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Conditions + definitions > MSK growth and repair > Flashcards

MSK growth and repair Flashcards

1
Q

What is a ligament

A

Dense band of collagenous tissue spanning a joint
Connects bone to bone
Gives joint stability
Multiple at joint

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2
Q

What is the structure of a ligament?

A 
Type 1 collagen fibres
Contain fibroblasts for communication
Contain sensory fibres (proprioception/stretch)
Have surface vesells
Are crimped allow for stretching
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3
Q

When does a ligament rupture occur?

A

When force exceeds strength of ligament

Either expected or unexpected

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4
Q

What are the types of ligament rupture?

A

Can be complete or incomplete

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5
Q

What are the side effects of a ligament rupture?

A

Pain
Stability loss
Proprioception loss in joint

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6
Q

How does the haemorrhage caused by ligament rupture heal?

A

Blood clot that is reabsorbed
The replaced with heavy cellular infiltrate
Has hypertrophic vascular response

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7
Q

What happens to the scar tissue produced by a ligament healing?

A

The disorganised connective tissue matrix becomes more ligament light
Although still has major differences in composition and function

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8
Q

How do you treat a ligament injury?

A

Conservative or operative
Conservative if parital, no instability or cannot have surgery

Operate on sportsmen
If multiple (and therefore compulsary)
Joint instability
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9
Q

What are the layers to a tendon?

A

Collagen bundles covered by endotenon
Make up fascicles covered by paratenon
Make up tendon covered by epitenon

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10
Q

Where are teh blood vessels in a tendon located?

A

In paratenon

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11
Q

How are tendons connected to their sheath?

A

By vinicula

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12
Q

What do the tendon sheaths contain?

A

A synovial lining + fluid for lubrication

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13
Q

What is the function of a tendon?

A

Flexible and very strong tension to allow for movement

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14
Q

What does immobility lead to?

A

Reduced water content
Reduced glycosaminoglycan concentration
Reduced strength

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15
Q

What are the types of tendon injury?

A 
degeneration
	inflammation
	enthesiopathy
	traction apophysitis
	avulsion  bone fragment  *
	tear - intrasubstance (rupture) *
	tear - musculotendinous junction
	laceration/ incision
	crush / ischaemia / attrition
nodules
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16
Q

What is tendon degeneration?

A

Intrasubstance mucoid degneration
May be swollen, painful tender
Maybe asymptomatic

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17
Q

What are the symptoms of tendon inflammation?

A 
Swollen
Tender
Hot
Red
Positive Finklestein test
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18
Q

What tendons are likely to become inflamed?

A

EPB
APL

Tendons through common tendon sheath at radial aspect of wrist

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19
Q

What is enthesiopathy?

A

Inflmmation at insertion to bone

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20
Q

Where is enthesiopathy likely to take place in a muscle?

A

The muscle origin rather than tendon insertion

Lateral humeral epicondylitis is a common example

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21
Q

What is traction apophysitis?

A

Where excessive pull by a large tenson causes damage to unfused apophysis
Recurrent load leading to inflammation

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22
Q

Who is likely to get traction apophysitis?

A

Adolescent active boys

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23
Q

What are some examples of traction apophysitis?

A

Osgood-Schlatter’s disease
Sever’s disease
Sinding Larsen’s disease

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24
Q

What is avulsion?

A

Where a structure is forcibly detached from it’s nomral point of insertion
I.e bone/ligament detachment leaving a fragment

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25
Q

How do you treat avulsion

A

Conservative - limited application

Operative - reattachment /fixation

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26
Q

What is an intrasubstance tendon rupture?

A

Where the tendon ruptures

Happens when load exceeds failure strength

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27
Q

What are the signs in an achilles tendon rupture?

A

Positive simmonds test (squeeze test)

Palpable tendon gap

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28
Q

What is a musculotendinous junction tear?

A

Where the joint between the tendon and its muscle tears

Often partial

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29
Q

How do you treat tendon ruptures?

A 
Conservative - splint/cast
Mobilise
Operative  - ends cannot be opposed
High risk of rereupture
High activity
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30
Q

How do you treat lacerations of tendons?

A

Repair surgically and quickly

More common in young adults and men

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31
Q

What is the structure of a nerve?

A

Axons, coated in endoneurium, bundled into fascicles which are bundled into form a nerve
Fasciles covered in Perineurium
Epinerium for nerve

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32
Q

What is the speed of an Aa neurone?

A

60-100m/s

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33
Q

What is the function of an Aa neurone?

A

Large motor axons

Muscle stretch + tension seconsry axons

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34
Q

What is the speed of Ab neurones?

A

30-60m/s

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35
Q

What is the function of an Ab neurone?

A

Touch
Pressure
Vibration
Prioprioception

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36
Q

What is the function of an Ay neurone?

A

Gamma efferent motor neruones

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37
Q

What is the speed of an Ay neurone?

A

15-30m/s

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38
Q

What is the function of an Ad neurone?

A

Sharp pain
Light touch
Temperature

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39
Q

What is the speed of an Ad neurone?

A

10-15m/s

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40
Q

What is the function of a B neurone?

A

Sympathetic preganglionic motor neurones

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41
Q

What is the speed of a B neurone?

A

3-10m/s

42
Q

What is the speed of a C neurone?

A

<1.5m/s

43
Q

What is the function of a C neurone?

A

Dull, sching or burning pain

Temperature sensation

44
Q

What are teh types of periheral nerve injury?

A

Compression

Trauma (direct or indirect)

45
Q

What are some examples of compression injuries?

A

Entrapment
“Classical conditions”
Carpal tuinnel syndrome (median nerve at wrist)
Sciatic (spinal root by intervertebral disc)
Mortons neuroma (digital nerve in 2nd/3rd webspace of foot)

46
Q

What are the three types of trauma injury?

A

Neurapraxia
Axontmesis
Neurotmesis

47
Q

What is neurpraxia?

A

A reversible conduction block caused by stretching or bruising
There is local ischaemia and demyelination
Good prognosis

48
Q

What is axonotmesis?

A

Disruption of axons but endoneurium intact

Often due to being stretched, crushed or direct blow

49
Q

What is the prognosis of axontmesis?

A

Okay - sensory often recover better than motor

May not go back to normal

50
Q

What follows axonotmesis?

A

Wallerian degeneration

51
Q

What is neurotmesis?

A

A complete nerve division, often caused by laceration or avulsion
Endoneural tubes disrupted

52
Q

What is the prognosis of neurotmesis?

A

No recovery unless repaired (graft/suture)
Even under repair “miswiring” common
Prognosis poor

53
Q

What is a closed nerve injury?

A

Associated with nerve injuries in continuity (neuroprains/axontmesis)
Spontaneous recover possible

54
Q

When is surgery indicated in a closed nerve injury?

A

After 3 months if no recovery identified

55
Q

What is an open nerve injury?

A

Frequently nerve division (often knife etc)

Distal portion dies (wallerian degneration)

56
Q

How do you treat an open nerve injury?

A

Early surgery

57
Q

What are the clinical features of a nerve injury?

A

Dsysaethesia (in sensory neurones)
In motor - paresis/paralysis + wasting
Dry skin due to no sweat gands
Reflexes - diminished or absent

58
Q

How do nerve injuries heal?

A

Distal nerve dies under wallerian degeneration
Myelin sheath degrades
Proximal axonal budding occurs after 4 days
Regeneration at 1mm/day
Pain is first modality to return

59
Q

What is the prognosis for recovery from a nerve injury?

A

Dependant on if pure or mixed

How distal the lesion is (further the better)

60
Q

What is Tinels sign?

A

Tap over site of nerve

Paraesthesia felt as distially as nerve recovered

61
Q

When would you do a direct nerve repair?

A

In laceration
No loss of nerve tissue
Bundle repair

62
Q

When would you use a nerve graft?

A

In nerve loss
Or late repair

Use sural nerve often

63
Q

What is the rule of 3?

A

Immediate surgery within 3 days for sharp/clean injuries
Early surgery within 3 weeks for blunt injuries
Delayed (3 months) surgery for closed injury

64
Q

What are the differences between cortical and cancellous bone?

A

Cortical bone found in diabpysis of bone
Resists bending + torsion
Circumfrentially laid
Less biologically active

Cancellous
Found in metaphysis of bone, resists compression
Site of longitudinal growth
Biologically active

65
Q

What is the diaphysis?

A

The shaft of a bone

66
Q

What is the metaphysis and epipphysis?

A

Metamysis is flare at end of shaft

Epiphysis is on the joint side of physis

67
Q

Where is the medullary canal found?

A

In the central cavity of the bone

68
Q

What is a fracture?

A

Break in continuity of bone

Could be crack, break, split, crumpling or buckle

69
Q

What can lead to a fracture (the bone failing)?

A

High energy transfer in normal bones
Repetive stress in normal bones (stress #)
Low energy in abnormal bones (osteoporosis, ostemalacia etc)

70
Q

What happens to the bone in a fracture?

A 
Mechanical + structural failure of bone
Disruption of blood supply
Regenerative process (no scar)
71
Q

What are the four stages to fracture repair?

A

Inflammation
Soft callous stage
Hard callous stage
Bone remodelling

72
Q

What happens in the inflammation stage of fracture healing?

A 
Begins immediately after #
Forms haematoma and fibrin clot
Lots of blood cells and by products f cell death
Angiogensis starts if hypoxic
Osteogenic induction of cells
73
Q

How might we help the inflammation stage of fracture healing?

A

NSAIDs

Treat aemotoma in open fractures with surgery

74
Q

What is the soft callus stage of fracture healing?

A

Begins when pain/swelling subside
Lasts until bony fragments united by fibrous tissue/cartilage
Some stability of fracture
Continued increase in vascularity

75
Q

How might we assits the soft callus stage of fracture healing?

A

Replace cartilage with demineralised bone matrix

Use bone graft

76
Q

What is the hard callus stage of fracture healing?

A

Conversion of cartilage to woven bone
Typical in long bone fracture -
Increased rigidity although obvious callus

77
Q

What is the bone remodelling stage of fracture healing?

A

Conversion of woven bone into lamellar bone
Medullary canal reconstituted
Bone responds to loading characteristics

78
Q

What ca cause delayed union?

A 
High energy union
Distraction (increased osteogenic jumping)
Instability
Infection
Steroids
Immune suppresants
Smoking
Warfarin
NSAIDs
Ciprofloxacin
79
Q

What is non-union?

A

Failure for fracture to heal

80
Q

What can cause non-union?

A 
failure calcification of fibrocartilage 
instability 
            -excessive osteoclasis
abundant callus formation
pain + tenderness
persistent fracture line
 sclerosis
81
Q

What is an open fracture?

A

Direct communication between external environent and fracture

82
Q

Why are open fractures significant?

A

Increased infection rate
Soft tissue complications common
Higher energy injury
Long term morbidity

83
Q

What are the types of open fracture?

A

type 1 - clean and simple, <1cm
Type 2 - wound 1cm+ with soft tissue damage, simple fracture pattern

Type 3 - extensive soft tissue damage, complex fracture pattern

84
Q

What are the features of a type 3 open fracture?

A

High energy
wound 10cm + often
Extensive soft tissue damage

85
Q

What are the subtypes of type 3 open fracture?

A

A - adequate periosteal coverage (not grossly contaminated)

B - tisse loss requiring soft-tissue coverage procedure (graft etc) - extensive muscle damage

C- vascular injury needing repair - neurovascular complication

86
Q

What are the tibial fracture patterns?

A

Transverse/short oblique tibial fractures with fibular fractures
Tibial fractures with communication with fibular fractures
Segmental tibial fractures
Fracutes with bone loss (either extrusion or debridement)

87
Q

What are soft tissue injury patterns in a tibial fracture?

A

skin loss that tension free closure not possible
Degloving
Injury to muscles requiring excision via wound extensions
Injury to 1+ major arteries in leg

88
Q

How do you manage a complex open fracture?

A

Full advance trauma life support assesment + treatment
Tetanus + antibiotic prophylaxis
Repeated neurovascular status examination
Wounds only handled to remove gross contamination

89
Q

What are the indications for surgery?

A 
Polytraumatise patient
Marine/farmyard environment
Gross contamination
Neurovascular compromise
Compartment syndrome
90
Q

When debriding and fixing (surgery) what is looked for?

A 
4 Cs
Colour
Contraction
Consistency
Capacity to bleed
91
Q

Who deals with skin coverage issues?

A

Plastic surgeons

Grafting

92
Q

When is amputation considered?

A

Insensate limb/foot
Irretrivable soft tissue or bony damage
Other life threatening issues

dual constultant decision

93
Q

What is a dislocation?

A

Complete joint disruption

94
Q

What is subluxation?

A

Partial dislocation (not fully outside joint)

95
Q

How do you diagnose dislocation?

A

Clinically + radiological

Associated injuries - neurovasculat damage, soft tissue/msk damage

96
Q

How do you treat dislocation

A

Relocation

Surgery if required

97
Q

What dislocations can occur at the shoulder?

A

Anterior - squared off

Posterior - locked in internal rotation

98
Q

What dislocations can happen at the elbow

A

Posterior - olecranon prominent posteriorly

99
Q

What dislocations can happen at the hip?

A

Posterior - Leg short, flexed
Internal rotation
Adduction

100
Q

What dislocations can occur at the knee?

A

Anteroposteriorly

Loss of normal contour, extended

101
Q

What dislocations happen at ankle?

A

Lateral most common - externally rotated

Prominent medial malleolus

102
Q

What locations occur at subtalar joint?

A

Lateral most common - displaced calcis (heel)

Conditions + definitions (68 decks)

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