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Musculo-skeletal > Musculoskeletal Growth and Repair: Bones and Tendons > Flashcards

Musculoskeletal Growth and Repair: Bones and Tendons Flashcards

1
Q

What are the components of the muscle/tendon unit?

A
  • Muscle origin (from bone)
  • Muscle belly
  • Musculotendinous junction
  • Tendon
  • +/- sesamoid bone
  • +/- tendon sheath
  • Tendinous insertion (into bone - Sharpey’s fibres)
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2
Q

Describe the structure of tendons

A
  • Longitudinal arrangement of cells
  • Mostly tenocytesand fibres (collagen type 1 - triple helix)
  • Fascicles of long narrow spiralling collagen bundles
  • Collagen bundles are covered by endotenon, fascicles are covered by paratenon and the tendon is covered by the epitenon
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3
Q

How do tendons get their blood supply?

A

The viniculum branches into a fine network of blood vessels in the paratenon

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4
Q

What are the features of a tendon sheath?

A
  • Tendons connected to sheath by vincula
  • Synovial lining + fluid (gliding lubrication and nutrition)
  • E.g. flexor tendons in distal palm and fingers
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5
Q

What is the function of the tendon sheath?

A

Flexibility and strength in tension

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6
Q

How can tendons be injured/

A

Degeneration, inflammation, enthesiopathy, traction apophysitis, avulsion +/- bone fragment, tear - intrasubstance, tear - musculotendinous junction, laceration/incision, crush/ischaemia/attrition and nodules

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7
Q

Describe the features of Achilles tendon degeneration

A
  • Intrasubstance mucoid degeneration
  • Swollen, painful, tender
  • May be asymptomatic
  • ?Precursor to rupture
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8
Q

Describe the features of de Quervain’s stenosing tenovaginitis

A
  • Inflammation of EPB + APL tendons passing through the common tendon sheath at the radial aspect of the wrist
  • Swollen, tender, hot and red
  • Positive Finklestein’s test
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9
Q

Describe the features of enthesiopathy

A
  • Inflammation at insertion to bone
  • Muscle/tendon: usually at muscle origin rather than tendon insertion e.g. lateral humeral epicondylitis
  • Ligament: Plantar fascilitis
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10
Q

Describe the features of traction apophysitis e.g. Osgood Schlatter’s disease

A
  • Insertion of patellar tendon into the anterior tibial tuberosity
  • Adolescent active boys
  • Recurrent load
  • Inflammation
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11
Q

Describe the features of avulsion +/- bone fragment

A
  • Failure at insertion
  • Load exceeding failure of strength while muscle is contracting
  • Mallet finger
    • Insertion of extensor tendon into dorsum of base of distal phalanx of the finger
    • Forced flexion of extended finger
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12
Q

What are the management options for avulsion?

A
  • Conservative: limited application and retraction of tendon

- Operative: reattachment of tendon (through bone) and fixation of bone and ligament

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13
Q

What is an intrasubstance rupture?

A

When load exceeds failure strength e.g. Achilles tendon rupture

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14
Q

Which clinical features would suggest an Achilles tendon rupture?

A
  • Positive “Simmond’s” (squeeze) test

- Palpable tender gap

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15
Q

Give an example of a musculotendinous junction tear

A

Medial head of gastrocnemius at musculotendinous junction with Achilles tendon

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16
Q

What are the management options for a tendon rupture?

A
  • Conservative: mobilise or splint/cast (where ends can be opposed)
  • Operative: high risk rupture, high activity and ends cannot be opposed
17
Q

What are the features of a tendon laceration?

A
  • Males>females
  • Young adults
  • Need repaired surgically
  • e.g. finger flexors (FDS) and FDP
18
Q

What are the features of cortical bone?

A
  • Diaphysis
  • Resists bending and torsion
  • Laid down circumferentially
  • Less biologically active
19
Q

What are the features of cancellous bone?

A
  • Metaphysis
  • Resists/absorbs compression
  • Site of longitudinal growth (physis)
  • Very biologically active
20
Q

Why do bones fail?

A
  • High energy transfer in normal bones
  • Repetitive stress in normal bones (stress fracture)
  • Low energy transfer in abnormal bones (osteoporosis, osteomalacia, metaastatic tumour and other bone disorders)
21
Q

Describe the components of stage 1 in fracture healing

A
  • Inflammation
  • Begins immediately after fracture
  • Haematoma and fibrin clot
  • Platelets, PMNs, neutrophils, monocytes and macrophages
  • Byproducts of cell death - lysosomal enzymes
  • Fibroblasts
  • Mesenchymal and osteoprogenitor cells (transformed endothelial cells from medullary canal and/or periosteum)
  • Angiogenesis
22
Q

How can we manage stage 1 of a fracture?

A
  • NSAIDs

- Loss of haematoma: open fractures and surgery

23
Q

Name the platelet concentrates

A
  • Platelet derived growth factor
  • Transforming growth factor-beta
  • Insulin like growth factor
  • Vascular endothelial growth factor
24
Q

Describe the features of stage 2 in fractures

A
  • Soft callus
  • Begins when pain and swelling subside
  • Lasts until bony fragments are united by cartilage or fibrous tissue
  • Some stability of fracture
  • Angulation can still occur
  • Continued increase in vascularity
25
Q

Which kind of bone graft is the best?

A

Autogenous cancellous bone graft

26
Q

Describe the features of stage 3 in fractures

A
  • Hard callus
  • Conversion of cartilage to woven bone
  • Long bone fracture: endochondral and membranous bone formation
  • Increasing rigidity: secondary bone healing and obvious callus
27
Q

What are the features of stage four of fractures?

A
  • Conversion of woven bone to lamellar bone
  • Medullary canal is reconstituted
  • Bone responds to loading characteristics
28
Q

What are the causes of delayed union?

A

High energy injury, distraction, instability, infection, steroids, immune suppressants, smoking, warfarin, NSAIDs and ciprofloxacin

29
Q

What are the features of non union?

A
  • Failure to heal
  • Failure of calcification of fibrocartilage
  • Instability
  • Abundant callus formation
  • Pain + tenderness
  • Persistent fracture line
  • Sclerosis
30
Q

What are the management options for delayed healing?

A
  • Different fixation
  • Dynamisation
  • Bone grafting

Musculo-skeletal (27 decks)

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