Musculoskeletal Flashcards
What are the characteristics of cerebral ataxia? What kind of problem is it?
Slow pace and wide based stance due to loss of balance and coordination. Central neurological problem.
Give three examples of glycoproteins
Osteonectin, fibronectin, laminin
Give five examples of proteoglycans
Versican, aggrecan, biglycan, decorin, hyaluronan
What are the visible signs 10 days post-tenotomy?
Nuclei becomes more round so tenocytes can grow and divide. White space between collagen fibres filled with proteoglycans which bind to water and cause swelling.
What does the cross-banding pattern of collagen fibrils suggest?
Organisation of protein molecules is in a crystalline structure. It is difficult to elongate, which allows for precise movement.
What does a tendon under pressure result in?
Increased proteoglycans
For normal tenocytes under tension, what is the percentage of PG’s? What PG is likely to be found here?
0.15% Decorin containing dermatan sulphate chains.
For tendons under pressure, what is the percentage of PG’s? What PG is likely to be found here?
2-4% Versican/Aggrecan containing chondroitin sulphate chains.
In pressure-bearing regions, what happens to tendon?
Tenocytes turn into chondrocytes. Fibrocartilage
What is the percentage of proteoglycans in the load bearing regions of hyaline cartilage?
10%
What increases the strength of hyaluronan?
GAG side chains are attached to collagen electrostatically.
More PG results in __________
More resistance to pressure
What were the results of the swing, straight, bent leg conditions experiment?
No movement and no weight bearing leads to 40% loss of PG in 4 weeks. Movement alone maintains PG’s.
What does the epidural space contain?
Fat, arteries, and veins. Most arteries and veins transcendant.
What does the subdural space contain?
Virtual space and veins (mostly going across)
What happens when fat pads behind the dura are lost?
Increases space for veins. This can pull on them and they can rupture. Small bleeds can happen, leading to confusion or loss of consciousness.
What is the epineurium?
A sheath around the nerve containing the best qualities of the three maters.
What is the purpose of the denticulate ligament?
Holds arachnoid and pia mater apart.
What does the subarachnoid space contain?
CSF
Which intermuscular septum in the thigh is the strongest?
Lateral
What does the fascia lata attach to superiorly, laterally, and posteriorly?
Superior: pubic tubercle, pubis, inguinal ligament
Lateral: iliac crest
Posterior: sacrum, coccyx, ischial tuberosity
Where is the femoral nerve formed?
Psoas major
What does the adductor canal contain?
Femoral artery, vein, nerve to vastus medialis, saphenous nerve
What is the adductor canal bound by medially, posteriorly, and laterally?
Medial: Sartorius
Posterior: Adductor longus and magnus
Lateral: Vastus Medialis
What are the two uses of the femoral artery in a clinical setting?
1) For arterial samples when unable to collect peripheral samples when shut down in shock.
2) Cardiac angiography, where a catheter is passed up the femoral artery to the aorta and coronary arteries and contrast inserted.
What is are the clinical uses for the femoral vein?
Cannulation. Used for central access. Long catheter inserted into femoral vein as it passes through the femoral triangle and blood samples or pressure measurements form the right side of the heart. Also used to give someone a lot of fluid.
True or false: bone has a lot of PG?
False. Bone has very little PG so collagen and minerals give it strength
How much decorin does bone contain? What is its function?
Very little. Holds together collagen fibres.
What is the purpose of osteonectin in bone?
It is a small molecule that binds together other molecules such as fibronectin and laminin.
What sends the signal to stop growing in primary osteon formation?
Blood vessel
Which compartment is most susceptible to compartment syndrome? Why so?
Anterior compartment of the leg. It is bounded on 3 sides by fairly rigid structures (tibia, IO membrane, anterior intermuscular septum)
Which bone can be removed for bone graft?
Fibula
What are the three points of attachment of the inferior extensor retinaculum?
Lateral: Upper surface of calcaneus
Medial proximal: Medial malleolus
Medial distal: Plantar aponeurosis
Where is the superior peroneal retinaculum?
Above to the lateral malleolus
Below to the lateral surface of the calcaneus
What is the inferior peroneal retinaculum attached to?
In front: continuous with cruciate crural ligament
Behind: lateral surface of calcaneus
Some fibres attached to peroneal trochlea, forming a septum between the tendons of peroneal longus and brevis.
Which nerve can be used for a nerve biopsy?
Sural nerve
What are the 5 clinical signs of compartment syndrome?
Pain, pallor, pulselessness, paraesthesia, paralysis
What are osteoclasts derived from?
Blood lineage (precursors of blood cells). Not from connective tissue.
What are the two steps of degradation of mineralised bone?
1) Focal decalcification by organic acids
2) Digestion of ECM by acid hydrolases
Give an example of an acid hydrolase
Cathepsin, which digests collagen
How do osteoblasts prepare the surface for osteoclasts?
They digest the osteoid (clear zone). Signal tells osteoblasts to move and osteoclasts come in to fresh bone surface.
How does PTH affect bone removal?
Increases osteoblast and osteoclast activity. Decreases bone mass.
How does calcitonin affect bone removal?
Decreases osteoclast activity, membrane ruffling, number of osteoclasts and movement of osteoclasts. Decreases SA for secretion of acids and enzymes.
Where is calcitonin produced?
By the C cells in the thyroid gland.
What does OPG stand for? What is it produced by?
Osteoprotegerin
Produced by osteoblasts
What are the stages of growth of long bone from cartilage?
Resting, proliferating, maturing, hypertrophy, calcification, new bone
What are the steps for healing of bone fractures?
- Periosteum and endosteum provide source of new bone
- Blood vessels grow slower than cells
- Osteoblasts under low O2 become chondrocytes so cartilage formed
- Capillaries grow in
- Oxygen concentration rises
- Osteoblasts form bone around cartilage
- Cartilage degenerates
- Bone invades
- Osteoclasts dig out channels
- New secondary osteons knit bone ends together
- Remodelling
- Thickness reduced
What can be done to reduce callus size?
Metal plates and screws carry load so the callus size is reduced and help align. Fractures are weaker when removed and takes longer to heal.
Where does the medial collateral ligament attach? Describe it
Medial femoral epicondyle to medial tibia
Broad ligament blends with underlying joint capsule
Where does the anterior cruciate ligament attach?
Anterior tibial spine to lateral condyle of femur
Where does the posterior cruciate ligament attach?
Posterior tibial spine to medial condyle of femur
What is the function of menisci?
Increases the articulation between the femur and tibia
Describe the medial meniscus
Attached to the joint capsule and medial collateral ligament. Less mobile
Describe the movement of the lateral meniscus
More mobile so reduced risk of damage
What can cause gluteal/Trendelenburg gait? Describe what happens.
Injury to Gluteus medius or superior gluteal nerve. Weak thigh abduction. Pelvis tilts down on unaffected side. When walking, must lean to affected side during swing through phase.
Describe the normal function of the gluteus medius when walking
Contracts to support pelvis and stop it tilting to lifted side when standing on one leg.
What are the possible hamstring injuries that may occur? What are they usually caused by?
Midsubtance strains/tears or avulsion from ischial tuberosity. Kicking/running sports.
What is piriformis syndrome?
Sciatic nerve compressed by piriformis. Results in pain, tingling, numbness in buttocks and down leg.
What does trochanteric bursitis result from?
Gluteus maximus fibres rubbing over greater trochanter.
Where is the joint capsule of the hip attached to proximally and distally?
P: Acetabulum and transverse acetabular ligament
D: Intertrochanteric line
What reinforcement does the iliofemoral ligament provide? What does it prevent? What is it attached to proximally and distally?
Superior anterior reinforcement
Prevents hyperextension by corkscrew effect
P: AIIS and acetabular rim
D: Intertrochanteric line
What reinforcement does the pubofemoral ligament provide? When does it tighten? What is it attached to proximally and distally?
Inferior anterior reinforcement
Tightens in extension and abduction to prevent over-abduction
P: Pubis
D: Joint capsule
What reinforcement does the ischiofemoral ligament provide? What does it prevent? Where is it attached proximally and distally?
Posterior reinforcement
Prevents hyper-extension by corkscrew effect
Ischial part of acetabular rim and spirals to base of greater trochanter