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ASforP > Muscularskeletal and soft tissue conditionss > Flashcards

Muscularskeletal and soft tissue conditionss Flashcards

1
Q

What is rhabdomyolysis?

A

The breakdown of striated muscle

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2
Q

What can cause rhabdomyolysis?

A

Most commonly direct traumatic injury

Also:
Prolonged bed rest/long lie after fall (Prolonged pressure and muscle hypoxia)
Toxins (Cocaine, statins and others)
Infections (Legionnaire’s disease, Malaria)
Ischemia
Electrolyte and metabolic disorders
Genetic disorders
Exertion
Temperature-induced states e.g. neuroleptic malignant syndrome (NMS), malignant hyperthermia (MH)

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3
Q

What are the classic signs of rhabdomyolysis?

A

Limb weakness
Myalgia
Swelling
Gross pigmenturia without hematuria/tea coloured urine (can be only sign)

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4
Q

What is the structure of intervertabral discs?

A

An inner nucleus of elastic substance called nucleus polposus surrounded by an outer layer of fibrous tissue and fibrocartiledge called the anulus fibrosus

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5
Q

What part of the intravertebral disc acts as a shock absorber?

A

The nucleus puposus

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6
Q

What is a herniated disc (‘slipped disc’)?

A

When the nucleus polposus protrudes out of place compressing the anulus fibrosus, surrounding tissue (including bones and nerves if posterior protrusion)

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7
Q

In what section of the spine are herniated discs more common?

A

Lumbar and sacral

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8
Q

Why do slipped discs become more common with age?

A

Aging weakens the nucleus polposus - it dries out and pushes on the anulus fibrosus

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9
Q

What can cause disc herniation?

A

Disc degeneration (usually age related)
Acute trauma
Connective tissue disorders

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10
Q

What are the symptoms of disc herniation?

A

Acute pain
Weakness
Sensory issues

Can be asymptomatic

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11
Q

Where does the sciatic nerve stem from?

A

From L4 to S2 or S3 (depending on the literature or individual anatomy)

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12
Q

What is the cauda equina?

A

Corda equina or ‘the horse’s tail’ is a group of nerves and nerve roots stemming from the distal end of the spinal cord, typically levels L1-L5 and contains axons of nerves that give both motor and sensory innervation to the legs, bladder, anus, and perineum.

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13
Q

What is cauda equina syndrome?

A

Severe compression of the corda equina

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14
Q

What can cause cauda equina?

A

Disc herniation
Intradural tumor
Epidural tumor
Lumbar anaesthesia
Infection

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15
Q

What are the symptoms of cauda equina?

A

Back pain
Bi-lateral radiculothopy
Sphincteric problems
Perineal sensory changes

Bowel and or bladder dysfunction
Saddle anaesthesia

Loss of all sphincter function
Neurogenic urine retention

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16
Q

How does rhabdomyolysis cause illness?

A

When muscle breaks down intracellular myocyte contents such as myoglobin and creatine phosphokinase are deposited into the blood stream in large quantities.
Attempting to filter all these toxins out can cause acute kidney injury. (Myoglobin breaks down into substances that can damage kidney cells, the heme pigment that is released from myoglobin and haemoglobin is nephrotoxic)

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17
Q

What is crush syndrome?

A

Crush syndrome(also known as traumatic rhabdomyolysis) is a medical condition characterized by major shock and kidney failure after a crushing injury to skeletal muscle.

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18
Q

How does cocaine cause rhabdomyolysis?

A

Cocaine use can cause a narrowing of blood vessels in the body (vasoconstriction), which can disrupt the normal flow of oxygen to skin, muscle, and organ tissue. Without enough oxygen, muscle tissue can begin to disintegrate and can die off. Cocaine can also have direct toxic effects on myocytes thus the underlying cellular process of rhabdomyolysis in cocaine addiction is due to the ischemic insult caused by impairment of muscle adenosine triphosphate (ATP) production.

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19
Q

How does Leigionnaire disease lead to rhabdomyolysis?

A

Legionnaires’ disease is a severe form of pneumonia caused by the bacterial pathogen Legionella which releases an endotoxin that causes rhabdomyolysis

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20
Q

How can rhabdomyolysis cause cardiac arrest?

A

Hyperkalaemia (Hyperkalemia and hyperphosphatemia result from the release of potassium and phosphorus from damaged muscle cells)

Increased extracellular potassium reduces myocardial excitability, with depression of both pacemaking and conducting tissues.
Progressively worsening hyperkalaemia leads to suppression of impulse generation by the SA node and reduced conduction by the AV node and His-Purkinje system, resulting in bradycardia and conduction blocks and ultimately cardiac arrest.

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21
Q

What is rickets?

A

Rickets is the softening and weakening of bones in children, usually because of an extreme and prolonged vitamin D deficiency. Rare inherited problems also can cause rickets.

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22
Q

What is the most common cause of acute back pain?

A

Muscular injury or strain

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23
Q

How does vitamin D deficiency lead to bone remodelling and rickets?

A

Vit D is produced naturally in skin exposed to ultraviolet light when the UV index is above 4.

Vit D promotes absorption of calcium from the intestinal tract.

If blood calcium falls, the parathyroid glands increase secretion of parathyroid hormone which increases calcium levels in the blood but decreases the level of phosphate in the blood

This results in weak bones that become bowed when weight bearing.

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24
Q

What deforminity is characteristic of rickets?

A

Bowing of the leg bones when weight bearing is attempted

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25
Q

What is osteomalsia?

A

A weakness and malformation of bones in adulthooddue to a vitamin D deficiency, similar to rickets but usually caused by small intrestine or liver. i.e. absoption and storage problem rather than limited exposure to sunlight.

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26
Q

What is the brief Hx and epidemiology of ricket?

A

A century ago rickets affected 25% of children in the UK (Paterson, Darby 1925)

In 1861 Trousseau identified absence of sunlight and poor nutrition as probable causes of rickets.

Socio economic - New reports in Canada show that Indigenous northern children have been affected disproportionately with VitD rickets (Irving, Ward 2022)

“125 cases met the case definition, an annual incidence of 0.48 per 100 000 children under 16 years. 116 children were under 5 years.” (Julies et al., 2020)

Results Between 2002 and 2008, 160 cases of symptomatic vitamin D deficiency were identified with twice as many cases in 2008 (n, 42) as in the previous years.

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27
Q

What is the BMJ definition of a dislocation?

A

“Complete separation of 2 articulating bony surfaces, often caused by sudden impact to the joint”

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28
Q

What are subluxations?

A

Partial dislocations

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29
Q

What are the risk factors for dislocations?

A

Frailty
Older adults
Connective tissue disorders (e.g., Ehlers Danlos)
Calcium deficiency – osteoporosis
Commonly synovial joints

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30
Q

What are the common causes of dislocations?

A

High force impact sports (E.G., rugby, skiing)
Falls
RTC’s
Any sudden force impacting the joint

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31
Q

What are the incidence rates for shoulder dislocations for sex and age?

A

72% dislocations occur in males (40.4 per 100,000) whereas females 15.5 per 100,000. Typically anterior dislocation. Peak age in males 17-22 and females 61-70 years

32
Q

What are the incidence rates for hip dislocations for sex and age?

A

Posterior dislocations account for 90% of hip dislocation injuries. Decreased incidence due to an improvement in technology e.g., air bags, seatbelts etc. however most prevalent equally in males and females in the 10-30 age group due to potential risk associated behaviour.

33
Q

What are the incidence rates for patella dislocations for sex and age?

A

Account for approximately 2-3% of knee injuries. Typically adolescent and active individuals and females are at a higher risk.

34
Q

What are the incidence rates for ankle dislocations?

A

Most common type of lower extremity fractures but dislocations occurs in approx. 30-50% of these injuries.

35
Q

What are the incidence rates for finger dislocations for sex and age?

A

Predominantly males and common in 15-19 year olds. High risk individuals include athletes and people engaging in ball sports. Males commonly affected 78.7% (17.8 per 100,000).

36
Q

How many recognised types of arthritis are there?

A

Over 100

37
Q

What are the 3 most common types of arthritis?

A

Osteoarthritis
Rheumatoid arthritis
Gout

38
Q

What is the most common form of arthritis?

A

Osteoarthritis

39
Q

How many adults over 45 in England have osteoarthritis of the knee?

A

1 in 5

40
Q

How many adults over 45 in England have osteoarthritis of the hip?

A

1 in 9

41
Q

Which joints can develop osteoarthritis, and which are the most common?

A

Any joint can develop osteoarthritis

Most common are wrists, knees and hips

42
Q

How many people in the UK have osteoarthritis?

A

Approximately 10 million

43
Q

Which tissue does osteoarthritis effect?

A

Articular cartilage

44
Q

What is the function of articular cartilage?

A

It is a protective ‘coating’ allowing for smooth articulation of the joint, stopping the bones from rubbing directly together. It also acts as a shock absorber

45
Q

What is synovial membrane?

A

The synovial membrane is a thin barrier that lines the inside of some of your joints. You might also see it referred to as your synovium. Your synovial membranes encase your joints in a layer of synovial fluid. The fluid protects your joints and helps them move smoothly.

46
Q

How does osteoarthritis affect the joints?

A

Smaller joint space:
-wearing away and damage to the hyaline cartilage
-subchondral sclerosis
-eventually bones run together directly

When bone ends wear away at eachother:
-formation of osteophytes
-formation of joint mice

47
Q

What are osteophytes and how are they formed?

A

Osteophytes (bone spurs) are lumps of bone tissues forming on the ends of arthritic bones, formed by the bones attempting to heal themselves from the damage caused from rubbing against each other

48
Q

What are joint mice and how are they formed?

A

Small fragments of bone that break away from the end of joints and float around in the joint cavity causing further damage

49
Q

What are the medical terms for joint mice?

A

Corpus liberum
or
Osteochondritis dissecans

50
Q

What is subchondral sclerosis?

A

Subchondral sclerosis is a thickening of the bone under the cartilage in joints. It is also called marginal sclerosis.

51
Q

What are the signs and symptoms of arthritis?

A

Pain and stiffness in joints
Joint tenderness
Joints appearing larger than normal
Crepitus
Limited range of motion in joints

All worsening over time

52
Q

Is osteoarthritis systemic?

A

No, will not necessarily affect joints symmetrically. Only one or a few joints may be affected

53
Q

In which type of joints is osteoarthritis more common, why?

A

Load bearing joints such as the knees, hips and spine

This is because it is not systemic/rheumatic. It’s severity will be affected by the mechanical stress on joints.

54
Q

What is the cause of osteoarthritis?

A

The exact causes are unknown

55
Q

What are the possible risk factors thought to increase incidence of osteoarthritis?

A

Joint injury (repetitive stress rather than acute trauma)
Other conditions such as gout
Age
Family history
Obesity

56
Q

How many adults have a confirmed recorded diagnosis of rheumatoid arthritis?

A

450,000

57
Q

What is the incidence of rheumatoid arthritis in the UK population?

A

About 1%

58
Q

Is rheumatoid arthritis more common in men or women?

A

Women

59
Q

What is rheumatoid arthritis?

A

An auto-immune disease causing inflammation of the joints, specifically the membrane lining the joint (synovium)

60
Q

Which tissue does rheumatoid arthritis particularly affect?

A

The synovium

61
Q

What causes rheumatoid arthritis and how does it develop?

A

Antibodies attacking the synovium in the joints resulting in inflammation, synovitis

Thickened synovial membrane gradually causes the cartilage and bones to erode making them exposed and pitted

Pannus will occur = more damage

Eventually bony ankylosis will form from the bones’ attempts to heal

62
Q

What is pannus?

A

An abnormal layer of fibrovascular tissue or granulation tissue

63
Q

What is bony ankylosis?

A

Fused sections of bone

64
Q

Which joints does rheumatoid arthritis most commonly affect?

A

Hands, feet and wrist - but any joint can be affected

65
Q

Is rheumatoid arthritis bilateral or unilateral?

A

Bilateral

66
Q

What other condition can rheumatoid arthritis increase the risk of, why?

A

Heart disease - exact mechanism not know but thought to be due to the amount of inflammation occurring in the body

67
Q

What non-bony tissues can rheumatoid arthritis affect?

A

Eyes, lungs, kidneys, skin, mouth

Any condition with long term inflammation can effect organs with many small vessels such as the kidneys and eyes

68
Q

What are the signs and symptoms of rheumatoid arthritis?

A

Erythema
Swelling
Pain
Deformity
Weakness
Limited range of motion

69
Q

What are the risk factors of rheumatoid arthritis?

A

Age - but can occur at any age
Gender
Genetics
Smoking
Gravida and parity (a complicated relationship exists here but flare ups can happen post-partun)
Socioeconomic factors (Lower income children are more likely to develop RA on adult life)
Obesity

70
Q

What is gout?

A

The formation of sharp uric crystals in and around joints (called tophi)

71
Q

What causes gout?

A

A build up of uric acid in the blood (hyperuricaema) due to an overproduction and/or underexcretion causes “tophi”.

High purine foods will contribute to the development

72
Q

What foods are high purine?

A

Alcoholic beverages (all types)
Some fish, seafood and shellfish, including anchovies, sardines, herring, mussels, codfish, scallops, trout and haddock
Some meats, such as bacon, turkey, veal, venison and organ meats like liver

73
Q

What is the most common inflammatory arthritis?

A

Gout, increasing in prevalence world-wide

74
Q

What ages and genders are more likely to develop gout?

A

It is more common in men over 30 and postmenopausal women. It is increases in incidence with age - rare in people under 20

75
Q

What are the signs and symptoms of gout?

A

Severe pain
Hot and tender joints
Swelling
Red shiny skin forming over the joints

76
Q

How quickly do gout symptoms usually develop and resolve?

A

Symptoms develop rapidly & usually last 3-10 days
Recurrent attacks can happen, usually within a year

ASforP (22 decks)

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