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Block 4: Musculoskeletal > Joints (Week 1--Metten) > Flashcards

Joints (Week 1--Metten) Flashcards

1
Q

How do MSK tissues develop?

A

Derived from mesoderm, which turns to mesenchyme, which turns to MSK cells (fibroblasts, chondrocytes, osteocytes) to make MSK tissues

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2
Q

Development of extremities

A

Pluripotent cells migrate to limb buds at day 26 to form mass of mesenchyme covered by epidermis

Fibrous tissue and vessels differentiate from mesenchyme

Bone forms at 6th week and muscle mesenchyme attaches to it

Nerves migrate in

Apoptosis of tissue between digits forms hand and foot

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3
Q

Fibrous tissue (connective tissue) composition

A

Fibroblasts produce ECM, which consists of fibers and ground substance

Fibers: collagen and elastic fibers

Ground substance: GAGs, proteoglycans (GAGs + core proteins (neg charge) hold in water and have consistency of egg whites), adhesion glycoproteins (fibronectin)

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4
Q

3 skeletal muscle wrappings

A

Endomycium: delicate loose fibrous tissue that surrounds each muscle fiber and contains capillaries that supply muscle fiber

Perimycium: fibrous tissue wrapping that encloses a fascicle of skeletal muscle fibers

Epimycium: dense fibrous tissue that wraps around entire muscle (is deep fascia of the muscle)

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5
Q

Myotendinous junction

A

Where epimycium and perimycium fuse to form a tendon

Abrupt, vascularized

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6
Q

Tendon structure

A

Produced by tenocytes

Endotenon wraps around bundles of collagen fibers (this is where capillaries are) and tendon is a collection of endotenons

Where the tendon wraps around a bone, it is less vascularized

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7
Q

Tendonitis

A

Acute inflammation of tendon, most often due to overuse injury

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8
Q

Tendonosis

A

Injury that results from microtears in tendon without significant inflammation

From overuse injury, compression injury, degenerative changes

Usually chronic

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9
Q

When tendon is injured (prolonged periods of tensile stress), what happens?

A

Prolonged periods of tensile stress –> collagen breakdown –> Ca2+ deposits

If you see Ca2+ deposits on X-ray means you’ve been injured there before

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10
Q

Tendon sheath

A

Fibrous tissue sheath that surrounds the tendon in certain locations (where high abrasion on tendon)

Inside is lined with synovial membrane (= synovium)

Ex: many tendons in hand are wrapped in tendon sheaths!

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11
Q

Tenosynovitis

A

Inflammation of tendon sheath (lined with synovium = synovial membrane)

Can cause Trigger Finger (inflamed tendon sheath causes nodule to form and can’t move finger because nodule in the way) and DeQuervain Tenosynovitis

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12
Q

Two different types of tendon attachment to bone

A

1) Fibrous: tendon fibers go through periosteum and attach to bone
2) Enthesis: tendons contain fibrocartilage and become more tough before going into bone (this attachment good for tendons that have a lot of pull/force on them); zones are tendon proper, fibrocartilage, mineralized fibrocartilage, bone insertion

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13
Q

Where tendons attach to bone, are there nerve endings?

A

Yes, nociceptors and mechanoreceptors

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14
Q

Enthesitis

A

Inflammation at enthesis

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15
Q

Ligament structure

A

Attach bone to bone

Similar structure to tendon (fibrous or enthesis attachments)

Nerve endings are nociceptors or mechanoreceptors (proprioception)

Have endoligament and epiligament?

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16
Q

Ligament pathology

A

Acute injury (sprain)

Degeneration

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17
Q

Bursa

A

Fibrous tissue sac lined with synovium

Located where muscle and bone or tendon and bone meet

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18
Q

Bursitis

A

Bursa becomes inflamed (actually is synovium inside bursa becoming inflamed)

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19
Q

Shoulder Impingement Syndrome

A

Overuse syndrome –> tendonitis of supraspinatus muscle tendon –> swelling –> ischemia –> tendinosis with tears in muscle tendon –> subacromial bursa becomes inflamed –> bursitis –> deposition of Ca2+ crystals in bursa is calcific bursitis –> lots of pain –> don’t want to use shoulder –> adhesive capsulitis (thickening of shoulder joint capsule)

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20
Q

Cartilage

A

Produced by chondroblast which make fibers and ground substance

Fibers: Type II collagen (hyaline and elastic cartilage), Type I collagen (fibrocartilage), elastic cartilage

Ground substance: GAGs, proteoglycans (GAGs (hyaluronan)+ core protein), adhesion glycoproteins

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21
Q

3 types of cartilage

A

1) Hyaline cartilage: Type II collagen (in joints!)
2) Elastic cartilage: Type II collagen and elastic fibers
3) Fibrous cartilage (fibrocartilage): Type I collagen and someType II collagen (and chondrocytes line up)

22
Q

Proteoglycan aggrecan structure of cartilage ECM?

A

Complex proteoglucan molecules (chondroitin sulfate, keratin sulfate)

Hyaluronan

Aggrecans form large aggregates

23
Q

Perichondrium of cartilage

A

Surrounds cartilage

Contains vessels, nerves

Nutrients diffuse from perichondrium to cartilage b/c no vessels in cartilage

Cushioning effect: when compressed, interstitial fluid moves away from proteoglycan aggregate structure but when compression released, interstitial fluid returns

24
Q

Types of injury to hyaline cartilage

A

Acute injury: cartilage cannot repair itself because does not have blood supply so no inflammation and no healing

Chronic injury: overuse injury and normal aging causes aggrecan structures to gradually break down and cartilage frays (fibrillation) and erodes (osteoarthritis)

25
Q

2 types of bone

A

Cortical/compact bone

Trabecular/spongy/cancellous bone

26
Q

2 bone membranes

A

1) Periosteum surrounds/lines outside surface of bone and is important because contains blood supply; abundant somatic sensory innervation, lymphatics; thicker in children
2) Endosteum lines all spaces inside bone

27
Q

Osteoid

A

Special name for ECM of bone created by osteoblasts

28
Q

How do you create bone?

A

Osteoblasts produce osteoid that becomes mineralized when minerals from blood come in and attach to collagen fibers in osteoid to form hydroxyapatite crystals

Very first bone produced is woven bone, then matures to lamellar bone

29
Q

Bone composition

A

Osteoblast makes ECM called osteoid, which contains fibers and ground substance

Fibers: Type I collagen

Ground substance: GAGs, proteoglycans (GAGs + core protein, and aggrecan molecules form aggregates)

30
Q

Osteocytes

A

Cell bodies in lacuna due to density of matrix

Cell processes are in canaliculi so can communicate with other osteocytes

Haversian system nourishes osteocytes

31
Q

Haversian canal

A

Lined by osteum

Within osteon

Contain blood vessels

32
Q

Osteon

A

Fundamental unit of compact bone–cylinder surrounding Haversian system

Central rod

Haversian system (Haversian canal (contains nerve and blood vessels) and canaliculi)

Increased pressure on the bone creates osteons

33
Q

Osteoclasts

A

Derived from bone marrow in mononuclear phagocyte system (derived from where monocytes come from–osteoclasts are semi-phagocytic!)

Lifetime is several weeks

Multinucleated, large

Regulated by hormones (calcitonin inhibits activity, PTH indirectly activates)

Osteoblasts signal osteoclasts to munch bone

34
Q

How are osteoclasts triggered to munch bone?

A

PTH binds osteoblasts and causes them to express RANKL which binds to RANK on osteoclast and activates it

Osteoclast has ruffled border and resorption pit where releases lysosymes to digest bone –> Howship’s lacuna is where bone has been removed by osteoclasts

35
Q

Blood supply of mature bone

A

Periosteal arteries

Nutrient artery

Epiphyseal and metaphyseal arteries –> at puberty they unite to form metaphyseal vessels only

Arteries branch and course in Volkmann’s canals –> Haversian canals

36
Q

Bone remodeling

A

7 - 10% of skeleton remodeled every year

Osteoclast removes bone forming cutting cone –> reversal –> osteoblast replaces bone

37
Q

Bone pathology

A

Bone sclerosis: bone responds to stress by remodeling a more dense bone

Osteophyte formation: excessive remodeling due to stress

Osteomyelitis: infection

Fractures

Tumors

38
Q

Synarthroses

A

Bone anchored to bone by fibrous tissue, resulting in limited to no movement at the joint

In functional classification, this is the class called immoveable joints (note: includes syncondrosis)

39
Q

Syndesmosis

A

Fibrous tissue union

In anatomical classification, this is a fibrous joint

In functional classification, this is a slightly moveable joint

40
Q

Synostosis

A

Bone union

41
Q

Synchondrosis

A

Cartilage union

In anatomical classification, this is cartilagenous joint

In functional classification, this is immoveable joint

42
Q

Intervertebral disk is what kind of joint?

A

Synchondrosis (cartilage union)

Has nucleus pulposus (mass of proteoglycans, 70 - 90% water), annulus fibrosus (fibrocartilage rests on vertebral endplate and outer edges attach to anterior/posterior longitudinal ligaments), vertebral endplate (hyaline cartilage that gradually ossifies)

43
Q

Disk degeneration

A

1) Annulus fibers tear (due to OA or degenerative disk disease) –> nucleus pulposus escapes thru tear (herniated disk) –> neuropathic pain (myelopathy if impingement on spinal cord; radiculopathy if impinges on spinal roots), nociceptive pain (from nociceptors on sinuvertebral nerve responding to irritated dura, ligaments, other soft tissues in spinal canal)
2) Proteoglycans break down in nucleus pulposus and it becomes dehydrated and dense, narrowing intervertebral space

44
Q

Synovial joints (diarthrosis)

A

In anatomical classification, this is synovial joint

In functional classification, this is highly moveable joint

Joint capsule: continuous with periosteum of articulating bones

Synovium (synovial membrane): fibrous tissue membrane lining inside of joint capsule

Articular cartilage: hyaline cartilage

Periarticular tissue: soft tissue surrounding joint

45
Q

Synovium

A

Intima: cells are synoviocytes (Type A are macrophage-like; Type B are fibroblast-like and produce hyaluronan)

Subsynovium: where capillaries are, blends with joint capsule

Synovial fluid: pale yellow, clear, consistency of egg white; lubrication/reduce friction, nourishes superficial layers of articular cartilage; sources are (1) capillaries in subsynovium and (2) Type B synoviocytes that secrete hyaluronan; has few WBCs, no neutrophils

46
Q

Joint effusion

A

Increase in synovial fluid in the synovial space

47
Q

4 zones of articular cartilage (hyaline)

A

1) Superficial zone
2) Middle zone
3) Deep zone

Tidemark

4) Calcified cartilage zone (gradually ossifies with age)

Subchondral bone (provides blood supply for calcified cartilage zone; bone layer just deep to cartilage; can form osteophytes)

48
Q

Facet joint is what kind of joint?

A

Synovial joint

Superior and inferior articular processes articulate and are supported by ligaments and deep back muscles

Bears less weight than intervertebral disk

Joint capsule innervated by sinuvertebral nerve

Reacts to trauma with pain, stiffness, deep back muscle spasm

49
Q

Sinuvertebral nerve

A

Nerve fibers innervate:

Posterior longitudinal ligament

Ligamentum flavum

Peripheral fibers of annulus fibrosis

Facet joint capsule

Smooth muscle in vessels

Dura mater

Periosteum

Branch of spinal nerve that contains nociceptive fibers from soft tissues in spinal canal and tells you that you have back pain

50
Q

Spine degenerative changes resulting in pain

A

1) Outer annulus fibrosis tears in ID (OA) –> interrupted blood supply, activate sinuvertebral nerve –> nociceptive pain (dull, poorly localized w/o paresthesia)
2) Breakdown of proteoglycan molecules in nucleus pulposus –> dehydration –> decrease intervertebral space –> spine malalignment –> laxity of ligaments –> facet joint takes on greater load –> articular cartilage injury –> OA (nociceptive pain)
3) Bone sclerosis –> osteophytes –> impingement of nerve roots in spinal canal –> neuropathic pain (sharp, well-localized with paresthesia-radiculopathy)

Block 4: Musculoskeletal (37 decks)

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