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Fall 2 > Muscoskeletal system > Flashcards

Muscoskeletal system Flashcards

1
Q

What does the Musculoskeletal system consist of? (6)

A
  1. Bones
  2. Joints
  3. Muscles
  4. Tendons
  5. Ligaments
  6. Cartilage + other connective tissue
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2
Q

What is the highest incidence group for back pain?

What % of people will be affected?

A

16-44 year age group

80%

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3
Q

What is the ratio of working days lost due to back pain?
How many days would a person take off in a year?
What is the estimated cost for the NHS?

A

1 in 6 working days lost

average 17.4 days off work

~420 million

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4
Q

Describe the condition of bones with ageing?

A

Loss of bone mass occurs >30 years in both men and women

Loss accelerates post-menopause in women

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5
Q

Describe the condition of joints with ageing?

A

Joints stiffen with age as ligaments and tendons become more rigid.
Cartilage thins leading to increased friction/wear and tear

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6
Q

Describe the condition of muscle with ageing?

A

Progressively lost from approx. 30yrs (sarcopenia), reduced mass and strength increases risk of injury

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7
Q

Define sarcopenia

A

the loss of skeletal muscle mass and strength as a result of ageing.

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8
Q

Symptoms of musculoskeletal conditions? Describe each

A
  1. Pain.
    Bone (deep penetrating or dull pain), e.g. trauma, infection and cancer
    Muscle (less intense that bone pain) e.g. trauma, inflammation and cramp/spasm
    Other joint pain (stiff, dull ache, worse when moved) e.g. trauma, sprains, arthritis
  2. Swelling
  3. Inflammation
  4. Bruising
  5. Loss of movement
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9
Q

Diagnosis of musculoskeletal conditions

A
  1. observation of movement
  2. Questions? Pain with movement, rest?
  3. Physical examination
  4. Blood tests e.g. Biomarkers, Inflammatory markers
  5. X-rays, Computed tomography (CT) scans
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10
Q

What are the (6) functions of the bone?

A
  1. Support - Framework for attachment of muscles etc
  2. Protection - Protects internal organs from injury (i.e. rib cage, vertebrae and skull)
  3. Movement - Enable body movement by acting as levers and points of attachment for muscles
  4. Mineral storage - Reservoir for calcium (99% of body’s calcium) and phosphorus (95% of body’s phosphorus)
  5. Haematopoiesis - Certain bones house bone marrow which is essential for the production of blood cells etc
  6. Energy storage - Certain bones contain fats/lipids (yellow marrow)
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11
Q

What are the two types of bone

A
  1. Compact/Cortical bone

2. Spongy/Cancellous/Trabeculae Bone

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12
Q

Describe the structure of Compact/cortical bone

A

Hard, dense outer layer of bone consisting of:

  • Proteins (collagen (95%), proteoglycans etc) make up 1/3 of bone mass
  • Hydroxyapatite (mostly calcium phosphate) makes up 2/3 of bone mass
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13
Q

Describe the structure of spongy/cancellous/Trabeculae bone

A

Low density and strength (honeycomb structure)

High surface area

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14
Q

Describe bone remodelling.

A

is the formation of new bone to replace old bone.

Occurs constantly in growing children to allow for lengthening and/or thickening of bones

Occurs in adults in response to:
trauma (fractures)
stress (i.e. weight bearing exercise)
Metabolic changes (use or replenishment of calcium stores)

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15
Q

What are the three cell types involved in bone remodelling ?

A
  1. Osteoblasts*
  2. Osteocytes
  3. Osteoclasts*
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16
Q

What is the function of Osteoblasts?

A

Form new bone. (Blasts Build Bone)

Synthesise and secrete collagen and other organic components of bone matrix

Initiate calcification – laydown of calcium

Located in bone membranes (i.e.periosteum and endosteum)

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17
Q

What is the function of Osteocytes?

A

Osteoblasts that have become surrounded by bone matrix

Connected to other osteocytes and the bone surface via canaliculi

Role to maintain bone, not by synthesising new bone, but by regulating mineral ion exchange

Osteocyte dies, surrounding bone dies

18
Q

What is the function of Osteoclasts?

A

Remove deteriorating bone or unnecessary new bone. Clasts Chew Bone

Large multi-nucleated cells

Secrete hydrogen ions to dissolve mineral matrix and hydrolytic enzymes (i.e. collagenase) to degrade other components of bone.

19
Q

Important note about origins of Osteoblasts and Osteoclasts

A

They do NOT originate from the same stem cells.

20
Q

What happens if there is an inbalance of Osteoblasts and Osteoclasts?

A

Too much Osteoblasts compared to OsteoClasts leads to Osteoporosis and Paget’s disease which is the lay down of too much unorganised bone

21
Q

Define Fracture, and what can cause it to occur and the presenting symptoms.

A

Fracture: a break in the bone, commonly associated with injury surrounding tissues.

Trauma is the most common cause, excessive use of steroids and other conditions such as osteoporosis can weaken bones.

Common symptoms:
Pain
Loss of function
Deformity
Crepitus (grating, popping, cracking)
Bleeding can occur from bone or surrounding tissues
22
Q

What are the phases of fracture repair?

A
  1. Inflammatory phase
  2. Inflam/Repair phase
  3. Repair phase
  4. Remodelling
23
Q

Describe the 1. Inflammatory phase of fracture repair

A

Haematoma (clot) formation. Lack of blood supply may lead to bone death. Area is painful, swollen, inflamed and bruised.

24
Q

Describe the Inflam/Repair phase of fracture repair

A

Callus (fibrous tissue + cartilage) formation

  • Debris cleared by macrophages.
  • Revascularisation occurs.
  • Fibroblasts produce collagen that spans break
  • Chrondroblasts begin to secrete cartilage matrix
  • Osteoblasts begin to form spongy bone
25
Q

Describe the Repair phase of fracture repair

A

Bony Callus Formation

  • Bone trabeculae increase in number
  • Fibrocartaginous callus is converted into bony callus of spongey bone
  • Typically takes 6-8 weeks
26
Q

Describe the Remodelling phase of fracture repair

A 
Bone remodeling (months)
- Bony callus is continually remodelled
- Bone structure is restored: 
Osteoclasts remove temporary supportive structures
Osteoblasts rebuild compact bone
27
Q

Describe the treatment for fractures

A

Immediate emergency treatment:

  • immobilise + support limb, elevate, ice
  • pain relief - NOT NSAIDs ( reports of delayed healing)
  • Open fractures need immediate treatment/surgery to clean and close wound
  • Closed fractures less urgent

Further treatment required

  • Immobilisation with casts or traction
  • Surgical fixation of fracture (rods, plates, hip replacement
28
Q

What complications of fractures can occur?

A
  1. Compartment syndrome: serious, caused by excessive swelling of injured muscle. Fibrous membrane surrounding muscle prevents expansion of swollen muscle and pressure builds within muscle
    Pressure in muscle restricts blood flow and this leads to hypoxia, further injury of muscle and even muscle death

Symptoms: increasing pain in immobilised limb after fracture
Emergency medical treatment required!

Surgery to relieve pressure in constricted tissue. If muscle/nerves have died, amputation might be necessary.

  1. Pulmonary embolism
    Sudden blockage of artery in lung by blood clot (usually travels from leg vein)

Common fatal complication after serious hip and pelvic fractures, less commonly in lower leg fractures and v. rarely in fractures of upper body

Risk increased due to combination of trauma to leg, forced immobility and reduced blood flow in veins due to swelling

Symptoms: chest pain, cough, shortness of breath
Emergency medical treatment required!

In those at risk of pulmonary embolism, heparin, warfarin etc can be given to reduce the occurrence of blood clots

29
Q

Define “joint” and describe features

A

Joint - junction between 2 or more bones
Range of movement vary: Joints in skull, Shoulder ( ball and socket), Finger (hinge)

Consists of components that ensure stability and reduce the risk of damage:

  • Articular cartilage
  • Synovial fluid and membrane
  • Stabilising ligaments
30
Q

What additional features do knee joints exhibit?

A
  • Meniscus, a cushion of cartilage that ensures even distribute the body weight in joint
  • Bursa, a fluid filled sac that cushions bone and tendon
  • Patella, protection of joint
  • Ligaments (5) provide stability while allowing range of movement
31
Q

Define Ligament

A

Tough fibrous cords of connective tissue that stabilise and strengthen joints

32
Q

Define Tendons

A

Tough bands of connective tissue (made up mostly of collagen)
Attach muscle to bone
Contained within a sheath and lubricated to allow movement without friction

33
Q

Define Bursa

A

Fluid filled sacs that lie beneath tendon and protect it from injury
Cushion tendon and adjacent structures from wear (i.e. bone and ligaments in knee).

34
Q

Describe Skeletal muscle

A

Skeletal (Striated) Muscle
Bundles of contractile fibres that are responsible for our movement and posture
Attached to bones and arranged in opposing groups
Biceps bend elbow, triceps straighten it
Opposing arrangement ensures smoothness of movement and limits risk of damage
Size and strength of muscle increase and decrease with workload

35
Q

Which cells are responsible for the growth and repair of skeletal muscle?

A

Satelite cells are myogenic stem cells that are responsible for the post-natal growth, repair and maintenance of skeletal muscle

36
Q

What types of sporting injuries can occur?

A

Strains
Damaged/torn muscle
i.e. Hamstring

Sprains
Damaged/torn ligaments
i.e. ACL injury

Tendinitis
Inflammation of tendon

Stress fractures of foot

Shin splints
Fractures of shin bone

37
Q

What is the Treatment of sporting injuries

A

RICE
Rest
Minimises internal bleeding and swelling, prevents further injury

Ice
Reduces pain and inflammation
Ice 10 minutes, remove 10 minutes, ice 10 minutes etc for 60-90 minutes to prevent cold injury

Compression
reduced swelling, risk of further injury

Elevation
Reduce swelling

38
Q

Describe the grading system for Ligament injuries (sprains)

A

Grade 1: Local tenderness, normal joint movement
Support, NSAIDS, encourage gentle use

Grade 2: slightly abnormal joint movement
More support/joint protection, NSAIDS, elevate, encourage middle range of use

Grade 3: abnormal joint movement
Requires orthopaedic consultation

39
Q

Treatment options for Strains

A

Haematoma
Bleeding within and between muscles can result in extensive bruising and stiffness
RICE regime and encourage pain-free movement
Physiotherapy

40
Q

Treatment options for overuse injuries

A

Stress fractures, joint tenderness, ligament or tendon sprains, muscle stiffness
Rest, NSAIDS, physiotherapy, improved training regime
Severe stress fractures of foot might require cast

Fall 2 (33 decks)

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