • Calcium reservoir
  • Haematopoeisis
34
Q

Cortical bone:
- Prevalence
- Role

A
  • 85%
  • Endoskeleton
35
Q

Horizontal trabeculae importance:

A
  • Increases bone strength by 16X
36
Q

Material properties of bone:

A
  • Skeletal mineralisation:
  • Collagen crosslink formation
37
Q

Bone remodelling:
- Description
- Timespan
- Provides
- Role

A
  • Lifelong process involving discrete sites throughout the skeleton
  • Each cycle takes 3-4 months
  • Provides supply of calcium for calcium homeostasis
  • Maintains bone integrity by replacing sites of fatigue damage
38
Q

RANK signalling in osteoclasts:

A
  • Stromal cells produce and present RANKL molecules
  • These bind to receptors on osteoclast precursor cells, activating them into mature osteoclasts
39
Q

OPG importance:

A
  • Produced by stromal cells to “mop up” excess RANKL molecules, providing a break from the resorption process
40
Q

Disorders associated with defective osteoclasts: Osteopetrosis

A
  • CLC-7 chloride channel deficiency
  • Deficiency of a3 subunit of the vacuolar H+ - ATPase proton pump
  • Carbonic anhydrase II deficiency
41
Q

Disorders associated with defective osteoclasts: Pycnodysostosis
- Mutation of
- Causes
- Presentations (3)

A
  • Cathespin K gene mutation
  • Defective degradation of organic bone matrix
  • Skull deformities with delayed cranial structure closure
  • Short stature and phalanges
  • Abnormally dense but brittle bones
42
Q

Osteoblast growth factors: Bone morphogenetic proteins (BMPs)
- Mechanism
- Mutation in BMP type I receptor ACVR1 causes

A
  • Activation of BMP type I receptor on cell surface causes a downstream effect, causing osteoblast differentiation
  • fibrodysplasia ossificans progressiva
43
Q

Osteoblast growth factors: Wnt signally pathway
- LRP5
- Sclerostin

A
  • Activating mutations of LRP5 cause high bone mass
  • Inactivation of sclerostin causes sclerostosis
44
Q

Sclerostin deficiency:
- Causes
- Clinical presentation

A
  • Causes a high bone mass phenotype
  • Mandibular overgrowth, facial palsy and deafness
45
Q

Bone remodelling in osteoporosis: trabecular bone (4)

A
  • Increased activation frequency
  • Increased erosion depth
  • Reduced trabecular thickness
  • Trabecular perforation
46
Q

Bone remodelling in osteoporosis: cortical bone (3)

A
  • Structural changes also affect cortical bone, characterised by
  • endosteal expansion
  • cortical thinning
  • an increase in size and number of haversian canals

Med Yr2 (12 decks)

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