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UM - MSK > labrum, intervertebral disc, and meniscus > Flashcards

labrum, intervertebral disc, and meniscus Flashcards

1
Q

What is the labrum and which joints is it located in

A

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

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2
Q

What are the purposes of the labrum

A 
Separate joint surfaces
assist in jt lubrication
shock absorption
transmit loads
protect joint edges
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3
Q

List the types of GH Labrum Tears/injuries

A
  • Radial tear
  • longitudinal tear
  • bucket handle tear
  • degenerative tear
  • labral fraying
  • dislocation/bankart lesion
  • SLAP lesion
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4
Q

Where are acetabular tears and their MOI?

A
  • 80% in anterior quadrant

- MOI mainly repetitive activity w/twisting and pivoting BUT can be femoral dysplasia or other abnormalities

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5
Q

What are general symptoms of labral tears

A
  • catching/locking sensation
  • painful clicking
  • restricted ROM
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6
Q

T or F: We know how the labrum heals

A

False - there is some evidence suggesting that ibuprofen limits it and being closer to blood supply is better

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7
Q

What are some common pathologies of the intervertebral discs

A
  • herniation
  • degenerative disc disease
  • discitis
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8
Q

what is the purpose of an intervertebral disc?

A

To act as a cushion b/t two bones to absorb shock

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9
Q

What should you see w/a normal lumbar disc

A
  1. even thickness
  2. no development of bone anteriorly
  3. easily see facet joints
  4. even disc space
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10
Q

What is the histology of an intervertebral disc?

A
  • 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)
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11
Q

Sequence of disc dysfunction

A
  1. normal
  2. degenerative disc
  3. bulging disc (slight w/o nucleus pulposus)
  4. herniated disc
  5. thinning disc
  6. disc degen w/osteophyte formation
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12
Q

Where is the blood supply in a disc

A

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

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13
Q

What is a degenerative disc

A

1st phase w/fissures developing over time (CRT - concentric, radial, or transverse) w/joint space narrowing and osteophyte development anteriorly

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14
Q

What is a disc bulge

A

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

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15
Q

What is an annular fissure

A

A focal disruption of the fibers of the annulus = herniation

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16
Q

What is a herniation?

A

Localized displacement of disc material beyond the limits of the intervertebral disc space

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17
Q

What are the types of herniation?

A

Focal (<25%)
Broad (25-50%)
Generalized [extruded or sequestered] (>50%)

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18
Q

What is a disc protrusion?

A

A focal, asymmetric condition in which a segment of the disc extends beyond the margin of the adjacent vertebrae into the spinal canal

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19
Q

What is a disc extrusion?

A

The nucleus extends beyond the annulus and posterior longitudinal ligament into the epidural space & may migrate up or down the canal

20
Q

What is disc sequestration?

A

A free fragment of disk detaches from remaining portion and floats around

21
Q

What is a Schmorl Node

A

A focal herniation of the nucleus pulposus through the vertebral endplates occurring near center or posterior part of the disc (vertically not horizontal)

22
Q

What are the S/S of disc herniation

A

Signs: LOF, weak mm w/o flacidity

Symptoms: SENSORY FIRST
pain radiating down, dermatome, and intensified or relaxed by different movements

23
Q

What occurs w/the nucleus pulposus once herniated (for healing)

A

It does not return to the middle of the disc but is absorbed over time

24
Q

What is a barrier to inflammation in disc healing post herniation

A

the annulus: if intact, inflammation cannot come inward

25
Q

What is degenerative disc disease (DDD)

A

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

26
Q

What is the pathophys of DDD

A

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

27
Q

What is observed on lateral view radiograph of DDD

A
  • narrowing of jt space

- osteophyte and sclerosis of jt margins

28
Q

What are the symptoms of DDD

A

severe dermatomal pain pattern, dull/aching discomfort below level of severe pain that worsens w/fatigue tension, postural factors and neck extension

29
Q

What are the signs of DDD

A
  • 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
30
Q

What are common areas for DDD?

A

L4-L5 and L5-S1

C5-C6 and C6-C7

31
Q

What is discitis

A

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

32
Q

What are the S/S of discitis?

A

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
33
Q

What is the treatment of discitis?

A

Medication (pain relief and anti-inflammatory)

34
Q

What are some common pathologies of the meniscus?

A

Tears
Degeneration
Discoid meniscus

35
Q

T or F: The blood supply is more anterior than posterior in the meniscus

A

FALSE IS MORE POSTERIOR so the anterior will not heal as well

36
Q

What are the different types of meniscus tears?

A
  • degenerative (fraying)
  • vertical longitudinal
  • vertical radial
  • horizontal
  • flap
  • parrot beak tear
  • bucket hand
37
Q

What is the most frequent tear of the meniscus?

A

Vertical longitudinal tears

38
Q

What is a vertical longitudinal tear of the meniscus

A

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

39
Q

What are vertical transverse tears of the meniscus?

A

A stable and less common radial tear almost always in the middle third of the lateral meniscus less than 5 mm

40
Q

What traumatic MOI for meniscus tears?

A

ALMOST ALWAYS INVOLVES ROTATION and can be contact or non-contact in younger people

41
Q

What is degenerative MOI for meniscus tear?

A

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

42
Q

Signs of Meniscus Tear

A

Signs:

  • Change in WB status
  • Min swelling
  • McMurray’s or Apley’s test positive
  • Springy end feel
43
Q

Symptoms of Meniscus Tear

A

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
44
Q

Indications for surgery of a meniscus tear

A
  • vertical tears
  • tears near the periphery
  • total tissue defect less than 2 cm
  • generally intact meniscal body
45
Q

What is a discoid meniscus

A

An asymptomatic (or symptoms: snapping, locking, severe pain, and swelling) abnormal meniscus seen in children prone to tearing

46
Q

How does the meniscal healing occur?

A

Does not occur in everyone

- if near the periphery and blood supply it can repair w/fibrocartilage

UM - MSK (9 decks)

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