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MSK > Musculoskeletal Growth/Injury and Repair > Flashcards

Musculoskeletal Growth/Injury and Repair Flashcards

1
Q

What is a ligament?

A

Dense bands of collagenous tissue which span a joint, being anchored to bone at either end

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2
Q

Ligament structure

A 
Type I collagen fibres 
Fibroblasts (communicate)
Sensory fibres
- proprioception 
- stretch 
- sensory 
Vessels (surface)
Crimping allow stretch
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3
Q

Compared to tendons, the composition of ligaments have….

A

Lower % of collagen
Higher % of proteoglycans and water
Less organised collagen fibres
Rounder fibroblasts

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4
Q

What happens to cause a ligament rupture?

A

Forces exceed strength of ligament

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5
Q

Stages of healing a ligament injury

A
  1. haemorrhage (blood clot)
  2. Proliferative phase (production of scar tissue)
  3. remodelling (matrix becomes more ligament like)
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6
Q

Treatment of ligament injuries

A 
Conservative if
- partial injury 
- no instability
- poor candidate 
Operative if
- instability
- expectation (sportsmen) 
- compulsory (multiple)
Repair
Augmentation 
Replacement
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7
Q

What does the muscle/tendinous composite unit consist of?

A

Muscle origin from bone
Muscle belly
Musculotendinous junction
Tendon (+/- sesamoid bone, +/- tendon sheath)
Tendinous insertion into bone (sharpeys fibres)

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8
Q

What arrangement do the cells of tendons have?

A

Longitudinal arrangement of cells (tenocytes)

Fibres (collagen type I - triple helix)

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9
Q

Function of tendons

A

Flexible and very strong in tension

Movement

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10
Q

What is an enthesiopathy?

A

Inflammation at insertion to the bone

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11
Q

What condition is enthesiopathy at a ligament?

A

Plantar fasciitis

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12
Q

Another name for lateral humeral epicondylitis

A

Tennis elbow

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13
Q

What does mallet finger present with?

A

Forced flexion of extended finger

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14
Q

Pathology of mallet finger

A

Tear of extensor tendon into dorsum of base of distal pharynx of finger

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15
Q

What test is done for an achilles tendon tear?

A

Simmonds squeeze test - palpable tender gap

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16
Q

Possible mechanisms of tendon rupture/tear

A

Pushing off weight bearing forefoot whilst extending the knee joint e.g. sprint starts or jumping movements (53%)

Unexpected dorsiflexion of ankle e.g. slipping into a hole (17%)

Violent dorsiflexion of plantar flexed foot e.g. fall from a height (10%)

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17
Q

Treatment of tendon rupture/tear

A

Mobilise (partial rupture)
Splint/cast
Operative

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18
Q

What combines to form a spinal nerve?

A

Anterior and posterior roots

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19
Q

What are peripheral nerves?

A

The part of a spinal nerve distal to the nerve roots

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20
Q

Function of C fibres

A

Dull, aching, burning pain
temp
sensation

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21
Q

What is carpal tunnel syndrome?

A

Compression of the medial nerve at the wrist

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22
Q

What is sciatica?

A

Compression of the spinal root by intervertebral disc

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23
Q

What is mortons neuroma?

A

Compression of digital nerve in 2nd or 3rd webspace in forefoot

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24
Q

Pathology of neurapraxia

A

Nerve In continuity, stretched or bruised

Reversible conduction block - local ischaemia and demyelination

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25
Q

Presentation of neurapraxia

A

Local ischaemia

Local demyelination

26
Q

Prognosis of neurapraxia

A

Good - weeks or months

27
Q

Pathology of axonotmesis

A 
Endometrium intact (tube in continuity) but disruption of axons - more severe injury 
Extremely stretched or crushed or direct blow
28
Q

Presentation of axonotmesis

A

Wallerian degeneration

29
Q

Prognosis of axonotmesis

A

Sensory recovery often better than motor

Often not normal but enough to recognise pain, hot and cold, sharp and blunt

30
Q

Pathology of neurotmesis

A

Complete nerve division
Laceration or avulsion
Endoneural tubes disrupted

31
Q

Prognosis of neurotmesis

A

poor
no recovery unless repaired (direct suturing or grafting)
endonueral tubes disrupted so high chance of “miswiring” during regeneration

32
Q

Can peripheral nerves regenerate?

A

yes

33
Q

What nerve injuries are closed fractures related to?

A

Nerve injuries in continuity e.g. neuropraxis, axonotmesis

34
Q

Treatment of nerve injury after closed fracture

A

Spontaenous recovery is possible

Surgery indicated after 3 months (if no recovery is indicated after clinical or EMG)

35
Q

Examples of nerve injuries in closed fractures

A

Brachial plexus injuries

Radial nerve humeral fracture

36
Q

What nerve injuries are open fractures related to?

A

Nerve division e.g. neuromeric injuries by knife/glass

37
Q

Treatment of nerve injury by open fracture

A

early surgery

38
Q

in open nerve fractures, how long is it after the injury when the distal portion of the nerve undergoes Wallerian injury?

A

up to 2-3 weeks after the injury

39
Q

presentation of nerve injuries

A 
dysaesthesia 
- anaesthetic (numb)
- hypo and hyper aesthetic 
- paraesthetic (pins and needles)
Paresis or paralysis +/- wasting
dry skin 
diminished or absent reflexes
40
Q

Definition of dysesthesia

A

Disordered sensation

41
Q

Definition of paresis

A

Weakness

42
Q

Why would a nerve injury cause dry skin?

A

Loss of tactile adherence since sudomotor nerve fibres not stimulating sweat glands in the skin

43
Q

How does nerve injury healing work?

A

Initial death of axons distal to site of injury, then Wallerian degeneration, then degradation of myelin sheath

  1. proximal axonal budding occurs thereafter 4 days
  2. regeneration proceeds at a rate of approx. 1mm/day in humans or 3-5mm per day in children
44
Q

What is the first modality to return in nerve injury?

A

Pain

45
Q

What does the prognosis of nerve injury healing depend on?

A

Wether the nerve is
- pure = only sensory or only motor
- mixed - both sensory and motor component in same nerve
How distal the lesion is - proximal worse

46
Q

What sign can monitor the recovery of nerve injuries?

A

Tinels sign

47
Q

The Rule of 3 - surgical timing in a traumatic peripheral nerve injury

A

Clean and sharp injuries = immediate surgery within 3 days
Blunt/contusion injuries = early surgery within 3 weeks
Closed injuries = delayed 3 months after injury

48
Q

Presentation of UMN lesion

A 
Decreased strength 
increased tone
increased deep tendon reflexes 
Clonus present 
Babinskis sign present 
Atrophy absent
49
Q

Presentation of LMN lesion

A 
Strength decreased
Tone decreased
Decreased deep tendon reflexes
Clonus absent 
Babinskis sign absent 
Atrophy present
50
Q

Definition of a fracture

A

Break in the structural continuity of bone

51
Q

How can a fracture happen?

A 
High energy transfer in normal bones
Repetitive stress in normal bones 
- stress fracture
Low energy transfer in normal bones 
- osteoporosis
- osteomalacia 
- metastatic tumour
52
Q

4 stages of fracture healing

A
  1. inflammation
  2. soft callus
  3. hard callus
  4. bone remodelling
53
Q

When does inflammation start after a fracture?

A

Immediately

54
Q

When does the soft callus occur after a fracture?

A

When the pain and the swelling subside

55
Q

What is the hard callus formation?

A

Conversion of cartilage to woven bone

56
Q

What is bone remodelling?

A

Conversion of woven bone to lamellar bone

57
Q

Causes of delayed union of bone fracture

A 
high energy injury 
distraction (increased osteogenic jumping)
instability 
infection 
steroids
immunosuppressants 
smoking
warfarin 
NSAIDs
Ciprofloxacin
58
Q

What is a significant risk factor for avascular necrosis?

A

Previous Chemotherapy

59
Q

What is avascular necrosis?

A

Death of bone tissue secondary to the loss of blood supply - leading to bone destruction and loss of joint function

60
Q

Causes of AVN of hip

A

Alcohol excess
Chemotherapy
Long term steriod use
Trauma

61
Q

Presentation of AVN of hip

A

Asymptomatic initially

Pain in joint

62
Q

Investigations of AVN of hip

A

MRI - 1st line

Xray (may be normal initially, osteopenia and microfractures may be seen early on

MSK (25 decks)

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