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Medical Sciences B > Muscle, tendon, bursae, ligament pathologies > Flashcards

Muscle, tendon, bursae, ligament pathologies Flashcards

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USMLE® Step 1 flashcards
1
Q

What is the role of acetylcholine at the neuromuscular junction?

A
  • Action potential reaches NMJ, causing ACh release into synapse
  • it binds to nicotinic receptors on motor end plate, causing release of Na into muscle fibre
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2
Q

What is the role of AChE at the NMJ?

A
  • one of the key functional proteins of NMJ

- does fast hydrolysis of ACh after its binding to postsynaptic receptors

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3
Q

What are the acquired disorders of muscle, tendon, lig, bursae?

A
  • Muscle, tendon, lig, bursa injury
  • Fibromyalgia
  • Myofascial pain syndrome
  • Chronic fatigue syndrome
  • NMJ disorders
  • Acquired myopathy
  • Neoplasms
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4
Q

What are the congenital disorders of muscle, tendon, lig, bursae?

A
  • Muscular dystrophies
  • Spinal muscular atrophy
  • Familial periodic paralysis
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5
Q

What is exercise induced muscle injury?

A
  • physiological response (NOT PATHOLOGICAL) -lactic acid buildup
  • DOMS
  • 24-48hrs after unaccustomed intense exercise, eccentric, viral infections
  • Muscle cell damage -> breakdown -> inflammatory response
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6
Q

What may be a complication of exercise induced muscle injury?

A

acute compartment syndrome

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7
Q

What is an intermuscular haematoma?

A
  • occur near inter muscular septa or fascial sheaths
  • facilitates tracking of haematoma with gravity to distal limb
  • early dispersal, minimise inflammatory response (and scarring)
  • early resolution
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8
Q

What is an intramuscular haematoma?

A
  • occur secondary to muscle damage
  • 2-3x longer recovery
  • confined, palpable mass
  • greater inflammatory response, scarring, risk for compartment syndrome myositis ossificans
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9
Q

Which degree muscle strain has the most pain?

A

2nd degree

-because when there is complete tear, it canot pull at the remaining strands when activated

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10
Q

Which degree muscle strain has a defect?

A

only 3rd degree

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11
Q

What causes a 1st degree muscle strain?

A
  • sudden overstretch
  • sudden contraction
  • decelerating limb
  • insufficient warm up
  • lack of flexibility
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12
Q

What are the recovery times for each degree muscle strain?

A

1st: 2-21 days
2nd: 20-90 days
3rd: 50-180 days

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13
Q

What is an Acute lumbar strain?

A
  • strain of spinal muscles
  • macro or microtrauma (repetitive lifting, bending, twisting)
  • pain, tenderness, spasm, swelling, stiffness
  • passive/active lengthening and active shortening cause pain
  • passive shortening relieves
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14
Q

What is chronic recurrent lumbar strain?

A
  • repeated episodes of partial tears
  • prolonged Hx of recurrences
  • failure to address the causes of acute strains
  • changes in surrounding tissue (myofascial pain syndrome)
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15
Q

What degree muscle strain has the most lost ROM?

A

2nd degree has some lost ROM

3rd degree has only lost active ROM

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16
Q

What is myoglobinuria?

A

another name for rhabdomyolysis

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17
Q

What is rhabdomyolysis?

A
  • group of disorders of muscle damage
  • release of myoglobin -> excreted in urine (damages kidneys)
  • causes pain, stiffness, weakness, fatigue, tenderness, red-brown urine
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18
Q

What are the causes of rhabdomyolysis?

A
  • truma
  • heat stroke
  • ischaemia to limb
  • overexertion
  • genetic
  • drugs, toxins, electrolyte disturbance
  • thyroid disorder
  • diabetic ketoacidosis
  • snake bites
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19
Q

What are the complications of rhabdomyolysis?

A
  • muscle damage
  • renal failure
  • seizures
  • cardiac arrhythmias
  • shock
  • death
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20
Q

What is the pathophysiology of rhabdomyolysis?

A

trauma -> break in cell wall -> Na+ and H2O into cell -> lysis (some contents damage neighbouring cells) -> myoglobin, K+, phosphorus, uric acid into blood stream

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21
Q

What is the pathophysiology of seizures in rhabdomyolysis?

A

electrolyte disturbance from broken cells

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22
Q

What is the pathophysiology behind renal failure in rhabdomyolysis?

A

high amounts of myoglobin in the blood stream from broken cells

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23
Q

What is the pathophysiology behind cardiac arrhythmias in rhabdomyolysis?

A

K+ in the blood stream from broken cells

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24
Q

How can rhabdomyolysis be fatal?

A

Can lead to crush syndrome
• renal failure (myoglobin)
• hypervolemic shock (metabolic acidosis from uric acid)
• cardiac arrhythmia (potassium)
• disseminated intravascular coagulation (happens when you have massive bleed and body trying to stop it)

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25
Q

What is myositis ossifians?

A
  • possible late complication of localized muscle injury
  • scar tissue -> calcify -> ossify
  • ex. equestrians thigh adductors
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26
Q

Compare sprain and strain?

A

Sprain:
• tear in ligament or capsule
• pain on end ROM and passive ROM

Strain:
• painful active ROM

Both:
• overstretch injury

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27
Q

Which degree sprain is most painful?

A

2nd degree

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28
Q

How does testing passive ROM tell us if it is a sprain or strain?

A

passive ROM increases in motion from 1st - 3rd degree sprain

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29
Q

What are the clinical presentations of sprains?

A 
Varying degrees of:
• pain
• rapid swelling
• heat
• discolouration
• limited function and stability
• local tenderness
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30
Q

What are common sites of sprains?

A
  • ankle (lateral side)
  • knee (collateral ligs and ant. cruciate)
  • elbow (ulnar side)
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31
Q

How long does healing take for healing of a third degree sprain?

A

3-6 weeks

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32
Q

What are the implications of a second degree sprain?

A
  • tendency for recurrence
  • needs modified immobilisation
  • may stretch out further with time
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33
Q

What are the implications of a third degree sprain?

A
  • needs prolonged protection
  • surgery maybe
  • often permanent functional instability
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34
Q

What are causes of tendonitis?

A
  • repetitive stress to tendon
  • ageing
  • acute trauma
  • deposition of crystals
  • hyper mobility of joint
  • vascular interference
  • postural malalignment
  • use of fluoroquinolone (antibiotic)
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35
Q

What is the pathophysiology of tendonitis?

A
  • inflammation -> vascular disruption -> degenerative changes
  • tendon thickens -> limits movement
  • more oedema or calcifications
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36
Q

What are some common examples of tendonitis?

A
  • lateral epicondylitis (tennis)
  • medial epicondylitis (golfer)
  • rotator cuff tendinopathy
  • bicipital
  • patella tendon (jumpers knee)
  • popliteus tendon
  • ITB syndrome
  • shin splints
  • achilles tendinopathy
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37
Q

What are clinical features of tendonitis

A
  • varying degrees of pain
  • tenderness
  • limitation of movement
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38
Q

What are causes of bursitis?

A
  • repetitive activities
  • overuse
  • excessive pressure (kneeling, tight shoes, leaning on elbow)
  • acute trauma
  • pre-existing joint disease
  • autoimmune disorders
  • crystals deposition
  • infections
  • obesity
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39
Q

What is the pathophysiology of bursitis?

A

increase in vascularity of bursal sac -> oedema -> spread to adjacent tissues

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40
Q

What are some common examples of bursitis?

A
  • housemaid’s knee (pre-patellar)
  • calcaneal
  • trochanteric
  • weavers bottom (ischiogluteal)
  • sub-acromal
  • olecranon
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41
Q

What are the clinical features of bursitis?

A

pain, swelling, tenderness, red

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42
Q

What is a central sensitivity syndrome?

A
  • group of syndromes with abnormality in the processing of pain by the CNS
  • development and maintenance of chronic pain
  • wind-up -> regulated in persistent state of high reactivity
  • hyperalgesia or allodynia
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43
Q

What is the definition of fibromyalgia?

A

syndrome characterized by widespread pain and constitutional manifestations (fatigue, cognitive impairment)

44
Q

What is the aetiology of fibromyalgia?

A
  • abnormal processing of pain by CNS
  • co-exists with systemic inflammation (SLE, RA, polymyalgia rheumatic)
  • biochemical, metabolic and immune regulation disturbances
45
Q

What are the symptoms of fibromyalgia?

A
  • aching, stiff multiple muscle groups
  • up to 40 tender points in consistant locations
  • pins, stabbing, numbness
  • severe joint pain, headaches, swelling
  • transient pain, fluctuating
  • maybe also chronic fatigue, depression, cognitive & sleep issues
46
Q

What is the difference between tender point and trigger point?

A

Tender:
• well defined, located at musculo-tendinous junction
• do not refer
Trigger:
• refer pain to specific area following stimulus

47
Q

What are some common sites of trigger points?

A
  • trapezius
  • epicondyles
  • attach. of elevator scap
  • post. iliac crest
  • SCM
48
Q

What are the signs of fibromyalgia?

A
  • joint & muscle tenderness
  • joint laxity
  • (rare) swelling, warm, red joint
49
Q

What is the diagnostic criteria for fibromyalgia?

A

Meet 3 conditions:
• WPI > 7 + SS scale score >5 or WPI 3-6 + SS scale score >9
• > 3 months
• not other disorder explaining this

50
Q

What is the WPI for fibromyalgia diagnosis?

A
  • Widespread pain index
  • number of area patient has had pain over the last week
  • score 0-19
51
Q

What is the SS scale score for fibromyalgia diagnosis?

A
  • Symptom severity scale score
  • severity of Fatigue, waking unrefreshed, cognitive symptoms (0-3)
  • plus severity of somatic symptoms in general (headache, IBS, depression..etc)
52
Q

What is the theorized pathophysiology of fibromyalgia?

A

pre-existing factors (serotonin receptors, endorphins) + precipitating factors (muscle microtrauma, dekconditioning, sleep disturbance) –> Pain, fatigue, depression manifested by skin hyperactivity + muscle contraction and deconditioning –> + cutaneous nociception, + muscle nociception –> spinal cord and cortex –> + sympathetic outflow (positive feedback loop)

53
Q

What is myofascial pain syndrome?

A
  • recurrent or chronic pain, located in 1 or more muscles
  • very common
  • pain more localized than fibromyalgia
54
Q

What are the clinical features of myofascial pain syndrome?

A
  • tight, tender muscles, limited ROM
  • weak (no atrophy)
  • autonomic symptoms
  • Local twitch response
  • trigger points
55
Q

What is the cause of myofascial pain syndrome?

A
  • uncertain
  • latent TrPs activated by muscle tension, poor posture, psychological stress
  • dysfunction of motor endplates
56
Q

What is the definition of chronic fatigue syndrome?

A

medically unexplained severe fatigue that persists or relapses for 6 months, associated with >4 or 8 distinctive physical symptoms

57
Q

What are the distinctive physical symptoms of chronic fatigue syndrome?

A
  • impaired memory/ concentration
  • recurrent sore throat
  • tender cervical or axillary lymph nodes
  • mild muscle pain
  • arthralgia
  • new headache types
  • sleep not refreshing
  • post-exertional malaise
58
Q

What is idiopathic chronic fatigue?

A

Severe fatigue but does not meet the diagnostic criteria for chronic fatigue syndrome

59
Q

What are the exclusion criteria for chronic fatigue syndrome?

A

1) Active medical condition:
• hypothyroidism
• sleep apnoea, narcolepsy
• effects of medication

2) Previous condition not completely resolved:
• previous malignancy
• hep B or C

3) Major depressive disorder with psychotic or melancholic features
• bipolar affective disorder
• schizophrenia, delusional disorders
• dementias
• anorexia or bulimia nervosa

4) Alcohol/ substance abuse within 2 years
5) Severe obesity (BMI>45)

60
Q

What is the aetiology of chronic fatigue syndrome?

A

Infectious agents
• chronic mycoplasma infections perpetuate and trigger
• viruses/bacteria (B.burgdorferi) trigger
Immunological factors
• perpetuate and pathogenesis
Neuroendocrine factors
• down-regulation of HPA-axis, disturbance of ANS, neuroendocrine dysfunction cause hyperalgesia and perpetuate and pathogenesis
Psychiatric factors
• pathogenesis and perpetuation

61
Q

Describe the chronic fatigue syndrome paradox?

A
  • current CDC definition states CFD is only when no other causes exist
  • but may be caused by infectious agent

Must either:
• narrow the definition
• broaden the definition

62
Q

Which is the most common neuromuscular junction disorder?

A

Myasthaenia Gravis

63
Q

What is the relationship between rhabdomyolysis, crush syndrome and compartment syndrome?

A
  • Rhabdomyolysis is a pathological process
  • crush and compartment syndromes are severe forms of rhabdomyolysis
  • in both cases: pressure builds up, squeezes arteries (less nourishment to muscle and nerves)
64
Q

What is compartment syndrome?

A
  • rhabdomyolysis localized in one fascial compartment
  • caused by trauma (haematoma, insect bite), oedema (frostbite, burn, overuse)
  • pain, parasthesia, passive stretch pain, tender, pulseless
65
Q

What is crush syndrome?

A
  • rhabdomyolysis of many large muscles
  • toxins accumulate in the body
  • risk of repercussion injury (when crushing item is suddenly removed, toxins flood whole body)
  • shock, pulseless, pale, absence of pain
66
Q

What is the function of a bursa?

A
  • fluid filled sack
  • located where muscles and tendons move over bony joint areas
  • reduce friction caused by tendons moving against skin and bones
67
Q

What is housemaid’s knee?

A
  • pre-patellar bursitis
  • knee pain,
  • knee swelling, tenderness, red, limited movement from pain
  • relieve of pain with rest
68
Q

What is allodynia?

A

perception of pain with non-pain stimulus

69
Q

What is hyperalgesia?

A

disproportional amount of pain from pain stimulus

70
Q

What are the pros and cons of using the ICD10 diagnostic criteria for fibromyalgia?

A

Advantages:
• gives patient a diagnosis
• excludes worry about other conditions

Disadvantages:
• all subjective, depends on patient’s awareness of their symptoms, how long
• pain may fluctuate on and off
• not just one test to rule it out

71
Q

How does myofascial pain syndrome differ from fibromyalgia?

A 
MPS
• localised
• trigger points
Fibro
• widespread
• tenderpoints
• plus fatigue, cognitive, functional issues
• comorbidities (depression)
72
Q

What is myasthenia gravis? (definition, age, sex, occurence)

A

disorder of episodes of muscle weakness
• occurs 20-40yrs
• males
• rare, 1/100 000 incidence

73
Q

What is the aetiology of myasthenia gravis?

A
  • autoimmune
  • antibodies to ACh receptors destroy receptors or prevent binding
  • associated with other autoimmune diseases (RA, SLE, thyroiditis
  • thymus gland issues
74
Q

What are the clinical features of myasthenia gravis?

A
  • double vision
  • ptosis
  • Difficulties: chewing, speaking
  • fatigue quickly
  • deep tendon reflex normal on first test
  • no sensory deficits
  • ice delays fatigue
  • symptoms worsen over time
  • 20-30% resolve
75
Q

What is ptosis?

A

weakness of eye opening

76
Q

What are myopathies?

A

Diseased function of muscle FIBRE only

• inherited or acquired

77
Q

What are the aetiologies of inherited and acquired myopathies?

A

Inherited
• dystrophies
• congenital

Acquired
• idiopathic (immune connective tissue disorder)
• drugs (steroids)
• excessive alchohol
• endocrine (thyroid)
• electrolyte (K+)
• acude periodic paralysis
• infections
78
Q

What is infections myositis?

A 
Acquired myopathy from infection
• tosoplasmosis
• coxsackie virus
• HIV
• influenza
• Lyme disease
• staph aureus
• parasites
• fungi
79
Q

What are the clinical features of myopathies?

A
  • muscle weakness (usually symmetrical, proximal)
  • fatigue and malaise
  • NO sensory changes
  • atrophy and hyporeflexia -late findings
80
Q

What are the tumours derived from skeletal muscles?

A

Rhabdomyoma

Rhabdomyosarcoma

both rare

81
Q

What is a rhabdomyoma?

A
  • benign tumour from skeletal muscle

* found in tongue, uvula, larynx, nasal cavity, axilla, heart and neck muscles

82
Q

What is a rhabdomyosarcoma?

A
  • malignant tumour from skeletal muscle
  • rapidly metastasize
  • found in head, neck, genitourinary track
83
Q

What is sarcoidosis? (definition, sites, age, sex)

A
  • non-caveating granulomas
  • affects many body tissues
  • mostly young adults
  • chronic or acute
  • aetiology unknown
  • equal in sexes
  • 20-40yrs
  • africans and Scandinavians
84
Q

What disorder pathologically most closely resembles sarcoidosis?

A

TB

• except no evidence of caseous necrosis or mycobacterium

85
Q

What are the clinical features of sarcoidosis?

A
  • often mild (incidental finding on chest x-ray)
  • fever, persistent cough, anorexia, weight loss
  • lymphadenopathy, hepatosplenomegaly
  • iritis, uveitis
  • skin rash
86
Q

What is the difference in resolution in acute vs chronic sarcoidosis?

A

Acute:
• high spontaneous rate of remission
• fever, arthralgia
• erythema nodosum of tibia

Chronic:
• bone lesions 
• skin lesions
• swelling, deformity of hands and feet
• >40yrs
• debilitating, often fatal systemic fibrosis (lungs)
87
Q

What is a muscular dystrophy?

A
  • group of inherited myopathies

* progressive muscle degeneration and regeneration

88
Q

What is the difference between myopathy, myositis and muscular dystrophy?

A

Myopathy: disease of muscle fibre

Myositis: inflammation of muscle

Dystrophy: inherited myopathy from breakdown of skeletal muscle

89
Q

What is Duchenne’s muscular dystrophy?

A
  • 1/3500 males
  • recessive gene carved by mothers
  • diagnosed at 3-5yrs
  • can’t walk, clumsy
  • mild mental retardation
  • contracture of calfs, weak toes
  • muscles fill with fat
  • increased lordosis
  • Gower’s sign
  • decreased deep tendon reflexes
  • heart tissue issues causes death at 20yrs
90
Q

What is Becker’s muscular dystrophy?

A
  • similar to Duchenne’s but later onset (10-15yrs)
  • recessive gene
  • live till 50-60yrs, walk until 40yrs
  • begins as muscle cramps
  • calf hypertrophy, limb girdle muscles
  • NO mental retardation
91
Q

What is pseudohypertrophic muscular dystrophy?

A

another name for Duchenne’s muscular dystrophy

92
Q

Which is the most common form of muscular dystrophy?

A

Duchenne’s MD

93
Q

Which is the most severe form of muscular dystrophy?

A

Duchenne’s MD

94
Q

What is Autosomal dominant muscular dystrophy?

A
  • affects face, shoulders, arms in that order
  • 1-2/100 000 incidence
  • onset 20yrs
  • familial
  • scap winging, camel-back, buttock protrusion
  • increased lordosis
  • decreased deep tendon reflexes
95
Q

What is Facio-scapulo-humeral dystrophy?

A

another name for Autosomal dominant dystrophy

96
Q

What is scapuloperoneal muscular dystrophy?

A
  • benign
  • distal lower legs, proximal upper arms
  • foot drop at 20-30yrs
  • deltoid, triceps, biceps next
  • decreased deep tendon reflexes
97
Q

What is Myotonic dystrophy?

A
  • multisystem
  • myotonia
  • autosomal dominant
  • 5/100 000 incidence
  • 10-50yrs
  • instability of Na and Cl channels in muscle membrane
  • thenar eminence
  • atrophy of cheeks, SCM
  • frontal baldness, testicular atrophy, cataracts
  • dysphagia
  • distal forearm and leg muscles
  • arrhythmia -> heart attack
  • 30% milf hypothyroidism
98
Q

What is myotonia?

A

failure of immediate muscle relaxation after voluntary contraction has stopped

99
Q

What is Limb girdle muscular dystrophy?

A
  • slow progressive, benign (not terminal)
  • teens-20s
  • pelvic girdle first, asymmetrical
  • little disability
  • male = fem
100
Q

What is spinal muscular atrophy?

A
  • degeneration of ventral horns of spinal cord
  • autosomal recessive
  • progressive skeletal muscle trophy
  • hypotonia
  • muscle weakness and fatigue
101
Q

Is spinal muscular atrophy a muscular dystrophy?

A

no

it is a neuromuscular disease

102
Q

What are the common muscular dystrophies?

A
  • Duchennes
  • Beckers
  • Autosomal dominant
  • Scapuloperoneal
  • Myotonic
  • Limb-girdle
103
Q

What is familial periodic paralysis?

A
  • autosomal dominant
  • episodes of hypokalaemia
  • precipitated by high carbohydrate diet or resting following exercise
  • common at night or on waking
104
Q

What are the aetiologies of 3rd degree strain?

A
  • previous muscle injury
  • collagen disease
  • abuse of anabolic steroids
105
Q

Compare Tietze’s syndrome vs Costochondritis?

A

Tietze’s: sternum + cartilage + rib

Costochondritis: cartilage + rib

Medical Sciences B (23 decks)

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