Pathology

Question 1

Types of bone fracture

Answer 1

• Transverse
• Spiral
• Oblique
• Comminuted
• Avulsion
• Open/closed

Question 2

Clinical features fractures

Answer 2

• pain
• deformity
• reduced ROM

Question 3

Cause of periosteal injury

Answer 3

direct blow, bleeding under the periosteum

Question 4

Wolff Law

Answer 4

Bone remodels in direct response to the force applied

Question 5

Define stress fracture

Answer 5

microfracture due to repetitive loading that, over time, exceeds bone’s intrinsic ability to repair itself

Question 6

2 mechanisms for bone overload

Answer 6

• Impact forces e.g. metatarsal in marching

- muscle pull e.g. neck of femur in runner

Question 7

Function of cartilage

Answer 7

• Joint lubricator

- shock absorber

Question 8

3 types of cartilage

Answer 8

• Hyaline cartilage (covers joint surfaces)
• Fibrocartilage (knee meniscus, vertebral disc)
• elastic cartilage (outer ear)

Question 9

What is osteochondral injury

Answer 9

Damage to articular cartilage +/- subchondral bone

Question 10

What is the issue with osteochondral injury?

Answer 10

Poor healing capacity because of inadequate blood flow (nutrition via diffusion from synovium, aided by joint loading)

Question 11

Articular cartilage overuse sequence

Answer 11

Microscopic inflammation –> softening –> fibrillation –> fissuring –> gross disruption

Question 12

What is osteochondritis dessecans

Answer 12

Separation of bone + cartilage from normal surrounding bone and cartilage

Question 13

Types of muscle contraction

Answer 13

• concentric = activity while muscle is shortening
• eccentric = activity whilst muscle in lengthening
• isometric = activity with no change in muscle length
• isotonic = movement occurring at equal force throughout range
• isokinetic = movement occurring at equal speed throughout range

Question 14

How are muscle strains/tears classified?

Answer 14

Grade 1-3

Question 15

Grade 1 muscle strain- pathology

Answer 15

• small number of muscle fibres torn
• fascia intact
• minimal bleeding

Question 16

Grade 1 muscle strain- clinical signs

Answer 16

• mild pain
• full ROM
• full strength

Question 17

Grade 2 muscle strain- pathology

Answer 17

• significant number of muscle fibres torn

- increased bleeding

Question 18

most common joint overuse injury

Answer 18

osteochondritis dessicans

Question 19

most common joint overuse injury

Answer 19

osteochondritis dessicans

Question 20

grade 2 muscle sprain/tear- clinical signs

Answer 20

• increased pain
• swelling
• decreased ROM + strength
• palpable haematoma

Question 21

Grade 3 muscle tear- pathology

Answer 21

complete tear, usually at the musculotendinous junction

Question 22

Grade 3 muscle tear- clinical signs

Answer 22

+++ bleeding and swelling

no active contraction

Question 23

What is a contusion

Answer 23

direct blow causes bleeding and haematoma formation (ie a bruise)- eg thigh contusion common in football

Question 24

what can repeated quad contusions lead to?

Answer 24

myositis ossificans

Question 25

3 common muscle overuse injuries

Answer 25

1) Focal fibrosis- repetitive 2) Chronic exertional compartment syndrome (CECS) 3) DOMS

Question 26

Focal fibrosis- aeitiology

Answer 26

microtrauma --> chronic inflammation + adhesions

Question 27

chronic exertional compartment syndrome- aeitiology

Answer 27

exercise --> increases intra-compartment pressure (build up of metabolites) --> tight fascia limits expansion --> impaired blood supply --> ischaemia --> pain

Question 28

DOMS- aetiology

Answer 28

eccentric exercise --> inflammatory cell/metabolite build up

Question 29

Clinical signs of myofascial pain

Answer 29

- v tender point in taught band of muscle - hardening of muscle upon trigger point palpation- hard nots beneath the skin - subjective weakness of involved muscle - referred pain from trigger points (note- shared symptoms with fibromyalgia but this is usually also associated with fatigue)

Question 30

Classic history CECS

Answer 30

- Squeezing/cramping/aching/burning, typically begins within 15-20 minutes of an exertional type activity - Well-localised to a specific compartment - often bilateral - Pain/symptoms disappear quickly after the cessation of activity. - Focal neurological findings, i.e., decreased sensation, paresthesias, or weakness

Question 31

How is CECS diagnosed?

Answer 31

- Hx- clinical examination is normal | - 1o = measurement of Intra-compartment pressure

Question 32

Mx of CECS

Answer 32

NSAIDs Botulinum toxin injections Gait training Open fasciotomy if refractory to treatment

Question 33

2 most common sites for tendon rupture

Answer 33

- site of least blood supply- eg 2cm above achilles tendon insertion - musculotendinous junction

Question 34

3 commonest forms of tendinopathy + an example of each

Answer 34

- Tendinosis- collagen degeneration, neovascularisation eg patella/achilles - Tendinitis- inflammation of tendon eg inflammatory arthritides - Paratenonitis- inflammation of connective sheath eg de Quervain's tenosynovitis in rowers

Question 35

bursa function

Answer 35

facilitate movement of tendon over bony surface

Question 36

2 categories of bursitis

Answer 36

- acute/traumatic- due to direct knock. causing bleeding into bursa - overuse - eg subdeltoid bursitis, prepatellar bursitis

Question 37

bursitis clinical findings

Answer 37

localised pain and tenderness over a bursa | may be swelling if the bursa is superficial

Question 38

Tx bursitis

Answer 38

- conservative- rest, analgesia - corticosteroid injections if Rx - excision of bursa is still Rx

Question 39

3 common nerve injuries in sport

Answer 39

- Acute- neuropraxia- due to direct trauma- tingling, parasthesia, pain, weakness - Acute/chronic- entrapment eg from prolapsed intervertebral disc impinging on nerve root - Chronic- adverse neural tension- irritation of nerve due to local inflammation causing pain or stretching of nerve eg RSI/carpal tunnel