MSK Changes Flashcards
Perichondrium
Diffuses nutrients to cartilage
ECM
Water
Proteoglycans
Collagen
Interstitial cartilage growth
Increased internal mass
Appositional cartilage growth
New surface
Joints don’t have this :(
Cartilage: over time
Thinning Atrophy Decreased water content Decreased number of chondrocytes Rougher surface = decreased joint efficiency
Bony maturity
20
Endochondral ossification except for clavicle, mandible, skull
Interstitial bony growth
Growth in length
Proliferation on diaphyseal end
Appositional bony growth
Growth in diameter
Most rapid during prenatal period
Bony rotational changes
Newborn - peak varum
1-2 years - peak straight
2-4 years - peak valgum
Approx 16 - adult
Anteversion
Decreases over time
Newborn 25-30
Adult 10-15
Joint formation
6-8 wks gestation
Growing pains
4-12 years
Late evening or night, resolve by am
Mostly LE
Cause? Mm grows slower than bone
None loss over time
Women > men
Estrogen slows bone resorption
Testosterone enhances Ca++ resorption
Pre-menopausal = 1% loss per year Post-menopausal = 3-4% loss per year
Scoliosis
Girls progress more
Measured by Cobb angle
Named for convex side (where it points)
Treatment
0-20 monitor
20-40 bracing and exercise
>40 surgical stabilization
Goal = halt the progression!!!
Apophysitis
Osgood Schlatters - tibial tubercle protrudes
Sever’s disease - when heel protrudes
Bone maturity
Growth plates complete by 25
Vertebra close last
Remodeling continues
Adult bony concerns
Annulus fibrosis increasingly fibrotic
Nucleus pulposus loses volume
IV DISCS = fibrocartilage
Mm growth
Prenatal and 1st year- increase in number
After first year - increase in size
Adult typical ratios
Intercostals 2 mos: breathing
Diaphragm 7 mos: more time upright
Soleus 10 mos: standing, creeping, cruising, walking
Adult speed
10 years
Boys
Longer growth period and sharper acceleration in growth
Strength gains
Related to growth curve
Genetic factors
Boys > girls
Child mm training
No notable change in mass
Neural adaptations may play larger role
Questionable efficacy
Strength over lifespan
Children - boys > girls
Adolescents - mass before strength, stretching important
Adults - peaks in 30s, declines in 50s
Trends in declining strength
Slightly less decline in UE than LE
Strength and speed affected
Women demonstrate earlier declines
Sarcopenia
Mm wasting 6-15% older adults *activity level *hormone level *loss of contractile properties
Motor neuron remodeling
Decreased number
Many type II fibers INN by slow twitch fibers
Motor unit firing slows
Other adulthood changes
Protein synthesis declines
Connective tissue increases (cross-linking)
Lost mm fibers replaced c fat and collagen
Hyaline/articular cartilage
Most rigid and most common
Vast majority of fetal skeleton made of this
Most water content - 80%