ortho 1 Test 1 Flashcards
Synarthroses
bones in direct contact not separated by snyovial cavity and immovably connected.
ex bones of cranium and face
Amphiarthroses
bones connected by broad flattened discs of fibrocartilage
ex intervertebral joints
Diarthroses
two bones covered in cartilage, connected by ligaments and having a synovial sac
Synovial joint features
- Ends of articulating bones covered in hyaline cartilage
- Joint space is enclosed in a capsule, reinforced by ligaments
- Synovial membrane present on inside of capsule
- Synovial fluid, produced by synovial membrane
- LPP- point where articular surfaces are least congruent and the most amount of joint play possible. Opposite: CPP
- Menisci- only present at certain synovial joints.
ex: TMJ, tibiofemoral, SC joint
Generalized Hypermobility
test is called the Beighton Scale; out of 9 points
ex. Eherlos Danlos Syndrome
Local hypermobility
due to a capsuloligamentous injury
5 factors that keep joint stable
- Joint geometry
- Passive Restraints
- Active restraints
- Negative intra-articular pressure
- Loads
Functional instability
subjective reporting that joint “gives way” during ADLs, recreation activity or sport
Mechanical Instability
Excessive joint mobility detected as part of the physical examination during passive mobility.
usually due to capsuloligamentous injury
Acute injury
Usually macrotraumatic, sudden onset injury.
Ex, fractures, contusion, sprains/strains, dislocations/subluxations, hemarthrosis.
Chronic injury
usually microtraumatic, gradual onset from overuse.
ex: Tendonitis, tenosynovitis, tendonosis, stress fracture,
5 contributing factors of microtraumatic injury
- Training error
- Weakness/ poor endurance
- Tightness
- Poor equipment
- Faulty technique
Ligaments
dense regular connective tissue, made of mostly collagen and some elastin.
have poor blood supply and good nerve supply
passive joint stabilizers, guide arthrokinematics, provide afferent information
Types of osteoarthritis
- Primary- no known cause
A- Localized - affecting only one join
B- Generalized- OA in 3-4 joints (common in post menopausal women) - Secondary- has an identified underlying cause ex obesity, trauma
Clinical features of OA
patients over 50,
pain and stiffness local to affected joint
morning stiffness less than 30 min
systemic symptoms are absent
joint tenderness and crepitus with movement
osteophyte and swelling may be present
Osteoarthritis general info
aka Degenerative joint disease(DJD), chronic degenerative disorder characterized by loss of articular cartilage
usually affects hip and knee, Lumbar spine or DIP and lower cervical spine
Risk factors of OA
age- chances increase with age
trauma- damage to ligaments, menisci or articular surfaces increases chance of OA
Exercise
Age- under 50 more men, 50-80 more women, after genders are equally effected
Ethnicity- more in european and americans than asians
Genetics
Obesity- most modifiable factor
Diet- Excessive vitamin C and deficient in Vitamin D may increase chances of OA
Bone density- Patients w OA have higher bone density bc of osteophyte formation
Imaging OA
Radiographs are gold standard
Look for 1.Joint space narrowing
2. osteophyte formation in late stages
3. bone cysts- fluid filled sac that extrudes from the joint
4. Subchondral sclerosis- thickening of subchondral bone
Interventions for OA
- Patient education
- Aerobic and anaerobic exercise- usually non impact
- Weight loss
- Physical therapy
- Appliances- braces, foot orthotics
- Assistive devices- cane or walker
Drugs for OA
- NSAIDS
- Hyaluronic Acid- injected into joint to increase viscoelasticity of synovial fluid
- Capsaicin cream- helps w substance P
- Glucosamine Sulphate- contain glycosaminoglycans that are found in articular cartilage
Surgical options for OA
- Debridement- clean out the joint
- Chondroplasty- reshaping condyles
- Osteomy- realignment of the bones
- Athrodesis- fusion of a joint
- Athroplasty- joint replacement
- Uni spacer- for medial compartment of tibio-femoral joint
Rhuematoid arthritis general info
Chronic disease characterized by inflammation of synovium
about 1% of US population has RA
70% are women, onset is usually betw 30-50 years
characterized by periods of exacerbation and remission, duration of periods are highly variable
Cause of RA
likely multifactorial, theories include genetics or infection
RA is considered an autoimmune disease bc cells from one’s own body attack other cells
Stages of RA
- Swelling of synovial lining. causes joint to be red, stiff, painful, warm,and swolen
- Pannus formation- rapid division and growth of synovial cells or pannus, causes synovium to thicken. may grow and cover the articular cartilage which could lead to death of cartilage
- Erosion- the inflamed cells release enzymes that may digest bone and cartilage, often causing the involved joint to lose its shape and alignment
Common joints of RA
Can be in any joint
Most common in smaller joints of fingers and wrists, usually is bilateral. Most common joints: MCP, wrist, PIP, knee, MTP, shoulder, ankle, cervical spine, hip, elbow, and TMJ
Symptoms of RA
- Symmetrical painful swelling usually starting in hands
- stiffness over an hour
- Rhuematoid nodules in 20%, can be movable or attached to tendons in fingers, hands, knuckles
- Flu like symptoms- fatigue, weakness, fever, loss of appetite
Patients are prone to Sjogren’s syndome- disorder of immune system w dry eyes and mouth
4/7 criteria must be met for at least 6 weeks to diagnose RA
- Morning stiffness at least an hour
- at least 3 joints simultaneously having swelling
- Swelling in the wrist, MCP or PIP
- Symmetrical arthritis
- Rheumatoid nodules
- Serum rheumatoid factor
- Radiographic changes including erosion in hand or wrist
Lab test for RA
- Complete blood count- people w RA often have low red blood cell count - Anemia
- Erythrocyte Sedimentation Rate- speed at which RBCs fall to bottom of test tube. The faster the rate the more severe the RA.
- C reactive protein- elevated when infection in the body.
- Rheumatoid factor- 70-80% of people with RA test positive.
RA imaging
- Xrays- good baseline for comparison with later xrays after disease has progressed.
- MRI good at seeing synovitis
- Joint ultrasound- joint inflammation
- Bone Densitometry (DEXA)- detects osteoporosis.
Treating RA
tailored to the individual.
Medication: NSAIDs, glucocoticoids, antirhuematic drugs
discontinuing activities when discomfort/fatigue occurs. use frequent but short bursts of exercise.
Strain
tearing of muscle tissue
Degrees of strain
1st- minor swelling, little loss in strength and function
2nd- moderate pain and swelling, decreased strength, defect may be plapable, unable to function
3rd- severe pain/swelling, unable to continue. need surgery to repair tissue
Strains most often occur
- muscle is in a lengthened position
- during an eccentric contraction
- primarily comprised of Type II fibers
Contusion
a hematoma caused by the breaking of blood vessels from trauma to the muscle.
Myositis Ossificans
abnormal formation of bone within the muscle. passive ROM is contraindicated, only active or active assisted ROM.
Compartment Syndrome
Acute- following contusion of muscle the pressure in a compartment rises, if it exceeds the pressure of the venous and arterial supply a fasciotomy is required
Chronic- aka Chronic exertional compartment syndrome. pressure increases with exercise
Delayed onset muscle soreness DOMS
soreness after exercising in a way that we are not used to. eccentric motions are responsible for damaging the sarcomeres. generally peaks 36 hours after activity. most effective treatment is gentle exercise
Epineurium
coat of connective tissue (collagen) surrounding the entire nerve
Perineurium
collagen surrounding each fasicle
Endoneurium
coat around individual axons
Neuropraxia
nerve damage without any anatomical discontinuity usually a compression injury local conduction block & demyelination thick myelinated nerves most affected resolves itself in weeks
Axonotmesis
microscopic division of nerve fibers without obvious discontinuity of the nerve sheath
usually a traction injury, could be severe compression
Wallerian degeneration occurs
worse with proximal injuries, limiting factor is distance of regeneration required
Neurotmesis
complete severance of the nerve trunk
no recovery unless repair undertaken
