Musculoskeletal Therapeutics Flashcards
What is included in the musculoskeletal system
Bones Cartilage and other connective tissue Ligaments Tendons Joints
When does arthritis normally occur
Women over 60
When does bone loss start to occur
30 years onwards
Accelerated in post menopausal women
What happens when the joints starts to stiffen
Ligaments and tendons become more rigid
Cartilage thins (increased friction wear and tear)
When does muscle loss start to occur
Progressively 30 years onwards (sarcopenia)
What are the three types of pain associated with musculoskeletal disorders and describe them
Bone pain- trauma, infection, cancer- deep penetration or dull pain
Muscle pain- trauma, inflammation, cramp or spasm- often less intense than bone pain but unpleasant
Other joint and tendon/ligament pain- trauma, sprains, arthritis- stiff dull ache, less intense than bone pain, worse when move or stretched
What are other symptoms associated with musculoskeletal disorders other than pain
Swelling
Inflammation
Brusing
Loss of movement
How do you diagnose musculoskeletal disorders
Observation of gait (persons walking) or patient movement
Pain with movement, rest, night or any trauma
Physical examination of swelling, bruising, tenderness or heat
Blood tests (biomarkers, inflammatory markers)
X rays, computed tomography, CT scans
How does the bone provide support
Framework for attachment of muscles
How does the bone provide protection
Protects internal organs from injury
How does the bone provide movement
Any body movement as bone acts as levers and points for muscle attachment
How does the bone provide mineral storage
Reservoir for 99% calcium and 95% phosphorus
How does the bone provide haematopoiesis
Certain bones consist of bone marrow that is essential for production of blood cells
How does the bone provide energy storage
Certain bones consist of fats and lipids (yellow marrow)
What is the compact/cortical bone made of
Hard dense outer layer bone made of:
Proteins- collagen 95%, proteoglycans 1/3 of bone mass
Hydroxyapatite- calcium phosphate 2/3 of bone mass
What does the trabeculae do in bone
Aligns along positions of stress and exhibit extensive cross bracing
What is the bone normally made out of
Compact cortical bone
Spongy, cancellous, trabeculae bone
When do bones remodel in adults
Trauma (fractures)
Stress- weight bearing exercise
Metabolic changes- replenishment of calcium storage
What do you need the perfect balance of in bone
Bone formation
Bone breakdown
What are the three main cell types involved in bone
Osteoblasts
Osteoclasts
Osteocytes
What do osteoblasts do and where are they found
Form new bone (Blast build bone)
Synthesise and secrete collagen and other organic components of bone matrix
Initiates calcification
Located in bone membranes- periosteum and endosteum
What do osteocytes do and where are they found
Maintain bone, not by synthesising new bone but regulation of mineral ion exchange
Osteoblasts surrounded by bone matrix- if osteocytes die, surrounding bone does too
Connect to other osteocytes and bone surface via canaliculi
What do osteoclasts do
Removal of deteriorating bone or unnecessary new bone (CLASTS chew bone
Large multinucleated cells
What is the mechanism of action of osteoclasts
Secretion of hydrogen ions to dissolve mineral matrix and hydrolytic enzymes (collagenase) to degrade other bone components
What is a fracture
Break in a bone, commonly associated with injury surrounding tissues
What are the underlaying conditions that can cause a fracture
Osteoporosis, infections or bone tumours
What are the common symptoms that can occur in a fracture
Pain Loss of function Deformity Crepitus (grating, popping, cracking) Bleeding- occur from bone or surrounding tissue
When does haematoma occur and what can it do to the bone
Fracture disrupts blood vessels that supply bone and causes extensive bleeding
Lack of blood supply- bone death
Describe the fracture repair inflammatory phase
Callus formation:
Granulation tissue form
Debris is cleared by macrophages
Revascularisation occurs:
Fibroblasts produce collagen that spans break
Chondroblasts begin to secrete cartilage matrix
Osteoblasts form spongy bone
Describe the bony callus formation in the fracture repair phase
Bone trabeculae increase in number
Fibrocartaginous callus is converted into bony callus of spongy bone (cartilage into bone)
Lasts 6-8 weeks
Describe the bone remodelling in fracture repair remodelling phase
Bone structure is restored
Osteoclasts- remove temporary supportive structures
Osteoblasts- rebuild compact bone
Describe how you treat bone fractures
Immobilise and support limb- elevate and ice
Pain relief
Open fractures- immediate surgery to clean and close wound
Closed fractures- less urgent- treatment of pain only
Immobilisation with cast or insertion of rods, plates
How do you live with a cast
Keep it dry
Do not itch
Make sure skin is not smelly, red or sore
Elevate regularly to reduce swelling risk
What is compartment syndrome
Limb threatening condition that occurs when fibrous membrane prevents expansion of swollen muscle and pressure builds within muscle
Pressure restricts blood flow leading to hypoxia, injury of muscle and muscle death
Symptoms: increasing pain in immobilised limb after fracture
How do you treat compartment syndrome
Surgery to relieve pressure in constricted tissue
Muscle and nerves dead may mean amputation is necessary
What is pulmonary embolism and its symptoms
Sudden blockage of artery in lung by blood clot, occurs after serious hip and pelvic fractures
Chest pain, cough, shortness of breath
How do you prevent risk of pulmonary embolism
Heparin and warfarin given to reduce occurrence of blood clots
What is a joint and what does it consist of
Junction between two or more bones
Articular cartilage
Synovial fluid and membrane- cushion between bones
Stabilising ligaments
What is the knee joint consist of
Meniscus- cushion of cartilage bone that ensures even distribution of body weight
Bursa- fluid filled sac that cushions bone and tendon
Patella- protection of joint
Ligaments- provides stability whilst allowing range of movement
What does the ligament consist of and its role
Tough fibrous cords of connective tissue (collagen and elastin fibres), stabilise and strengthen joints
Connects one bone to another
What does the tendon consist of and its role
Tough bands of connective tissue (collagen)
Attachment of muscle to bone
Connected via sheath and lubricated to allow movement without friction
Describe what skeletal muscle is
Bundles of contractile fibres that are responsible for movement and posture
attached to bones and in opposing groups- limits risk of damage and smoothness of muscle
Size and strength of muscles- increase and decrease depending on workload
What is the satellite cell responsible for
Post natal growth, repair and maintenance of skeletal muscle
What are common sporting injuries and explain them
Strain- damaged torn muscle
Sprain- damaged torn ligaments
Tendinitis- inflammation of tendons
Stress fractures of foot
Shin splits
How do you treat sporting injuries (RICE)
Rest- minimises internal bleeding and swelling
ICE_ reduces pain and inflammation
COMPRESSION- reduces swelling and further injury
ELEVATION- reduced swelling
What is the main drug of use in sporting injuries
NSAIDs
