Msk

Question 1

How does a tendinopathy occur?

Answer 1

1. overload - one off or recurrent
2. overload detected by cells
3. cells activate (reactive stage)
4. aggrecan gets produced=hydrophilic
5. Apoptosis increase (cells die faster)
6. matrix looses structure
7. providing opportunity for vascular penetration

Question 2

Lateral epicondylititis (tennis elbow)

Answer 2

Common overuse syndrome related to the excessive wrist extension, causing pain in the region of the attachment of the common extensor tendon around the lateral aspect of elbow.

• Pathophysiology: radial head compresses against under surface of ECRB/L causing problems
• symptoms: pain around lateral elbow and may worsen with activity

Question 3

What occurs with the structural change with a tendinopathy?

Answer 3

• Alterations to Tendon cell population – increased number of tenocytes, increased tenoctye metabolism, increased immature tenocytes, increased rates of apoptosis, immunoactive cells.
• Disorganisation of collagen, reduction type I collagen, disorganised areas with higher concentrations of immature collagen bundles (increased type III).
• Ground substance changes– PG and GAG content alters, increased H2O, chemical alterations – substance P, Glutamate and lactate.
• Neovascularization – influx of blood vessels into the anterior surface and mid substance this is associated with various nerve fibres ingrowing into the tendon.

Question 4

Medial epicondylitis (Golfers elbow)

Answer 4

Another overuse tendinopathy, similar to tennis elbow - associated with racket and throwing sports.

• Pathophysiology: affecting the common origin of the forearm flexors and pronator muscles. Commonly at the interface between pronator teres and flexor capri radialis origins
• symptoms: pain

Question 5

What is the process of osteoarthritis?

Answer 5

Breakdown of articular cartilage
Changes in GAGs/PGs
Fibrillation
fissures
gross ulceration
disappearance of articular surface
osteophyte formation
thickening of subchondral bone
synovial membrane

Question 6

What is Carpal tunnel syndrome and why does it occur?

Answer 6

Carpal tunnel syndrome is the compression of the median nerve within the carpal tunnel . This causes symptoms in the median nerve distribution. CTS occurs due to swelling in the carpal tunnel or changes to the flexor retinaculum. This is often related to changes in one of the 9 tendons that pass through the carpal tunnel.

Question 7

What is De Quervains Tenosynovitis?

Answer 7

Reactive thickening of the tendon sheath around extensor pollicis brevis and adbductor pollicis longus.

• Pathological changes: 1. inflammation of synovial sheath of EBP and APL.
  2. swelling of the sheaths & eventual thickening as swelling becomes organised
  3. adhesion may develop between tendon and sheath restricting movement
  4. constricting of enclosed tendons=’stenosing tenosynovitis’

Question 8

Dupuytrens contracture

Answer 8

Nodular hypertrophy and contracture of the superficial palmar fascia - severe fixed flexion deforming

Question 9

Gluteal tendinopathy

Answer 9

• occurs when leg is adducted
• area compresses against bone, will cause increase compression, with tensor load and that causes breakdown of tissue leading to tendinopathy

Question 10

Achillies tendinopathy

Answer 10

paratenonitis - inflammation of sheath
AT tendinosis - degeneration of tendon without sign of inflammation
Paratenonitis - inflammation of sheath with degenerative changes in tendon

Question 11

Patella femoral pain syndrome

Answer 11

• pain at the front of the knee

- usually related to excessive mechanical loading - mechanical/chemical irritation of the nerve endings

Question 12

What is P/F dislocation/subluxation?

Answer 12

• dislocation: patella slipped out and had to be manually relocated
• subluxation: patella slipped out and spontaneously relocated

Question 13

What is Planter Fasciotherapy (planter heel pain syndrome)?

Answer 13

traditionally ‘ inflammation of the plantar aponeurosis

Question 14

What is spondylisthesis

Answer 14

• this is a condition which involves the bone of the vertebral spine becoming dispositioned, by either gradually slipping forward or backwards
• it is most common at the lumbosacral joint, however it can also occur at the mid to upper thoracic spine or cervical spine.

Question 15

What is lumbar/ cervical spondylosis?

Answer 15

• cervical: osteophyte formation, vertebral body degeneration, compression of the spinal cord and cervical spondylotic myelopathy
• lumbar/cervical spondylosis - degenerative condition that have a negative affect on the vertebral bodies & the joints within the lumbar/cervical vertebrae

Question 16

What occurs with a prolapsed disc?

Answer 16

a disc herniates when part of the centre nucleus pushes through the outer edge of the disc and backward towards the spinal canal. This puts pressure on the nerves. Spinal nerves are very sensitive to even slight amounts of pressure, which can result in pain or weakness in one or both legs.

Question 17

Spinal stenosis

Answer 17

• narrowing of the space within the vertebral foramen, causing pressure on the spinal cord
• can occur at multiple sites in the spine, most commonly the cervical and lumbar spine

Question 18

Ankylosing spondylitis

Answer 18

• AS is a inflammatory disease of the spine, sacroiliac joints & occasionally extra articular surfaces
• it is characterised by inflammation at the sacroiliac joints & of the junction between of the vertebral bodies and the inter-vertebral disc, bony growth and eventual fusion of the vertebrae.
• it is associated with the HLA-B27 gene
• typical presentation on an x ray would be a bamboo spine or railroad spine

Question 19

Soft Tissue repair stages (4)

Answer 19

1. Bleeding/Homeostasis - begins onset of injury. The body activates its emergency repair system, the blood clotting system, and forms a dam to block the drainage.
2. Inflammatory stage - changes in blood flow occur with the exudation of protein rich fluid (oedema). Also, leukocyte emigration, phagocytosis & lympathic drainage takes place.
3. Proliferation - collagen is produced to form scar tissue. Revascularisation and fibroblast migration occurs
4. Remodelling - continuous remodelling of scar tissue, collagen synthesis by fibroblasts. Reorientation of scar tissue to increase tensile strength. At the end of 3 months wound strength has reached 70% of normal