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Orthopedics > Lecture 3: Articular & Soft Tissue Injury > Flashcards

Lecture 3: Articular & Soft Tissue Injury Flashcards

1
Q

what are the 3 phases of healing

A

inflammatory - response phase

Fibroblastic repair phase

Mature remodeling phase

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2
Q

What is the inflammatory response phase

A

occurs immediately after an injury

the damaged material initiates a response

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3
Q

What is the repair phase called and what happens in this phase

A

Fibroblastic phase

Fibroblastic cells are laid down in a matrix of collagen fibers and forming scar tissue in random manner

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4
Q

How can we use scar tissue to our advantage

A

We want to communicate to fibroblast to please do better. We can use the scar tissue to our advantage. In repair and maturation phase you are putting as much load as you can without exceeding their adaptive potential.

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5
Q

How long does the maturation remodeling phase take

A

long term process (2 years)

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6
Q

What happens in the maturation remodeling phase

A

Realigning of collagen fibers that make up the scar tissue to the tensile force to which scar is subjected

On going breakdown and synthesis of collagen occur with a steady increase in the tensile strength of the scar matrix

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7
Q

What are the joint stuctures

A 
Joint capsule - outer layer
Synovial
Cartilage
Ligaments
Muscle
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8
Q

Does the joint capsule have a good blood supply

A

outer layer no

inner layer yes

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9
Q

Outer layer of the joint capsule is called, attaches to, vascularity, innervation, and function

A

Stratum fibrosum (outer layer)
◦ Attaches to periosteum
◦ Reinforced by ligamentous & musculotendinous structures –> checks movement
◦ Capsular redundancy allows full ROM (e.g. GH joint)
◦ Poorly vascularized
◦ Richly innervated by joint receptors
◦ Protects inner layer (synovium)

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10
Q

Inner layer of the joint capsule is called, vascularity, innervation, and function

A

Stratum synovium (inner layer)
◦ Highly vascularized
◦Poorly innervated ◦Synoviocytes synthesize HYALURONIC ACID

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11
Q

How can you reduce the viscosity of synovial fluid

A

rapid movement and higher temperatures

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12
Q

What are the components of synovial fluid

A 
Hyaluronic acid
Proteins (lubricin)
Blood plasma constituents
WBC's
No fibrinogen or prothrombin - does not clot
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13
Q

What does hyaluronic acid do

A

contributes to viscosity

reduces friction between capsule and cartilage

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14
Q

What does lubricin do

A

contributes to cartilage to cartilage lubrication

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15
Q

Cartilage, what is it, what are the components and what are the two types

A

Connective tissue

Large fibrous component -Collagen

Small cellular component - Chondrocyte

Two types

  • Hyaline cartilage
  • Fibrocartilage
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16
Q

Hyaline cartilage is located

A

Articular cartilage

epiphyseal growth plate

17
Q

Hyaline cartilage ECM includes

A

elastin

18
Q

Hyaline cartilage in adults

A

is mostly avascular and aneural

-this means it doesn’t heal

19
Q

Articular cartilage is

A

17 mm thick covering the articular ends of bones

Unique design of collagen fibers at right angles to subchondral bone and parallel to articular surface

Can tolerate high loads of compression

It is porous and sponge like

20
Q

Is immobilization good for cartilage?

A

No, death to cartilage

21
Q

How does articular cartilage get nutrition

A

synovial fluid and some from blood vessels in bony endplates

Depends on intermittent compression

  • WBing
  • Muscle contraction
  • ROM: closed packed position
22
Q

How is fibrocartilage similar and different to hyaline cartilage

A

Same general properties as hyaline cartilage, but greater proportion of collagen therefore it is less distensible

23
Q

Where is fibrocartilage found

A 
Found in  joint  spaces  to increase  congruency and serve as  shock  absorber 
◦ TMJ 
◦ Knee 
◦ Intervertebral disc 
◦ Pubic  symphysis
24
Q

When a joint capsule is injured, what happens

A

Increased vascularity

Thickening of capsule

Swelling → overstretching of capsule

Likely decrease in proprioception

Typically associated with ligament sprain

25
Q

Can we treat a decrease in proprioception in a joint capsule? If so give an example

A

Yes, after ankle sprain we put people on balance routine. Because of damage to the joint capsule. We are trying to build new neurological pathways

26
Q

Injury to joint capsule MAY be associated with injury to other musculotendinous structures such as

A

Tendinitis

Tendinosis

Muscle Strain

27
Q

Two types of injury to the synovium

A

post-traumatic synovitis

Chronic synovitis- gradual fibrosis

28
Q

What is post-traumatic synovitis

A

Capillaries of the synovial membrane dilate and filtration increases

Edema and exudate in the joint

Slight hyperemia (blood) of the synovial membrane

29
Q

Chronic Synovitis leads to

A

fibrosis

30
Q

What is chronic synovitis

A

Synovial membrane infiltrated with lymphocytes

Increased protein synthesis by the synovial cells

Lymphocytes ingest macrophages and then die

Proteolytic enzymes released

Normal tissue attacked

31
Q

Reaction of synovial fluid to trauma

A

if trauma is minor - might see slight elevation in protein and WBC

if prolonged - WBC go up a lot and fluid becomes cloudy.
Protein and viscosity increase and if bloody this will cause damage to cartilage

32
Q

How is articular cartilage’s ability to heal itself

A

poor

33
Q

What are the two types of articular cartilage injuries

A

Those that do not penetrate the subchondral bone

Those that penetrate the subchondral bone

34
Q

What is a partial thickness defect (in regards to articular cartilage)

A
  • MAY heal, depending on diffusion from viable periosteum & synovium (movement, WBing, closed packed position)
  • If does not heal will lead to necrosis
35
Q

What is a full thickness defect (in regards to articular cartilage)

A
  • Into subchondral bone

* Heals with fibrocartilage

36
Q

Articular cartilage injury cycle

A 
Cyclical  tissue  breakdown 
◦ Fracturing  of  collagen  fibers 
◦ Depletion  of  ground  substance 
◦ Synovial  inflammation 
◦ Capsular  fibrosis 
◦ Altered  mechanics 
◦ Osteoarthritis
37
Q

Symptoms of articular cartilage injury

A 
◦ Symptoms not present until subchondral bone exposed -b/c it's aneural
◦ Dull ache
◦ Stiff- worse w/ inactivity
◦ Swelling
◦ Decreased ROM

Orthopedics (12 decks)

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