labrum, intervertebral disc, and meniscus Flashcards
What is the labrum and which joints is it located in
It is a marginal fibrocartilage that is largely anueral w/no lymphocytes but has a vascular supply and is located in the GH and hip joints
What are the purposes of the labrum
Separate joint surfaces assist in jt lubrication shock absorption transmit loads protect joint edges
List the types of GH Labrum Tears/injuries
- Radial tear
- longitudinal tear
- bucket handle tear
- degenerative tear
- labral fraying
- dislocation/bankart lesion
- SLAP lesion
Where are acetabular tears and their MOI?
- 80% in anterior quadrant
- MOI mainly repetitive activity w/twisting and pivoting BUT can be femoral dysplasia or other abnormalities
What are general symptoms of labral tears
- catching/locking sensation
- painful clicking
- restricted ROM
T or F: We know how the labrum heals
False - there is some evidence suggesting that ibuprofen limits it and being closer to blood supply is better
What are some common pathologies of the intervertebral discs
- herniation
- degenerative disc disease
- discitis
what is the purpose of an intervertebral disc?
To act as a cushion b/t two bones to absorb shock
What should you see w/a normal lumbar disc
- even thickness
- no development of bone anteriorly
- easily see facet joints
- even disc space
What is the histology of an intervertebral disc?
- Fibrous annulus fibrosis (extrnal layer of overlapping fibrocartilage and collagen in cross-fiber pattern)
- Nucleus Pulposus (jelly filled rich in hyaluronic acid and type II collagen fibrils)
Sequence of disc dysfunction
- normal
- degenerative disc
- bulging disc (slight w/o nucleus pulposus)
- herniated disc
- thinning disc
- disc degen w/osteophyte formation
Where is the blood supply in a disc
through the middle of the vertebral bodies only meaning not a lot of blood in annulus fibrosis or nucleus pulposus itself just little arterioles towards it
What is a degenerative disc
1st phase w/fissures developing over time (CRT - concentric, radial, or transverse) w/joint space narrowing and osteophyte development anteriorly
What is a disc bulge
Circumferential diffuse extension of annulus 3 mm (50-100% of disc tissue) or more beyond the adjacent vertebral end plates w/o nucleus pulposus or rupture of annulus fibers
What is an annular fissure
A focal disruption of the fibers of the annulus = herniation
What is a herniation?
Localized displacement of disc material beyond the limits of the intervertebral disc space
What are the types of herniation?
Focal (<25%)
Broad (25-50%)
Generalized [extruded or sequestered] (>50%)
What is a disc protrusion?
A focal, asymmetric condition in which a segment of the disc extends beyond the margin of the adjacent vertebrae into the spinal canal
What is a disc extrusion?
The nucleus extends beyond the annulus and posterior longitudinal ligament into the epidural space & may migrate up or down the canal
What is disc sequestration?
A free fragment of disk detaches from remaining portion and floats around
What is a Schmorl Node
A focal herniation of the nucleus pulposus through the vertebral endplates occurring near center or posterior part of the disc (vertically not horizontal)
What are the S/S of disc herniation
Signs: LOF, weak mm w/o flacidity
Symptoms: SENSORY FIRST
pain radiating down, dermatome, and intensified or relaxed by different movements
What occurs w/the nucleus pulposus once herniated (for healing)
It does not return to the middle of the disc but is absorbed over time
What is a barrier to inflammation in disc healing post herniation
the annulus: if intact, inflammation cannot come inward
What is degenerative disc disease (DDD)
Similar process of normal joint degen as OA causing a decrease in water content and therefore decreased ability to WB causing breakdown of annulus fibrosis
What is the pathophys of DDD
Marginal tears –> radial tears (of annulus) –> disc herniation leading to less disc height & alteration in mechanics leading to laxity and sublux causing develop of osteophytes to try and reestablish normal position
What is observed on lateral view radiograph of DDD
- narrowing of jt space
- osteophyte and sclerosis of jt margins
What are the symptoms of DDD
severe dermatomal pain pattern, dull/aching discomfort below level of severe pain that worsens w/fatigue tension, postural factors and neck extension
What are the signs of DDD
- tender to palpate w/mm spasms and trigger points common
- distraction increases pain
- painful AROM and PROM
- no capsular pattern
- abnormal flattening of the normal lordosis
What are common areas for DDD?
L4-L5 and L5-S1
C5-C6 and C6-C7
What is discitis
A disease space infection (bacterial or viral) or auto-immune disease as an inflammatory lesion of the intervertebral disc that occurs in adults but more commonly in children younger than 10
What are the S/S of discitis?
Signs:
- refusal to walk
- dec. mobility in the back
- stiffness
- narrow disc space on radiograph
- MRI positive for inflammation
- elevated WBC
Symptoms:
- low grade fecer
- irritability
- back pain
- abdominal pain
What is the treatment of discitis?
Medication (pain relief and anti-inflammatory)
What are some common pathologies of the meniscus?
Tears
Degeneration
Discoid meniscus
T or F: The blood supply is more anterior than posterior in the meniscus
FALSE IS MORE POSTERIOR so the anterior will not heal as well
What are the different types of meniscus tears?
- degenerative (fraying)
- vertical longitudinal
- vertical radial
- horizontal
- flap
- parrot beak tear
- bucket hand
What is the most frequent tear of the meniscus?
Vertical longitudinal tears
What is a vertical longitudinal tear of the meniscus
tear greater than 1 cm in length that is unstable with stress and causes a lot of symptoms w/more occurring on the medial aspect than lateral
What are vertical transverse tears of the meniscus?
A stable and less common radial tear almost always in the middle third of the lateral meniscus less than 5 mm
What traumatic MOI for meniscus tears?
ALMOST ALWAYS INVOLVES ROTATION and can be contact or non-contact in younger people
What is degenerative MOI for meniscus tear?
Horizontal cleavage or flap tear in ages over 40 most commonly medial, but could be either possibly due to bending, squatting, turning and twisting over the years
Signs of Meniscus Tear
Signs:
- Change in WB status
- Min swelling
- McMurray’s or Apley’s test positive
- Springy end feel
Symptoms of Meniscus Tear
Symptoms:
- pain at the time of injury
- persists and interferes w/WB activity
- recurrent episodes w/minor stress
- baker’s cyst
- knee is giving away
Indications for surgery of a meniscus tear
- vertical tears
- tears near the periphery
- total tissue defect less than 2 cm
- generally intact meniscal body
What is a discoid meniscus
An asymptomatic (or symptoms: snapping, locking, severe pain, and swelling) abnormal meniscus seen in children prone to tearing
How does the meniscal healing occur?
Does not occur in everyone
- if near the periphery and blood supply it can repair w/fibrocartilage
