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Year 3 MSK (JK) > MSK - growth, injury and repair > Flashcards

MSK - growth, injury and repair Flashcards

1
Q

Give a brief description of a ligament

A

dense bands of collagenous tissue which are anchored to bone at each end and allow joint stability

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2
Q

Type of collagen fibres in ligaments

A

1

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3
Q

5 components of the structure of a ligament

A 
type 1 collagen 
vessels at the surface 
fibroblasts
sensory fibres 
crimping to allow stretch
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4
Q

4 differences in ligaments compared to tendons

A

less % of collagen and less organised
higher % of proteoglycans and water
rounder fibroblasts

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5
Q

When does ligament rupture occur?

A

when forces exceed the strength of ligament

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6
Q

3 phases of ligament healing

A

haemorrhage
proliferative phase
remodelling

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7
Q

Describe the haemorrhage stage of ligament healing

A

blood clot
replaced with heavy cellular infiltrate
hypertrophic vascular response

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8
Q

describe proliferative phase of ligament healing

A

scar tissue

disorganised collagenous connective tissue

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9
Q

describe the remodelling of ligament healing

A

matrix becomes more ligament like

major differences persist

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10
Q

Treatment of ligament rupture and reasons for this

A

conservative if partial/no instability/poor candidate
operative –> replace or augmentation
–> expectation ie sportsman, instable or compulsory/multiple

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11
Q

Where is cortical bone found in a bone?

A

diaphysis

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12
Q

what does cortical bone resist?

A

bending and tension

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13
Q

How is cortical bone laid down?

A

circumferentially

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14
Q

Is cortical or cancellous bone more biologically active?

A

cancellous

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15
Q

Where in a bone is cancellous bone found?

A

metaphysis

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16
Q

What does cancellous bone resist?

A

compression

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17
Q

sign for a fracture

A

#

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18
Q

3 reasons why bones fail

A

high energy transfer in normal bones
repetitive stress in normal bones –> stress fracture
low energy transfer in abnormal bones eg osteoporosis

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19
Q

4 stages of fracture regeneration

A

inflammation
soft callus
hard callus
bone remodelling

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20
Q

Inflammation in fracture healing brief description

A

occurs immediately after with a haematoma and fibrin clot

platelets, PMN, neutrophils, MO, monocytes

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21
Q

What are the by products of cell death in stage 1 of fracture healing?

A

lysosomal enzymes

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22
Q

Where are mesenchymal and osteoprogenitor cells derived?

A

transformed endothelial cells from medullary canal and or periosteum

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23
Q

Requirement for angiogenesis and macrophages producing angiogenic factors

A

low oxygen gradient

hypoxic conditions

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24
Q

How may we affect the inflammation phase of fracture healing?

A

NSAIDs
loss haematoma - open fractures and surgery
extensive tissue damage - poor blood supply

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25
Q

4 growth factors in buffy coat platelet concentrates

A

IGF
VEGF
TGF-B
PDGF

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26
Q

When does soft callus of fracture healing begin and end?

A

when pain and swelling subside

bony fragments united by collagen/fibrous tissue

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27
Q

angulation

A

abnormal bend

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28
Q

How might we affect soft callus phase?

A

replace cartilage

jump straight to bone - graft

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29
Q

Is autogenous cancellous bone graft osteoinductive or conductive?

A

both

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30
Q

Is allograft bone osteoconductive or inductive?

A

osteoconductive

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31
Q

Risk of allograft bone

A

disease transmission

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32
Q

Brief description of hard callus

A

cartilage –> woven bone

endochondral and membranous bone formation

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33
Q

Bone remodelling

A

woven bone –> lamellar bone

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34
Q

What law does bone remodelling follow?

A

wolff’s

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35
Q

Best way to express instability

A

magnitude of strain - % change of initial dimension

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36
Q

What happens if strain is too low?

A

mechanical induction of tissue differentiation fails

37
Q

What happens if strain is too high?

A

healing process does not progress to bone formation

38
Q

10 things which can lead to delayed union

A 
instability 
NSAIDs 
warfarin 
ciprofloxacin 
smoking 
steroids 
high energy injury 
distraction 
infection 
immune suppressants
39
Q

6 reasons for non union

A 
failure of calcification fibrocartilage
instability --> increased osteoclasis 
pain and tenderness 
abundant callus formation 
sclerosis 
persistent fracture line
40
Q

3 alternatives if healing delayed

A

different fixation
bone graft
dynamization

41
Q

Fibres named when tendon inserts into bone

A

sharpeys fibres

42
Q

Arrangement of tenocytes

A

longitudinal

43
Q

collagen type in tendon

A

1

44
Q

State which each of these is covered by
a- collagen bundles
b - fascicles
c - tendon

A 
a = endotendon 
b = paratenon 
c = epitenon
45
Q

How are tendon connected to sheath in flexor tendon in palm?

A

vincula

46
Q

Thickenings of tendon sheath form?

A

annular pathways - pulleys

47
Q

function of tendon sheath

A

flexible and very strong in tension

48
Q

What does immobility do to water content and glycosaminoglycan concentration and strength?

A

reduce

49
Q

Name 10 tendon injuries

A 
degeneration 
nodules 
inflammation 
laceration/incision 
avulsion +/- bone fragment 
enthesiopathy
ischaemia
traction apophysitis 
tear - intrasubstance/rupture 
tear - musculotendinous junction
50
Q

Tendon degeneration

A

mucoid degeneration
swollen, pain, tender or no symptoms
precursor to rupture

51
Q

positive test in de Quervains stenosing tenovaginitis

A

finklestein

52
Q

Where does enthesiopathy occur? eg..

A

muscle origin

common extensor origin at lateral humeral epicondyle - tennis elbow

53
Q

traction apohpysitis example and explain

A

Osgood schatters disease
insertion of patellar tendon into anterior tibial tuberosity
active adolescent boys
recurrent load and inflammation

54
Q

When does avulsion occur

A

failure at insertion when load > fail strength when muscle contracting

55
Q

Mallet finger

A

insertion of extensor tendon - fixed flexion

56
Q

Treatment of mallet finger

A

conservative = limited application, retraction tendon

surgery - reattach tendon through bone or fixation of bone fragment

57
Q

When does intrasubstance rupture occur?

A

load > failure strength

ruptured achilles tendon

58
Q

3 mechanisms of achilles rupture and explain

A

pushing off with weightbearing forefoot when extending knee joint eg jumping
unexpected dorsiflexion of ankle - slip into hole
violent dorsiflexion of plantarflexed foot eg fall from height

59
Q

2 findings of achilles tendon rupture

A

positive Simmonds squeeze test

palpable tender gap

60
Q

example of musculotendinous junction tear

A

medial head of gastrocnemius at musculotendinous junction with achilles tendon

61
Q

treatment of musculotendinous junction tear

A

conservative
- where ends can be opposed mobilise of splint
- healing will occur
operative -high risk of rerupture, high activity and ends cannot be opposed

62
Q

Finger flexor laceration

A

common in young adult males - need surgery early

63
Q

motor unit

A

anterior horn cell in gray matter of spinal cord, motor axon and muscle fibres

64
Q

sensory unit

A

cell bodies in posterior root ganglia

65
Q

how do spinal nerves exit spinal cord?

A

intervertebral foramen

66
Q

what are these coated with?
a - axons
b - fascicles
c - nerve

A

a - endoneurium
b - perineurium
c - epineurium

67
Q

entrapment of nerve example

A

mortons neuroma - digital nerve in 2nd or 3rd web space of forefoot

68
Q

classical nerve compression - 2 examples

A

sciatica

carpal tunnel syndrome

69
Q

briefly describe neurapraxia

A

nerve in continuity and good prognosis
stretched or bruised
reversible conduction block

70
Q

briefly describe axonotmesis

A

endoneurium intact but axons disrupted
stretched, crushed or direct blow
prognosis fair

71
Q

sensory or motor more likely to recover?

A

sensory

72
Q

Name for degeneration which follows axonotmesis?

A

wallerian

73
Q

briefly describe neurotmesis

A

complete nerve division and no recovery unless repaired or graft
endoneural tube disruption

74
Q

closed nerve injuries

A

neuropraxis and axonotmesis

spontaneous recovery possible - surgery after 3 months

75
Q

axonal growth rate

A

1-3mm/day

76
Q

example of closed nerve injury

A

brachial plexus injury

radial nerve humeral fracture

77
Q

open nerve injury

A

eg knife, early surgery and distal proportion undergoes Wallerian degeneration 2/3 weeks after injury

78
Q

sensory features of nerve injury

A

dysaesthesia - anaesthetic, hypo and hyper aesthetic, paraesthesia

79
Q

motor features of nerve injury

A

paresis or paralysis and muscle weakness

dry skin

80
Q

Why dry skin due to motor disruption?

A

loss of tactile adherence since sudomotor nerve fibres not stimulating sweat glands in skin

81
Q

Healing of nerve injury - brief explanation

A

slow and starts with initial death of axons distal to injury

proximal axonal budding, 1mm/day

82
Q

What returns first after nerve injury?

A

pain

83
Q

3 things prognosis of nerve injury depends

A

how distal lesion is - proximal worse
nerve is pure ie sensory mixed
nerve mixed

84
Q

What sign can monitor nerve injury recovery and explain

A

Tinels

tap over nerve and paraesthesia felt as distally as regeneration

85
Q

How is nerve injury assessed and recovery monitored?

A

electrophysiology nerve conduction studies

86
Q

direct nerve repair

A

laceration - no loss of nerve tissue

microscope - bundle repair and growth factors

87
Q

Nerve grafting done when?

A

nerve loss and late repair (retraction)

sural nerve

88
Q

rule of 3 - surgical timing in traumatic peripheral nerve injury

A

immediate surgery in 3 days - clean and sharp injury
3 weeks - blunt/contusion
delayed - closed injuries

Year 3 MSK (JK) (30 decks)

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