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Part 3 – PM3B > (PM3B) Musculoskeletal Therapeutics > Flashcards

(PM3B) Musculoskeletal Therapeutics Flashcards

1
Q

What comprises the musculoskeletal system?

A

(1) Bones
(2) Joints
(3) Muscles
(4) Tendons
(5) Ligaments
(6) Cartilage

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2
Q

What are tendons?

A

Attaches muscle to bone

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3
Q

What are ligaments?

A

Attach bone to bone

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4
Q

What is the most common musculoskeletal condition?

A

Osteoarthritis

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5
Q

What is the first line management of lower back pain?

A

(1) stretching/ strengthening/ aerobics/ yoga

then 2nd line

(2) NSAIDs

then 3rd line

(3) Weak opioids, e.g. codeine

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6
Q

When may surgery be required for lower back pain?

A

Prolapsed discs

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7
Q

What happens to bones with ageing?

A

Loss of bone mass in those >30yrs old

Bone loss accelerates post-menopause in women (due to drop in oestrogen levels)

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8
Q

What happens to joints with ageing?

A

Stiffen with age

Ligaments + tendons become more rigid

Cartilage thins, leading to increased friction
- arthritis

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9
Q

What happens to muscle with ageing?

A

Progressively lost from ~30yrs old
- sarcopenia

Reduced mass + strength leads to an increase in risk of injury

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10
Q

What is the main symptom of most musculoskeletal conditions?

A

Pain

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11
Q

What is bone pain?

A

Deep/ penetrating pain

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12
Q

What is muscle pain?

A

Often less intense than bone pain

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13
Q

What is joint, ligament, or tendon pain?

A

Stiff

Dull ache

Less intense than bone pain

Worse when moved/ stretched

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14
Q

When can back pain be misleading?

A

Kidney infection/ stone

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15
Q

How are musculoskeletal conditions diagnosed?

A

Observation of gait/ movement of the patient

Questions

Physical examination

Blood tests

  • biomarkers
  • inflammatory markers
  • CT scan
  • X-ray
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16
Q

What are some of the functions of bone?

A

(1) Support
- framework for attachment of muscles

(2) Protection
- of internal organs

(3) Movement
- levers + points of attachment for muscles

(4) Mineral storage
- reservoir for calcium

(5) Haematopoiesis
- housing of bone marrow
- production of blood cells + platelets

(6) Energy storage
- contain fats/ lipids
- yellow bone marrow

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17
Q

What is compact or cortical bone?

A

Hard + dense outer layer of bone

~80% of human skeleton

Comprised of proteins (1/3 bone mass) + hydroxyapatite (2/3 bone mass)

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18
Q

What is spongy bone?

A

Porous + highly vascularised

Storage of bone marrow

Low density + strength

Honeycomb-like structure

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19
Q

What is cancellous bone?

A

Porous + highly vascularised

Storage of bone marrow

Low density + strength

Honeycomb-like structure

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20
Q

What is trabeculae bone?

A

Porous + highly vascularised

Storage of bone marrow

Low density + strength

Honeycomb-like structure

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21
Q

What are the openings on the surface of spongy bone called?

A

Canaliculi

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22
Q

Describe the structure of trabeculae.

A

Align along positions of stress

Exhibit extensive cross-linking
- for reinforcement + strength

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23
Q

What is bone remodelling?

A

Formation of new bone to replace old bone

Occurs constantly in growing children

Allows for lengthening/ thickening of bones

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24
Q

When can bone remodelling occur in adults?

A

(1) Trauma
- fractures

(2) Stress
- weight-bearing exercise

(3) Metabolic changes
- replenishment of calcium stores

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25
Q

What are osteoblasts?

A

Bone cell type

Essential for bone formation

Cuboidal cells located along the bone surface

Secrete collagen proteins + proteoglycan
- mainly type 1 collagen

Initiate calcification

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26
Q

What are osteocytes?

A

Bone cell type

Maintain + repair bone

Comprise 90-95% of total resident bone cells

Located within lacunae

Surrounded by mineralised bone matrix

Connected to other osteocytes via canaliculi

When osteocyte dies, surrounding bone dies

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27
Q

What are osteoclasts?

A

Bone cell type

Breakdown bone

  • removal of deteriorating bone
  • removal of unnecessary new bone

Large multinucleated cells
- originate from bone marrow

Secrete hydrogen ions
- to dissolve mineral matrix

Secrete hydrolytic enzymes

  • to degrade other components of bone
  • e.g. collagenase
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28
Q

How can a condition such as osteoporosis be caused?

A

Imbalance between bone resorption and formation

29
Q

What happens when an osteocyte dies?

A

Surrounding bone dies

30
Q

What is the purpose of mechanosensors in bone tissue?

A

To sense bone health

31
Q

What happens at the end of a bone formation cycle?

A

Osteoblast subpopulation become osteocytes in the matrix

32
Q

How do osteocytes maintain bone?

A

Regulation of mineral ion exchange

33
Q

How is an osteoclast formed?

A

(1) Haemopoietic prescursor
(2) Preosteoclast
(3) Osteoclast

can also be formed from:

(1) Mesenchymal stem cell
(2) Preosteoblast
(3) Osteoclast

34
Q

What happens if the number of osteoclasts outweighs number of osteoblasts?

A

Osteoporosis

Weakens bone strength

35
Q

What is the most common cause of fractures?

A

Trauma

36
Q

What are some common symptoms of fractures?

A

(1) Pain
(2) Loss of function
(3) Deformity

(4) Crepitus
- grating/ popping/ cracking sound

(5) Bleeding can occur from bone/ surrounding tissues

37
Q

What is the treatment for fractures?

A

(1) Immobilise + support limb

(2) Pain relief
- not NSAIDs as reports of delayed healing

(3) Immobilisation with casts/ surgical fixation of fracture

38
Q

What should be advised to a patient with a fracture cast?

A

(1) Keep it dry
(2) Do not itch with sharp/ pointed objects
(3) Check visible skin for redness/ smell/ sores
(4) Rest with care
(5) Elevate regularly to reduce risk of swelling
(6) Contact doctor if tight or causing pain

39
Q

What is compartment syndrome?

A

Serious limb-threatening condition

Caused by excessive swelling of injured muscles

Fibrous membrane surrounding muscle prevents expansion of swollen muscle
- Pressure builds within the muscle

Pressure in muscle restricts blood flow

  • leads to hypoxia
  • leads to death of muscle fibres
40
Q

What are the symptoms of compartment syndrome?

A

Increasing pain in immobilised limb following fracture

41
Q

What is the treatment of compartment syndrome?

A

Surgery to relieve pressure in constricted tissue

Amputation may be necessary if muscles/ nerves have died

42
Q

What are some potential complications of fractures?

A

(1) Compartment syndrome

(2) Pulmonary embolism

43
Q

What is a pulmonary embolism?

A

Sudden blockage of artery in lung by a blood clot
- usually from leg vein

Common + fatal

  • following serious hip/ pelvic fractures
  • less common in lower leg fractures
  • very rare in upper body fractures
44
Q

Why does a fracture increase risk of pulmonary embolism?

A

(1) Trauma to leg
(2) Forced immobility
(3) Reduced blood flow to veins

45
Q

What are some symptoms of pulmonary embolism?

A

(1) Chest pain
(2) Cough
(3) Shortness of breath

46
Q

Describe the prophylaxis of pulmonary embolism following fractures.

A

(1) Anticoagulants
- e.g. heparin
- often given with warfarin
- reduces occurrence of blood clots

47
Q

What is a joint?

A

A junction between 2 or more bones

48
Q

What types of joint are there?

A

(1) Ball + socket

(2) Hinge

49
Q

What components of a joint reduce risk of damage?

A

(1) Articular cartilage
(2) Synovial membrane + fluid
(3) Stabilising ligaments

50
Q

What components are present in the knee joint?

A

(1) Meniscus
(2) Bursa
(3) Patella
(4) Ligaments

51
Q

What is the meniscus in the knee?

A

Lateral/ medial

Cushion of fibrous cartilage

Ensures even distribution of weight on the joint

52
Q

What is the bursa in the knee?

A

Fluid-filled sac

Lined by synovial membrane

Provides a cushion between bone + tendons

53
Q

What is the patella in the knee?

A

Knee cap

Protects knee joint

54
Q

What are ligaments comprised of?

A

Collagen + elastin fibres

Provide stability bone-bone

Allow a range of movement

55
Q

Describe the structure of tendons.

A

Tough bands of connective tissue
- mostly comprised of collagen

Contained within a sheath

Lubricated to allow movement without friction

56
Q

What types of muscle are there?

A

(1) Skeletal
- striated

(2) Smooth
(3) Cardiac

57
Q

What is striated muscle?

A

Skeletal muscle

Bundles of contractile fibres

Responsible for movement + posture

Arranged in opposing groups

58
Q

What are satellite cells?

A

Myogenic stem cells

Responsible for post-natal growth/ repair/ maintenance of skeletal muscle

59
Q

How do satellite cells cause muscle growth?

A

(1) Activates by injury/ trauma
(2) Differentiate asymmetrically into another satellite cell + a myoblast
(3) Myoblast matures
(4) Mature myoblast fuses

60
Q

How do satellite cells cause muscle repair?

A

(1) Activates by injury/ trauma
(2) Differentiate asymmetrically into another satellite cell + a myoblast
(3) Myoblast matures
(4) Mature myoblast fuses

61
Q

How do satellite cells cause maintenance of skeletal muscle?

A

(1) Activates by injury/ trauma
(2) Differentiate asymmetrically into another satellite cell + a myoblast
(3) Myoblast matures
(4) Mature myoblast fuses

62
Q

What is a strain?

A

Damaged/ torn muscle

e.g. hamstring injury

63
Q

What is a sprain?

A

Damaged ligaments

e.g. ACL

64
Q

What is tendinitis?

A

Inflammation of tendon

65
Q

What are shin splints?

A

Fractures of shin bone

66
Q

What is the primary treatment of sporting injuries?

A

RICE

R = Rest
- minimises internal bleeding + prevents further injury

I = Ice
- Reduces pain + swelling

C = Compress
- Reduces swelling + further risk of injury

E = Elevate

  • reduces swelling
  • area should be above the level of your heart
67
Q

(1) What is the purpose of icing a sporting injury?

(2) How should it be done?

A

(1) Cold reduces pain + inflammation

(2)
- Wrap ice in towel and apply for 10 minutes
- Remove for 10 minutes
- Repeat for 60-90 minutes to prevent a cold injury

68
Q

Why is ice applied and removed cyclically in treatment of a sporting injury?

A

To prevent a cold injury

Part 3 – PM3B (32 decks)

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