Musculoskeletal Therapeutics Flashcards by Wing Vong

What is included in the musculoskeletal system

Bones 
Cartilage and other connective tissue
Ligaments
Tendons
Joints

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When does arthritis normally occur

Women over 60

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When does bone loss start to occur

30 years onwards

Accelerated in post menopausal women

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What happens when the joints starts to stiffen

Ligaments and tendons become more rigid

Cartilage thins (increased friction wear and tear)

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When does muscle loss start to occur

Progressively 30 years onwards (sarcopenia)

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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

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What are other symptoms associated with musculoskeletal disorders other than pain

Swelling

Inflammation

Brusing

Loss of movement

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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

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How does the bone provide support

Framework for attachment of muscles

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How does the bone provide protection

Protects internal organs from injury

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How does the bone provide movement

Any body movement as bone acts as levers and points for muscle attachment

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How does the bone provide mineral storage

Reservoir for 99% calcium and 95% phosphorus

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How does the bone provide haematopoiesis

Certain bones consist of bone marrow that is essential for production of blood cells

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How does the bone provide energy storage

Certain bones consist of fats and lipids (yellow marrow)

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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

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What does the trabeculae do in bone

Aligns along positions of stress and exhibit extensive cross bracing

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What is the bone normally made out of

Compact cortical bone

Spongy, cancellous, trabeculae bone

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When do bones remodel in adults

Trauma (fractures)

Stress- weight bearing exercise

Metabolic changes- replenishment of calcium storage

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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