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BRS > Musculoskeletal & Rheumatology > Flashcards

Musculoskeletal & Rheumatology Flashcards

1
Q

What 3 categories make up the Musculoskeletal System

A

Bone
Muscle
Connective Tissue

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2
Q

How many bones in adults and children respectively?

A

206 (+ sesamoids)

270 children

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3
Q

What is the Axial skeleton comprised of?

A

Cranium
Vertebral Column
Rib Cage

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4
Q

What is the Appendicular skeleton comprised of?

A

Pectoral girdle
Upper and Lower Limbs
Pelvic Girdle

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5
Q

What are the functions of the skeleton?

A

Supports body so you can stand up and not fall
Protection of your vital organs
Movement - works with muscles so you can get around
Mineral storage - Stores calcium and phosphate
Produces blood cells

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6
Q

How do bones develop in utero?

A
  • Intramembranous Ossification* - First occurs after conception → flat bones
  • Endochondral Ossification* - Begins 2 months into utero → long bones
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7
Q

Explain how intramembranous ossification leads to the development of mesenchymal to bone

A
  1. Mesenchymal stem cells aggregate and form osteoblasts by differentiation
  2. Ossification center forms
  3. Osteoblasts begin to secrete osteoid
  4. Peripheral mesenchymal cells continue to differentiate
  5. Osteoblasts secrete osteoid inwards towards the ossification center, trapping themselves, causing differentiation into osteocytes, hardening the bone -> calcification
  6. Osteoid continues to be deposited, assembles in a random manner around embryonic blood vessels
  7. Development of trabeculae with red bone marrow populating them
  8. Mesenchyme begins to differentiate into periosteum
  9. Lamellar bone replaces woven bone at outer edge creating layers#Internal spongy bone remains
  10. Vascular tissue within trabecular spaces forms red marrow
  11. Osteoblasts remain on the bone surface to remodel when needed
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8
Q

Explain how endochondral ossification leads to the development of mesenchymal to cartilage to bone before birth

A
  1. Mesenchymal stem cells differentiate into hyaline cartilage, which forms a ring of tissue around it (perichondrium)
  2. This cartilage then forms a calcified matrix, which then forms a primary ossification center (diaphysis) supplied by a nutrient artery
  3. Newly formed osteoblasts gather at the diaphysis wall to form a bone collar
  4. Chondrocytes within the central cavity enlarge, causing the matrix to calcify, making it impermeable to nutrients, causing cell death
  5. Central clearing forms where cells have died (supported by bone collar)
  6. Healthy chondrocytes elsewhere cause elongation
  7. Periosteal bud, which consists of arteries, veins, lymphatics, and nerves, and delivers osteogenic cells,
    invades the cavity, causing the formation of spongy bone.
  8. Osteoclasts degrade cartilage matrix while osteoblasts deposit new spongy bone, bone continues to elongate
  9. Diaphysis continues to enlarge and osteoclasts break down newly formed spongy bone
  10. Medullary cavity begins to form and cartilaginous growth now only within epiphysis causing a bony epiphyseal surface to form
  11. Diaphysis and epiphysis join at the epiphyseal plate, which is where bone growth happens after birth.
  12. Primary ossification center forms the center of long bones. Secondary ossification (epiphysis) centers form the ends of long bones (one on each end)
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9
Q

What are the different types of bone cells found and what do they do?

A

Osteogenic cell -> Bone stem cell
Osteoblasts -> Bone ‘forming’; secretes ‘osteoid’ and catalyzes the mineralization of osteoid
Osteoclasts -> Bone ‘breaking’, dissolve and resorb bone by phagocytosis and are derived from bone marrow
Osteocytes -> ‘Mature’ bone cell, formed when osteoblast becomes imbedded in its secretions and they sense mechanical strain to direct osteoclast and osteoblast activity

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10
Q

Where are Osteogenic cells and Osteocytes found respectively?

A

Osteogenic cells - Deep layers of periosteum

Osteocytes - Entrapped in matrix

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11
Q

Where are Osteoclasts and Osteoblasts found respectively?

A

Osteoblasts - Growing portions of bone, including periosteum and endosteum
Osteoclasts - Bone surfaces and at sites of old, injured, or unneeded bone

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12
Q

What are the organic and inorganic compositions of the bone matrix?

A

Organic - 40%
Type 1 Collagen 90%
Ground Substance 10% - Proteoglycans,
glycoproteins, cytokine, and growth factors
Inorganic - 60%
Calcium hydroxyapatite
Osteocalcium phosphate

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13
Q

Describe the structure of immature bone

A

Laid down in a ‘woven’ manner - relatively weak

Mineralized and replaced by mature bone

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14
Q

How would you describe the structure of mature bone?

A

Mineralized woven bone. Can be cortical (compact/lamellar) or cancellous (spongy).
Cortical bone is compact and suitable for weight-bearing. Cancellous bone is spongy and not suitable for weight-bearing.

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15
Q

Describe the structures of the individual mature bone types (Cortical and Cancellous)

A

Cortical
‘Compact’ - dense -> shell that surrounds osteon
Suitable for weight-bearing
Cancellous:
Spongy, trabecular, and has a lot of airspaces in it.
It’s light but not very strong. Not suitable for weight-
bearing

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16
Q

Describe what an osteon is comprised of?

A

Concentric ‘lamellae’ around a central ‘Haversian Canal’

The ‘Haversian Canal’ contains blood vessels, nerves, and lymphatics

17
Q

What are Lacunae?

A

Small spaces containing osteocytes

Tiny Canaliculi radiate from lacunae filled with extracellular fluid

18
Q

What are Volkmann’s Canals?

A

Transverse perforating canals in the bone connecting 2 Haversian systems together

19
Q

What are the structures of a long bone (from to tip to center)

A

Epiphysis (at the joint)
Physis (growing plate)
Metaphysis (Right below physis)
Diaphysis (long bone itself)

20
Q

What kind of bones undergo interstitial growth?

A

Long bones

21
Q

What is the physis and what happens here during interstitial growth?

A

The physis is the zone of elongation in long bones
Physeal plates contain hyaline cartilage.
On the Epiphyseal side, the hyaline cartilage is active and divides to form a hyaline cartilage matrix.
On the Diaphyseal side, the cartilage calcifies and dies and is then replaced by bone.

22
Q

What is the difference between interstitial growth and appositional growth?

A

Interstitial growth -> increase in length

Appositional growth -> increase in diameter or thickness

23
Q

In the femur, where does growth occur?

A

Proximal physis around the hip and the distal physis around the knee

24
Q

What is appositional growth?

A

Deposition of bone beneath the periosteum to increase thickness

25
Q

How does appositional growth occur?

A

Ridges in the periosteum create grooves for new periosteal blood vessels.
These periosteal ridges fuse, forming an endosteum-lined tunnel.
The osteoblasts in the endosteum build new concentric lamellae inward towards the center of the tunnel, forming a new osteon.
Bone grows outwards as the osteoblasts in periosteum build new circumferential lamellae. Osteon formation repeats as new periosteal ridges fold-over blood vessels.

26
Q

How do you classify the 3 joints?

A

Fibrous (bones connected by fibrous connective tissue)
- Sutures, Syndesmosis, Interosseous membrane
Cartilaginous (bones connected with cartilage)
- Primary: Synchondroses (hyaline cartilage - spine),
Secondary: Symphyses (fibrocartilage - pubic bone)
Synovial
- Plane, Hinge, Condyloid, Pivot, Saddle, Ball &
Socket

27
Q

What are the different types of synovial joints?

A

Hinge / uniaxial (ankle, elbow) -> can move in only one plain
Biaxial (saddle joint) -> can move in two plains
Ball and socket / multiaxial spheroidal joints (hip, shoulder) -> can move in all plains

28
Q

Describe the structure of the synovial joint capsules

A 
Articular capsules (Outer) - keeps bones together structurally
Synovial membrane (Inner) contains synovial fluid
29
Q

What is the function of synovial fluid?

A

To reduce friction during movement

30
Q

How are synovial joints stabilized?

A

Bone surfaces - hip joint for example has a congruent bone surface so the ball and socket are very stable
Ligaments - prevent bones from moving in excess and in extreme directions to keep the joint intact

31
Q

How does having more and tighter ligaments affect the stability and mobility of the joints respectively?

A

Increases stability

Decreases mobility

32
Q

What effect does having fewer ligaments and laxer ligaments have on the joints respectively?

A

Decreases stability

Increases mobility

33
Q

How does poor stability affect your risk of dislocation of that joint?

A

Increases the risk of dislocation

34
Q

How does excessive ligament laxity increase the risk of injury?

A

Excessive ligament laxity → Hypermobility → Greater risk of injury

35
Q

How does the shoulder joint’s stability compare with that of the hip?

A
  • *Joint articulation** - Mismatch-shallow socket, whereas the hip has a complete fit as it has a deep socket
  • *Joint Capsule** - Weak in the shoulder, strong in the hip
  • *Ligaments** - Lacks strong ligaments in the shoulder, strong network of ligaments in the hip
  • *Muscles** - The shoulder is dependent on the rotator cuff but the hip joint is supported by muscles in the hip
  • *Stability** - Unstable in the shoulder, more stable in the hip
  • *Mobility** - Extremely mobile in the shoulder, less mobile in the hip
36
Q

How can joints be classified in terms of their mobility?

A

Synarthosis - no or little mobility (mainly fibrous joints)
Amphiarthosis - limited mobility (usually cartilaginous joints)
Diarthosis - free mobility (mainly synovial)

BRS (9 decks)

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