Musculoskeletal and Trauma Flashcards
Sedentary behaviour and immobilisation result in (apart from DVT)
Muscle atrophy and insulin resistance (muscle less able to increase glucose uptake in response to elevated blood glucose)
State the two changes in protein balance during immobilisation (e.g. due to immobilisation)
Muscle protein synthesis declines
Muscle protein breakdown increases but not as much as the decrease in synthesis
Anabolic resistance - even if you eat more protein = protein synthesis still declines = atrophy
Describe the 3 cellular factors that induce muscle proteolysis
Increased Ca2+ = increased protein breakdown
Ubiquitin proteasome-dependent - breakdown of defective and old proteins
Lysosomal
Describe the pathway involved in increased muscle protein synthesis in response to exercise
increased phosphorylation of the Akt/mTOR pathway. Increased ATP demand = increased AMP = increased activation of glucose transporters = increased glucose uptake and Ca2+ release
Muscle protein breakdown is also inhibited
Post immobilisation , lean muscle and strength can be recovered by …
Isometric high load exercise
Trauma and inflammation
Inflammation induces muscle atrophy via elevation of muscle cytokines = increased muscle breakdown and inhibition of muscle protein synthesis
Muscle becomes resistant to the insulin and impairs carbohydrate oxidation
Roles of the different bone cells
Osteoclast - resorb bone; responds to calcitonin
Osteoblast - lay down bone; responsd to all hormones (PTH, Vit D)
Osteocyte - trapped osteoblast that has become a regulatory cell after it has laid down bone
Describe cortical bone
Compact
Found in mature bone
80% of the adult skeleton
Lamellae in concentric rings with lines of force (from exercise/activity)
Canals present (haversian canals) for blood vessels/lymph vessel/nerves
Primary bone healing
Requires stability - reduced motion and gap between the cells
Doesn’t occur naturally - operation induced
Secondary bone healing
Haematoma - pool of mostly clotted up
Nears blood vessels and spongy bone trabeculae form within the haematoma = fibrocartilaginous callus
Fibrocartilaginous callus becomes a bony callus
Bone remodelling
What is a fracture
Soft tissue damage along with bone break
Describing fractures
Bone
Location within a bone - proximal/middle/third ; intraarticular(inside joint or outside joint)
Fracture type - oblique/transverse/spiral
Complications of fractures
dislocation; ligament tear; rupture of tendon; internal bleeding (higher risk in patients taking anticoagulants); nerve damage; pulmonary embolism; fat embolism (fat released from interior of long bones); compartment syndrome - compression of blood vessels due to excessive swelling of muscles; scar tissue in cartilage can lead to osteoarthritis
What is traction ?
Pulling on the limb to reposition the bones and putting pins in to hold them in position
Traction allows control of haemorrhage
Complication - clots, pressure sores, atrophy of muscle, skin tears, pin site infection
External fixation and nails result in what type of healing
Secondary
Intermedullary nails
Running along the centre of the bone (medullary cavity)
Provide stability to whole bone
Minimal soft tissue dissection
Intermedullary nails
Running along the centre of the bone (medullary cavity)
Provide stability to whole bone
Minimal soft tissue dissection
Intervention techniques for fractures *
PRICE (protect by immoblising with splint or cast, rest, ice, elevate)
Hip fracture
Particularly dangerous because blood supply is compromised (no anastomosis) = femoral head dies if fracture occurs intracapsularly
The 4Ps of compartment syndrome
Pain on passive flexion and extension
Pallour
Paresthesia
Pulselessness
Fasciotomy
a surgery to relieve swelling and pressure in a compartment of the body. Tissue that surrounds the area is cut open to relieve pressure.
Skin graft may be given to replace the skin
Life long scarring
Define neuropraxia
Axonotmesis
Neurotmesis
Neuropraxia - loss of motor function without nerve degeneration
Axnotmesis - axon is damaged but the surrounding connecting tissue remains intact
Neurotmesis - both the axon and connective tissue are damaged is called neurotmesis.
Complications of plasters
Pressure sores
Respiratory complications
Clots
Muscle wasting
What are soft tissue injuries
Most common kind of injury
Soft tissue includes muscles, tendons, ligaments, fascia, nerves, fibrous tissue, bursa and fat pads , blood vessels, synovial membrane
Describe overuse injuries
If exercise is applied in a way that adaptation of the muscle and tendons cannot occur, microscopic injuries can occur leading to inflammation
Causes - training errors, improper form, excessive training, inadequate, rests muscle weakness
Overuse injuries associated with bone
Stress fracture
Osteitis - bone inflammation
Periostitis
Apophysitis
Overuse injuries associated with articular cartilage
Chondropathy
Overuse injuries associated with joints
Synovitis - inflammation of connective tissue lining the inside of a joint capsule
Osteoarthritis
Overuse injuries associated with muscles
Chronic compartment syndrome
DOMS
Focal tissue fibrosis
Describe the different types of mechanism of injury
Blunt or penetrating Direct or indirect trauma Torsion Shearing Hyperextension or hyperflexion
Describe the initial treatment of soft tissue injuries
Use acronyms PRICE and HARM
Protect - support or splint Rest Ice - 15-20 mins every 2-3 hours Compressed Elevate
Also avoid Heat Alcohol Running Massage
Later treatment for soft tissue injuries
Stretching, mobilisation, isometric and resistance exercise
Stretching, weighted exercise
Strengthening and proprioception training (injury cause nerve pathway damage that affects your ability to control joint position)
What are bursa
Tendons, ligaments, muscles, and skin must glide over bones during joint movement. Tiny, slippery sacs of synovial fluid called bursae facilitate this gliding motion
Energy deficiency syndrome
Disordered eating (or low energy availability), amenorrhoea/oligomenorrhoea (in women), and decreased bone mineral density (osteoporosis and osteopenia) are present.
Most common basketball and football injuries
Basketball - inversion
Football - ACL tear
Describe the features of sub-maximal exercise
Can be sustained between 30-180 minutes before fatigue
Rate of muscle ATP resynthesis is low, metabolic fuel integration occurs (carbs + fat both used)
Glycogen availability is an important determinant of fatigue
How can liver and muscle glycogen recovery be maximised? Why is this important?
By ingesting carbs immediately after glycogen-depleting exercise when insulin sensitivity is at its highest
Improves capacity for repeated exercise; useful for athletes
Describe chronic pain
>3 months Tissues have healed Pain is unhelpful Caused by changes to nerve network Medication has limited effectiveness
Pain is produced by
Receptors that detect damage produce threat signals
The brain has to decide , do i need to protect the threat with pain
Risk factors for DVT
> 60 , obesity, smoke, contraceptive pill/ HRT, cancer, CHF, varicose veins, dehydration, being bed-bound, long journeys, pregnancy
Describe cellulitis
What is it ?
Symptoms
Treatment
Bacterial deep infection of skin
usually affects arms and legs, sometimes eyes/mouth/anus/belly ;
can happen spontaneously but usually after skin break due to trauma or surgery
Makes affected areas red, painful and swollen ; swollen and painful glands
What does erythematous mean?
Superficial reddening of skin
Describe the features of synovial joints
Consists of two bone ends separated by synovial fluid and enclosed in fibrocollagenous capsule with synovium secreting cells
Hyaline cartilage covers bone ends not perichondrium in order to reduce friction and absorb shock
Fibroelastic ligaments and tendon attachments prevent excessive movement
Osteoarthritis - clinical presentation
Monoarticular - only one or a few
No morning stiffness
Crepitations - audible grinding when the joints are moved
Aching/enlarged/rigid/deviated joints; typically occurs at lumbar/cervical spine, proximal and distal hand joints, feet (metatarsophalangeal joint)
Joint effusion/warmth/tenderness
Functional impairement - poor hand grip/dexterity/walking/driving etc
X-ray - narrowing of joint space/osteophytes ; only order x-ray is referral for surgery is an option
No abnormalities in biochemistry/blood tests
Symptoms of rheumatoid arthritis
Morning stiffness for at least 1 hour and present for at least 6 weeks
Simultaneous swelling of three or more joints for at least 6 weeks
Symmetric joint swelling for 6 or more weeks
Rheumatoid nodules anywhere on skin
Serum rheumatoid factor positive
Compare rheumatoid arthritis and osteoarthritis
RA is inflammatory always, osteoarthritis more due to normal wear and tear
Osteoarthritis often occurs in single joints; rheumatoid arthritis occurs in several joints and is symmetrical
fever, anemia, fatigue, loss of appetite also accompany the symptoms of RA
RA is two to three times more common in women; OA is more common in men before age 45. More common in women after age 45.
Genetic predisposition for OA; less of a genetic component for RA
OA often gets better after waking up, RA stays the same throughout the day
Pathogenesis of osteoarthritis
Damage leads to chondrocyte inflammatory response = release of cytokines
This results in the alteration in cartilage composition:
reduced proteoglycans and collagen; increased water, chondrocyte hypertrophy. Cartilage spilts and erodes
Surface cracks, and bone is exposed. Eburnation occurs - bone rubs against bone
Sclerosis(bone becomes more dense) and subchondral osteoporosis
Muscle weakness
bone shock absorbing properties reduced
Osteophytes: abnormal bony
outgrowths form in response to subchondral bone damage
Synovitis/inflammation of joint capsule with hyperplasia and oedema
Label the types of femur fracture
Radiographic changes typical of rheumatoid arthritis on hand or wrist radiographs
erosion; reduced joint space in all joints
soft tissue swelling
osteoporosis: initially juxta-articular, and later generalised
PIP and MCP joints affected
