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Year 2- MSK > Musculoskeletal Growth Injury and Repair – Ligament, Tendon and Bone > Flashcards

Musculoskeletal Growth Injury and Repair – Ligament, Tendon and Bone Flashcards

1
Q

What are ligaments?

A

Dense bands of collagenous tissue which span a joint and provide stability

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2
Q

What are ligaments made of?

A

Type 1 collagen fibres
Fibroblasts
Sensory fibres
Surface vessels

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3
Q

Ligaments are said to have crimping. What does this allow for?

A

Stretch

->idk think of crimping a pasty allowing it to stretch while cooking in the oven

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4
Q

What is the difference in the composition of tendons and ligaments?

A

Ligaments have a lower percentage of collagen but higher percentage of water and proteoglycans

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5
Q

Why may ligament ruptures occur?

A

Force exceeds the strength of the ligament

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6
Q

What is one of the most common sites of a ligament injury?

A

Ankle joint

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7
Q

Describe the healing process of ligaments.

A

Initial haematoma
Proliferative phase to produce scar tissue
Remodelling so matrix becomes more ligament like

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8
Q

When would a ligament injury require conservative treatment?

A

Partial injury
No instability
Poor surgery candidate

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9
Q

When would a ligament injury require operative treatment?

A

Instability
Expectation of highly functioning ligaments e.g. sportsmen
Compulsory- multiple

->if ligament cannot be repaired, may be replaced, often with tendon taken from the hamstrings.

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10
Q

Which structure is often attached to muscle and comes an a composite unit?

A

Tendon

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11
Q

Tendons may have a sesamoid bone within the tendon itself. Give an example.

A

Patella

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12
Q

What do all tendons have?

A

Some form of tendon sheath

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13
Q

What is the structure of tendon like?

A

Longitudinal arrangement of tenocytes and type 1 collagen fibres

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14
Q

How does blood supply get into tendons?

A

Via vincula

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15
Q

How are tendons connected to the tendon sheath?

A

Via vincula

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16
Q

What holds the tendon to the bone in the fingers?

A

Strong annular pulleys

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17
Q

What is the function of tendons?

A

Very strong under tension and flexible- they pull on bones in order to bend joints

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18
Q

What happens if tendons are immobilised for a long period of time?

A

The water and GAG content falls and reduces strength

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19
Q

Tendons can have problems with degeneration.
Which tendon is known for having problems with degeneration?

A

Achilles tendon

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20
Q

Sometimes degeneration of the Achilles tendon can be a precursor to what?

A

Rupture

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21
Q

Which areas of tendon are more likely to degenerate?

A

Areas with a lower blood supply

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22
Q

Give an example of a common type of tendon inflammation.

A

De Quervain’s tenosynovitis/tenovaginitis

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23
Q

Which test is used to diagnose de Quervain’s syndrome?

A

Finklestein’s test

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24
Q

What is enthesiopathy?

A

Inflammation at the insertion to bone muscle/tendon

->usually at muscle origin rather than tendon insertion

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25
What causes enthesiopathy?
Repetitive movements ->e.g. tennis elbow or lateral humeral spicondylitis
26
Tennis elbow is a type of enthesiopathy. What type of enthesiopathy is it known as?
Lateral humeral epicondylitis
27
There can be enthsiopathy at insertion of ligaments. Give an example.
Plantar fasciitis
28
Osgood Schlatter's disease is an example of a traction apophysitis injury. What happens here?
The patellar tendon inserts into the anterior tibial tuberosity. If it pulls on the apophysis rather than the bone, it causes pain and swelling of the apophysis
29
In which group of people is traction apophysitis like Osgood Schlatter's disease more common?
Adolescent active boys
30
What is the management of Osgood Schlatter disease?
If want the pain to stop completely, need to stop the activity causing pain If want to continue the activity and can put up with the pain, this can be done
31
What is meant by an avulsion fracture?
Small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone.
32
Where in the body are avulsion fractures more common?
Fingers ->common in rugby players who are grabbing onto shirts and then are suddenly pulled away
33
What does the treatment of avulsion fractures depend on?
The site of the tendon
34
What is the treatment for the majority of avulsion fractures?
Operative reattachment of the tendon, often through bone
35
What is an intrasubstance rupture?
Tear somewhere in the middle of a tendon
36
Where is a common site of intrasubstance rupture?
Achilles tendon
37
What are the different mechanisms of a tendon rupture?
1. Occurs when pushing off with weight bearing forefoot while extending the knee Therefore, common with sprint starts or jumping movements 2. Unexpected dorsiflexion of ankle e.g. slipping into hole 3, Violent dorsiflexion of flexed foot e.g. fall from height
38
What sign is positive in an Achilles tendon rupture?
Simmond's test
39
When is conservative treatment chosen for a ruptured tendon?
When the ends can be opposed- often shows up on an ultrasound
40
What is the conservative treatment for a ruptured tendon?
Splints or casts
41
When is operative treatment carried out in a ruptured tendon?
When there is a high risk of rerupture - those who need stronger tendons or have higher activity levels
42
Which tendons are lacerations or incisions more common in?
FDS FDP
43
Who is more likely to get a tendon laceration?
Males > females Young adults
44
When may someone get a laceration tendon injury?
Most common when preparing food
45
What is the treatment for tendon lacerations?
Surgery immediately as issues of with retraction
46
What allows bones to grow?
Primary ossification centre and then secondary ossification centre
47
What type of bone is compact?
Cortical bone
48
What is another name for spongy bone?
Cancellous bone ->usually between two layers of compact/cortical bone
49
What does cortical bone resist?
Bending and torsion
50
What does cancellous/spongey bone resist?
Compression
51
Which type of bone is more biologically active e.g. blood vessels?
Spongey/cancellous bone
52
Which part of the bone tends to be cortical?
Bone at the diaphysis
53
What part of the bone tends to be cancellous?
Metaphysis
54
What is meant by a fracture?
Break in the structural integrity of a bone e.g. crack, break, split, etc.
55
What is the shorthand sign for a fracture in notes?
#
56
Name some conditions which weaken bones, most commonly seen in the elderly.
Osteoporosis Osteomalacia Metastatic tumours
57
What happens to the bone in a fracture?
Mechanical and structural bone failure Disruption of the blood supply
58
What is different between the healing process of bone compared to everything else in the body?
No scar left in healing of bone, is a regenerative process
59
There are four stages of bone regeneration. What are they?
Inflammation Soft callus Hard callus Bone remodelling
60
What happens immediately after a fracture?
Inflammation stage Haematoma, fibrin clot, platelets, neutrophils, monocytes and macrophages are released Made into a 'soup' with lysosomal enzymes which bring in new cells to initiate repair
61
What may we do as doctors which hinder the repair process of a fracture?
Give NSAIDs- reduces inflammation and the ability to repair as this is part of the healing process Surgery as can cause loss of haematoma which is also required as part of healing process
62
What does stage two of the soft callus begin?
Begins when the pain and swelling subside
63
What does the soft callus stage last until?
Lasts until bon fragments are united by cartilage or fibrous tissue
64
What can be done by doctors in the soft callus stage to help the bone?
Could replace the cartilage during surgery Could use bone grafts or substitutes so place between gap in fracture
65
What is the golden standard for treating fractures?
Autogenous cancellous bone grafts ->involves collecting cancellous bone, often from iliac crest, and transplant it
66
Autogenous cancellous bone grafts are osteoconductive. What does this menan?
It is a structure which allows cells to grow enough to create the bone ->basically, if you fill the gap with this, cells can go on it and bridge the gap essentially
67
What is allograft bone?
Bone taken from other humans, usually cadavers, and can be used in patients Can get cortical, cancellous and it can be fresh or prepared
68
What happens in the stage of hard callus?
Conversion of cartilage to woven bone This increases rigidity ->woven bone is bone without structure, isn't cortical or cancellous
69
What happens in bone remodelling?
Conversion of woven bone into lamellar bone Medullary canal (found in all bones, nutrients etc, remember first year), is reconstituted
70
What happens to the healing if the strain on a fracture is too low or high?
Movement is too low or high and fracture ends at different stages of fracture healing meaning the healing will not progress
71
Delayed union?
Fracture fails to heal in the expected time
72
List some of the tings which can cause delayed union.
High energy injury- lots of damage to repair Distraction- fracture ends are far apart and more healing required Instability Infection Steroids Immune suppressants Smoking Warfarin NSAIDs Ciprofloxacin
73
Name some of the drugs which can cause delayed union of a fracture.
NSAIDs Warfarin Ciprofloxacin Immune supressants
74
When delayed union of a fracture occurs, alternative management should be considered. What may this involve?
Different fixation Bone grafting Dynamization (in attempt to get ends of a fracture closer together)
75
Non-union of a frcature?
Complete failure to heal
76
Why can non union of a fracture occur?
Failure of fibrocartilage/soft callus to form any bone Instability- too much movement Two separate masses of bone are formed but they don't join together
77

Year 2- MSK (36 decks)

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