M11: Musculoskeletal Flashcards
Ligament, tendon basics p.1422
Ligaments
* Function: Connect bones and provide joint stability. They are critical in preventing excessive movements that could lead to joint injuries.
* Structure: Made of dense regular connective tissue, primarily collagen, making them tough but flexible.
* Clinical Consideration: Ligament injuries, called “sprains,” are graded based on the severity from I (mild) to III (complete tear).
Tendons
* Function: Tendons connect muscles to bones, transmitting the force generated by muscle contraction to the skeleton, facilitating movement.
* Structure: Composed similarly to ligaments but are designed to withstand the different types of stress associated with movements.
* Clinical Consideration: Tendon injuries, or “strains”, often result from overuse, leading to conditions like tendinitis or rupture.
Both: * Both can withstand significant distraction (stretching) force but buckle with compressive force
Fracture physiology; healing p 1429-1430
Physiology
* Bone Fractures: Occurs when the physical force exerted on a bone surpasses its strength.
* Types: Can be classified based on severity, location, and nature - simple, compound, comminuted, etc.
Healing
* Involves an orchestrated multi-phase process:
o Inflammatory Phase: Blood clots form around the fracture to stop bleeding and recruit necessary cells for healing.
o Reparative Phase: Soft callus forms and is later replaced by a hard bony callus.
o Remodeling Phase: The newly formed bone is remodeled to resemble the bone’s original structure and functionality.
Wnt genes: protein signalling factors
Bone remodeling
This process is crucial for maintaining bone health, accommodating stress, and healing fractures. It involves the balanced activity of osteoclasts (bone resorption) and osteoblasts (bone formation). Factors influencing this balance include nutritional status, hormonal changes, and physical activity.
* Repair of microscopic injuries and maintenance of bone integrity
* Phases
o Activation of the remodeling cycle
o Resorption
o Formation of new bone (secondary bone)
Takes 4–6 months
Bone remodeling Process
Bone remodeling process
Repair: Bone heals itself
* Hematoma formation
o Clot forms.
* Procallus formation
o Produces granulation tissue.
* Callus formation
o Forms membranous or woven bone.
* Callus replacement
o Replaces the callus with lamellar bone or trabecular bone.
* Remodeling
o Periosteal and endosteal surfaces are remodeled to the size and shape of the bone before the injury.
Muscular Diagnostics- p 1423
Different tools and tests diagnose muscular disorders, including:
* Muscle Biopsy: For histological examination of muscle tissue.
* Electromyography (EMG): Assesses the electrical activity of muscles. ;the summation of action potentials of the muscle is recorded.
* Blood Tests: Elevated levels of muscle enzymes, like Creatine Kinase, can indicate muscle damage.
Serum creatine kinase
* Is increased when muscles are diseased or damaged.
Myoglobin
* Is detectable in urine with acute muscle damage.
Sprain p. 1432
- Ligament tears are known as sprains.d/t sudden overstretching
- Most common in the wrist, ankle, elbow, and knee joints
- The complete separation of a tendon or ligament from its bony attachment is known as an avulsion. An avulsion is an abnormal stress on the ligament and is common in young athletes.
- First Degree: fibers are stretched but the muscle (strain) or joint (sprain) remains stable.
- Second Degree: there is more tearing of the tendon or ligament fibers, resulting in muscle weakness or some joint instability and incomplete tearing of the fibers.
- Third Degree: results in full tearing of fibers, creating an inability to contract the muscle normally (strain) or cause significant joint instability (Sprain)..may require surgical intervention.
- PRICE for 24-48 hours
- P: Protection
- R: Rest
- I: Ice
- C: Compression
- E: elevation
OsteoArthrits p 1452-1455
- char by pathological changes in cartilage, bone, synovium, ligament, muscle, and periarticular fat.
- lead to joint dysfunction, pain, stiffness, functional limitation, and loss of activities.
- Inflammatory disease, mostly considered a degenerative disease of cartilage.
- The physiologic changes include cartilage degradation, bone remodeling, osteophyte formation (bone spurs), joint inflammation, loss of normal joint function, and progress to illness.
- Commonly found in the knees, hips, hands and spine.
- Risk factors
o Age
o Female
o Obesity
o Genetics
o Previous joint injury - Primary OA (idiopathic) is the most common and is diagnosed with the absence of a predisposing trauma or disease
- Secondary OA occurs with preexisting joint abnormality from conditions such as congenital joint disorders, inflammatory arthritis, Paget disease, osteoporosis, osteochondritis dissecans, metabolic disorders, hemoglobinopathy, Ehlers-Danlos syndrome, or Marfan syndrome.
- Progressive destruction of the extracellular matrix is considered a hallmark.
- Triad of symptoms include joint pain (deep, achy) that worsens with use, morning stiffness, and motor restriction
- Other manifestations can include muscle weakness, crepitus, and balance issues.
- Joint deformities can develop: Bouchard nodes and Heberden nodes (deformities in the fingers)
- Clinical Diagnosis of OA is made when the following are found
o Pain worse with activity and better with rest
o Age greater than 45 years
o Morning stiffness lasting less than 30 minutes
o Bony joint enlargement
o ROM limitation
TX: pain relief & maint. fxn though meds, PT, & lifestyle mods
Carpal Tunnel Syndrome
- Caused by pressure on the median nerve, which provides sensation to the thumb and digits 2-4 (excludes the 5th digit). The median nerve passes through the carpal tunnel
- Swelling and narrowing of this passage puts further constriction on this nerve, yielding symptoms
- Risk factors include:
o Obesity
o Female sex
o Pregnancy
o Diabetes
o RA
o OA
o Hypothyroidism
o Connective tissue disorders
o Preexisting mononeuropathy
o Genetic predisposition
o Aromatase inhibitor use
o Workplace factors: repetitive/forceful hand and wrist use, use of vibrating tools, sustained pressure on the wrist or palm, prolonged extension or flexion of the wrist.
o Trauma
DX:
o Phalen Maneuver: dorsal aspect of hands pressed together with the wrists in full flexion and elbows flexed.
Positive sign is defined as pain and/or paresthesia in the median nerve innervated fingers with 1 minute of wrist flexion.
o Tinel Test: firm percussion over the course of the median nerve proximal to or on top of the carpal tunnel
A positive test is defined as pain and/or paresthesia in the median nerve innervated fingers on percussion over the median nerve.
o Manual Carpal compression: applying pressure over the transverse carpal ligament.
Deemed positive if pain and/or paresthesia were noted in median innervated fingers within 30 seconds of compression.
TX: wrist splint to surgery for sev.
Muscle contraction physiology p. 1419-1420
Muscle contraction is a complex process facilitated by the sliding filament theory:
* Actin and Myosin Interaction: Myosin heads bind to actin, forming cross-bridges that pivot, pulling the actin filaments inward and resulting in muscle contraction.
* Role of Calcium and ATP: Calcium ions expose binding sites on actin, while ATP provides the energy for cross-bridge movement and detachment.
4 steps:
Excitation:
Coupling
Contraction
Relaxation
Fibromyalgia p 1463-1465
- FM is a chronic musculoskeletal syndrome characterized by chronic widespread pain (CWP).
- Pain can affect the whole body from head to toe.
- Nociplastic pain: pain arising from altered nociception despite no evidence of tissue damage.
- Symptoms can include
Very vague
o Anxiety, depression, PTSD, concentration difficulty, memory deficits, insomnia, frequent awakening, non-restoring sleep
o Generalized pain (Head to toe) is described as neuropathic pain, paraesthesias
o Physical and mental fatigue
o Morning stiffness not exceeding 60 minutes
o Blurred vision, photophobia, and xerophthalmia
o Feeling of instability
o Xerostomia
o Variations in responses to cold (Raynauds)
o Orthostatic HTN
o Migraine or headache, stomach ache or dyspepsia, IBS, dysmenorrhea, vulvodynia, dysuria
o Hypersensitivity to light, odors, and sounds
Etio: genetics/enviorn
TS: symp mgmt thru meds, exercise and stress reduction
Age-related bone loss p. 1441
Bones lose density and mass with age, leading to conditions like osteopenia and osteoporosis. This loss increases the risk of fractures. Prevention and management include calcium and vitamin D supplementation, weight-bearing exercises, and medications to reduce bone loss.
Aging and the Musculoskeletal System
* Bones
* Loss of bone tissue
* Stiff, brittle, decreased strength
* Lengthened bone remodeling cycle
* Slow mineralization
* Evidence of osteoporosis
* Increased bone resorption
Joints
* Cartilage: More rigid, fragile, stiff; increased risk of fraying
* ROM: Decreased
Muscles
* Apoptosis of muscle cells
* Sarcopenia: Age-related loss of muscles from loss of satellite cells
* Decreased muscle strength and bulk
* Reduced oxygen intake, basal metabolic rate, and lean body mass
Gouty arthritis p 1460-1462
- Gout is a form of inflammatory arthritis caused by the deposition of uric acid crystals in the joints
- Elevated levels of uric acid in the blood (hyperuricemia)
- Crystals form and accumulate in the joints, leading to inflammation, pain, and swelling
- MC joint is the big toe, but it can affect ankles, knees, wrists, and elbows
- Presents as sudden and severe pain, swelling, redness, and tenderness in the affected joint.
*Risk factors
o Genetics
o Obesity
o High purine diet (red meat, seafood, and alcohol)
o Medications (diuretics)
o Kidney disease
o Men more likely than women - If left untreated or poorly managed can lead to chronic joint damage, tophi (accumulation of urate crystals under the skin), and kidney stones
Mgmt: dietary changes, meds, anti-inflams during attack
Open fracture p.1427
An open (or compound) fracture involves a break in the bone that protrudes through the skin, creating a risk of infection. Immediate medical treatment is crucial to prevent infection and properly realign the bone.
Bursitis Causes p 1432-1433
Bursitis is the inflammation of the bursae, small fluid-filled sacs that cushion bones, tendons, and muscles near joints.
Causes include repetitive motion or pressure, injury, and infection, autoimmune.
Treatment involves resting the affected joint and protecting it from further trauma.
Joint Aspirates
Joint aspiration (arthrocentesis) involves withdrawing fluid from a joint through a needle. It’s used for diagnostic purposes, to relieve pressure, or to deliver medications directly into the joint. Analyzing joint fluid can help diagnose disorders like gout, arthritis, and infections.
