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Year 1 Locomotion > Joints and Joint Disease > Flashcards

Joints and Joint Disease Flashcards

1
Q

What does ground substance consist of?

A
  1. Proteoglycans
  2. Glycoproteins
  3. Water
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2
Q

What is the significance of the ECM?

A

The composition of the ECM determines the tissues’ physical properties

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3
Q

Name the 2 fibres of connective tissue

A
  1. Collagen
  2. Elastin
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4
Q

Describe collagen and the three types

A

Good at resisting tensile forces

Type 1 = bone, tendons, ligaments, dermis, organ capsules

Type 2 = Hyaline cartilage, elastic cartilage

Type 3 (reticular fibres) = structural framework of spleen, liver, lymph nodes, smooth muscles and adipose tissue

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5
Q

Describe Elastin

A
  • Major component of elastic fibres
  • Enables stretch and recoil of tissues
  • Often mixed with collagen to prevent overstretch
  • Found in a wide variety of structures e.g. the walls of large arteries, lungs and skin
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6
Q

Describe loose connective tissue

A
  • Contains lots of cells
  • Contains nerve fibres and blood vessels
  • A loose arrangement of fibres (collagen, reticular and elastic) and abundent ground substance and EC fluid
  • Cells contained within the ECM include fibroblasts, adipose cells, macrophages, mast cells and other transient cells responsible for immune and allergic reactions
  • Found in a wide variety of places including below epithelial layer of resp and GI tract, below the skin and glands
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7
Q

Describe dense irregular connective tissue

A
  • Contains lots of fibres and fewer cells
  • Collagen fibres are arranged randomly and resist stress from all directions
  • Can contain network of elastic fibres
  • forms the dermis of the skin, capsules of organs including kidneys, testes, ovaries, spleen and lymph nodes, sheaths of nerves
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8
Q

Name 5 different specialised connective tissues

A
  1. Dense regular connective tissue (tendons, ligaments, aponeuroses)
  2. Cartilage
  3. Adipose tissue
  4. Haemopoietic tissue (bone marrow, lymphoid tissue)
  5. Blood
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9
Q

Describe dense regular connective tissue

A
  • colagen fibres are densely packed and arranged in parallel
  • Thin sheet-life fibroblasts are located between collagen bundles
  • Resistant to axial loaded tension but allows some stretch so forms tendons, ligaments and aponeuroses
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10
Q

Which connective tissue forms tendons, ligaments and aponeuroses?

A

Dense regular connective tissue

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11
Q

Which conective tissue forms the dermis of the skin, organ capsules and sheaths of nerves?

A

Dense irregular connective tissue

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12
Q

Which connective tissue sits below the epithelia of the resp and GI tracts and below the pleura, peritoneum and therefore forms part of the serous membrane?

A

Loose irregular connective tissue

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13
Q

Name 3 important characteristics of cartilage

A
  1. Strong, flexible, semi-rigid
  2. Can withstand compression forces, therefore acts as a shock absorber
  3. Smooth surface enables friction-free movement
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14
Q

Name 3 functions of cartilage

A
  1. Forms articulating surface of bones
  2. Growth and development of bones (endochondral ossification)
  3. Supporting framework of some organs, e.g. walls of airway
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15
Q

How is the ECM of cartilage specialised?

A
  • Contains AGGRECAN (a proteoglycan) which has an osmotic effect and so the ECM has a high water content which resists compressive forces
  • Contains Collagen and Elastin
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16
Q

Describe the structural appearance of cartilage

A

Consists of Perichondrium

  • Outer fibrous layer
  • Inner cellular layer
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17
Q

Describe how cartilage gets its blood supply

A

Cartilage is avascular, receibes blood supply via diffusion

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18
Q

Describe the development of cartilage cells

A
  • Derived from mesenchyme
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19
Q

Name the 2 steps in cartilage growth and repair

A

Appositional growth and Interstitial growth

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20
Q

Describe Appositonal growth in cartilage

A

Surface layers of matrix are added by chondroblasts in the perichondrium

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21
Q

Describe interstitial growth in cartilage

A
  • Chondrocytes grow and divide and lay down new matrix
  • Articular cartilage and endochondral ossification
  • Occurs in childhood and adolescence
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22
Q

Can cartilage regenerate?

A

Poor regeneration except in children

–Chondrogenic cells from perichondrium form new cartilage

–Large defects involve replacement with dense connective tissue

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23
Q

Name 3 types of cartilage

A
  1. Hyaline
  2. Fibrocartilage
  3. Elastic
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24
Q

Describe Hyaline cartilage

A
  • Most common but weakest type of cartilage
  • Contains short and dispersed Type II collagen fibres and large amounts of proteoglycans
  • Has a perichondrium layer (except on articular surfaces)

Found in

  • Articular surfaces of joints
  • Costal cartilage
  • Epiphyseal growth plates
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25
Q

Describe Fibrocartilage

A
  • Strongest form of cartilage
  • Contains thick parallel bundles of type I collagen alternating with hyaline cartilage matrix
  • No perichondrium

Found in:

  • Insertion points of ligaments and tendons to bone
  • IV discs
  • Joint capsules
  • Knee menisci
  • Pubic sympysis
  • Temporomandibular joint
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26
Q

Describe Elastic cartilage

A
  • Strong, flexible, resilient
  • Present in structures requiring deformation, then rapidly return to original shape
  • Contain elastic fibres and Type II collagen fibres
  • Has a perichondrium

Found in:

  • External ear
  • Larynx
  • Epiglottis
27
Q

What is a Synarthrodial joint?

A

A joint that is fixed and does not allow movement e.g. the cranial sutures

28
Q

What is a amphiarthrodial joint?

A

A joint which is only slightly moveable such as the pubic symphysis

29
Q

What is a Diarthrodial joint?

A

A joint which is freely moveable such as the shoulder/hip

30
Q

Name the types of joints

A
31
Q

Describe fibrous joints

Name the 2 different types of fibrous joint

A

Bones connected by dense connective tissue containing mainly collagen and no cartilage.

2 types:

  • Sutures = between flat bones of skull, synarthrodial.
  • Syndemoses = interossus membrane connecting long bones, amphiarthrodial. E.g. between tibia and fibia & radius and ulna
32
Q

Describe cartilaginous joints and name the two types

A

Bones connected entirely by cartilage

Either hyaline and/or fibrocartilage

Can be immoveable or slightly moveable

Allow more movement than a fibrous joint but less than highly mobile synovial joint

Types: Primary and secondary

33
Q

Describe a primary cartilaginous joint

(Synchodroses)

A

Hyaline cartilage only

Epiphyseal growth plates, costal cartilage

34
Q

Describe a secondary cartilaginous joint

(Symphysis)

A

Hyaline cartilage lines the bones with pad of fibrocartilage in between

IV discs, pubic symphysis, and manubriosternal joint

35
Q

Describe a synovial joint

A

Presence of a joint cavity between the bones that contains synovial fluid.

Hyaline Cartilage

Joint is enclosed by a joint capsule

Contains outer fibrous membrane and inner synovial membrane (synovium)

36
Q

What is a bursa?

A

Sac made of synovial membrane, containing synovial fluid that reduces friction of one structure moving over another

E.g. in the knee

37
Q

Name the types of synovial joint and the movements they allow

A

Movements of synovial joints:-

  • Hinge, e.g. elbow joints – flexion and extension
  • Ball and socket, e.g. glenohumeral joint – movement in several axes
  • Plane, e.g. acromioclavicular joint – gliding or sliding movements
  • Saddle, e.g. metatarsophalangeal joint – consists of concave and convex surfaces
  • Pivot, e.g. atlantoaxial joint – rotation
  • Condyloid, e.g. metacarpophalangeal joint – flexion, extension, adduction, abduction and circumduction

Synovial joints may also be classified as:

  • Uniaxial – movement in one plane
  • Biaxial – movement in two planes
  • Multiaxial – movement in three planes
38
Q

What is the most common joint disease?

A

Osteoarthritis

39
Q

What factors are involved in osteoarthritis development

A

Complex interaction between genetic, metabolic, biochemical and biomechanical factors

40
Q

Describe what happens in osteoarthritis

A

1. Degradation of cartilage

2. Fibrillation of cartillage

3. Chronic synovitis triggered by cartilage fragments (synovial phagocytes release degradative enzymes)

41
Q

Name some risk factors for osteoarthritis

A

Risk factors for osteoarthritis include:

  • Genetic
  • Increasing age
  • Female sex
  • Trauma
  • Mechanical stress on joints
  • Obesity
  • High bone density – increases the risk of developing osteoarthritis
  • Low bone density – increases the risk of progression of knee and hip osteoarthritis
42
Q

What is the difference between primary and secondary osteoarthritis?

A

–Primary - due to genetic factors and occurs in the absence of a precipitating insult

–Secondary - occurs as a sequelae of joint pathology, e.g. trauma, infection, joint defects, inflammatory conditions.

43
Q

Where does osteoarthritis commonly affect?

A

knees, hips and small joints of the hands

44
Q

what 3 things happen to the cartilage in osteoarthritis?

A

Change in composition of cartilage -> reduced shock absorbing abilities

Erosion of cartilage in joints -> fissures (fibrillation)

Ulceration of cartilage -> exposes underlying bone -> microfractures and subchondral cysts

45
Q

What happens to the joint capsule in osteoarthritis?

A

Inflammation of synovium

Thickening of joint capsule -> stiffness and restricted movement

46
Q

What radiographic changes would you see in a patient with osteoarthritis?

A

Joint space narrowing – characteristically asymmetric

Subchondral cysts and sclerosis

Osteophytes

Malalignment

47
Q

How might you notice osteophytes in a clinical exam?

A

Osteophytes are commonly seen on examination in osteoarthritis of the small joints hand where they present as hard swellings around the distal interphalangeal joints (Herberden nodes) and/or proximal interphalangeal joints (Bouchards nodes) and at the base of the thumb.

48
Q

Name signs and symptoms of osteoarthritis

A

Joint stiffness – short-lived morning stiffness and post-inactivity stiffness

Joint pain – worse on movement

Functional limitation

Rest/night pain

Examination findings:

–Restricted movement

–Crepitus

–Bony swelling

–Joint effusion

–Joint instability, deformity and muscle wasting

49
Q

Briefly describe the management of osteoarthritis

A

Education, advice and information

Non-pharmacological

–Exercise – build muscle strength, loose weight

–Physiotherapy

–Aids and devices

Pharmacology

–Pain management – topical and/or oral

Surgical

–Joint replacement (arthroplasty)

–Joint fusion

–Joint excision

–Realignment surgery

50
Q

Name 3 types of inflammatory arthritis

A
  1. Rheumatoid arthritis
  2. Spondyloarthritis
  3. Crystal arthritis e.g. gout
51
Q

How is osteoarthritis different from rheumatoid?

A

Rheumatoid arthritis:

  • usually begins 25-50yrs
  • AI response affecting synovial membrane leads to joint destruction
  • develops in weeks/months
  • usually symmetrical, affects small joints primarily
  • signs of inflammation present
  • morning stiffness often >1hr
  • more common in females
  • no ostephytes
  • RF frequently present
  • generalised symptoms present e.g. fatigue, weight loss, anaemia

Osteoarthritis:

  • Usually begins after 40
  • biomechanical - leads to loss of cartilage matrix
  • develop slowly over many years
  • usually affects weight bearing joints
  • pain associated with joint use, less inflammatory signs
  • morning stiffness usually <20mins
  • no general symptoms
  • common in males and females
  • osteophytes may be present
  • No RF present
52
Q

What is gout caused by?

which joints are commonly affected?

A

An inflammatory response to urate crystals deposited in and around joint and synovial fluid

Due to Hyperuricaemia

Crystal formation tends to occur in peripheral areas, e.g. metatarsal-phalangeal joints, especially of big toe

53
Q

What does gout lead to?

A

synovitis, cartilage destruction and joint degeneration

54
Q

What is the difference between primary and secondary gout?

A

–Primary (95%) - due to an inherited disorder that causes an overproduction or underexcretion of uric acid

–Secondary (5%) – other factors causing overproduction of uric acid (e.g. high dietary purine, drugs, or conditions resulting in increased nucleic acid turnover, e.g. lymphoma, psoriasis, haemolysis etc. etc.) or under-excretion (e.g. chronic renal failure, alcohol, drugs etc.)

55
Q

What complication can gout cause?

think kidneys

A

Urate crystals can also be deposited in the renal parenchyma, resulting in renal failure, and urate calculi (kidney stones) can be formed in the urine

56
Q

Name important risk factors for gout:

A

Therefore, important risk factors to remember include:

  • High serum urate
  • Family history
  • Excess alcohol
  • Renal disease
  • Chemotherapy for malignancy
57
Q

Describe signs and symptoms of acute gout

A

Acute gout:

–Sudden onset

–May be precipitated by excess food or alcohol, dehydration or diuretics

–Joint inflammation

–Tender, swollen, hot, red joint

–Often affects first metatarsophalangeal joint

58
Q

Describe signs and symptoms in chronic gout

A

Chronic tophaceous gout

–Often associated with renal impairment and long-term use of diuretics

–Tophi – deposits of monosodium urate crystals in bursae, tendons, cartilage or periarticular bone. May ulcerate and discharge

–Chronic joint pain

–May have superimposed acute gout attacks

59
Q

What radiographic changes might you see in a patient with chronic gout?

A

Joint effusion

“Punched out” bony erosions with sclerotic margins and over-hanging edges

Opacities (tophi) in soft tissue

Soft tissue swelling

Narrowing of joint space in late stages of disease

60
Q

Briefly describe the management of gout

A

General measures:

–Reduce alcohol intake

–Avoid purine-rich foods

–Loose weight

–Review medications including diuretics

Acute attack – NSAIDs or colchicine

Chronic gout

–Allopurinol (xanthine oxidase inhibitor – reduces synthesis of uric acid)

–Uricosuric drugs (increases urinary excretion of uric acid)

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Year 1 Locomotion (18 decks)

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