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Part 3 – PM3B COPY T > (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
What are osteoblasts?
Bone cell type Essential for bone formation Cuboidal cells located along the bone surface Secrete collagen proteins + proteoglycan - mainly type 1 collagen Initiate calcification
26
What are osteocytes?
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
27
What are osteoclasts?
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
28
How can a condition such as osteoporosis be caused?
Imbalance between bone resorption and formation
29
What happens when an osteocyte dies?
Surrounding bone dies
30
What is the purpose of mechanosensors in bone tissue?
To sense bone health
31
What happens at the end of a bone formation cycle?
Osteoblast subpopulation become osteocytes in the matrix
32
How do osteocytes maintain bone?
Regulation of mineral ion exchange
33
How is an osteoclast formed?
(1) Haemopoietic prescursor (2) Preosteoclast (3) Osteoclast can also be formed from: (1) Mesenchymal stem cell (2) Preosteoblast (3) Osteoclast
34
What happens if the number of osteoclasts outweighs number of osteoblasts?
Osteoporosis Weakens bone strength
35
What is the most common cause of fractures?
Trauma
36
What are some common symptoms of fractures?
(1) Pain (2) Loss of function (3) Deformity (4) Crepitus - grating/ popping/ cracking sound (5) Bleeding can occur from bone/ surrounding tissues
37
What is the treatment for fractures?
(1) Immobilise + support limb (2) Pain relief - not NSAIDs as reports of delayed healing (3) Immobilisation with casts/ surgical fixation of fracture
38
What should be advised to a patient with a fracture cast?
(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
What is compartment syndrome?
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
What are the symptoms of compartment syndrome?
Increasing pain in immobilised limb following fracture
41
What is the treatment of compartment syndrome?
Surgery to relieve pressure in constricted tissue Amputation may be necessary if muscles/ nerves have died
42
What are some potential complications of fractures?
(1) Compartment syndrome | (2) Pulmonary embolism
43
What is a pulmonary embolism?
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
Why does a fracture increase risk of pulmonary embolism?
(1) Trauma to leg (2) Forced immobility (3) Reduced blood flow to veins
45
What are some symptoms of pulmonary embolism?
(1) Chest pain (2) Cough (3) Shortness of breath
46
Describe the prophylaxis of pulmonary embolism following fractures.
(1) Anticoagulants - e.g. heparin - often given with warfarin - reduces occurrence of blood clots
47
What is a joint?
A junction between 2 or more bones
48
What types of joint are there?
(1) Ball + socket | (2) Hinge
49
What components of a joint reduce risk of damage?
(1) Articular cartilage (2) Synovial membrane + fluid (3) Stabilising ligaments
50
What components are present in the knee joint?
(1) Meniscus (2) Bursa (3) Patella (4) Ligaments
51
What is the meniscus in the knee?
Lateral/ medial Cushion of fibrous cartilage Ensures even distribution of weight on the joint
52
What is the bursa in the knee?
Fluid-filled sac Lined by synovial membrane Provides a cushion between bone + tendons
53
What is the patella in the knee?
Knee cap Protects knee joint
54
What are ligaments comprised of?
Collagen + elastin fibres Provide stability bone-bone Allow a range of movement
55
Describe the structure of tendons.
Tough bands of connective tissue - mostly comprised of collagen Contained within a sheath Lubricated to allow movement without friction
56
What types of muscle are there?
(1) Skeletal - striated (2) Smooth (3) Cardiac
57
What is striated muscle?
Skeletal muscle Bundles of contractile fibres Responsible for movement + posture Arranged in opposing groups
58
What are satellite cells?
Myogenic stem cells Responsible for post-natal growth/ repair/ maintenance of skeletal muscle
59
How do satellite cells cause muscle growth?
(1) Activates by injury/ trauma (2) Differentiate asymmetrically into another satellite cell + a myoblast (3) Myoblast matures (4) Mature myoblast fuses
60
How do satellite cells cause muscle repair?
(1) Activates by injury/ trauma (2) Differentiate asymmetrically into another satellite cell + a myoblast (3) Myoblast matures (4) Mature myoblast fuses
61
How do satellite cells cause maintenance of skeletal muscle?
(1) Activates by injury/ trauma (2) Differentiate asymmetrically into another satellite cell + a myoblast (3) Myoblast matures (4) Mature myoblast fuses
62
What is a strain?
Damaged/ torn muscle e.g. hamstring injury
63
What is a sprain?
Damaged ligaments e.g. ACL
64
What is tendinitis?
Inflammation of tendon
65
What are shin splints?
Fractures of shin bone
66
What is the primary treatment of sporting injuries?
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
(1) What is the purpose of icing a sporting injury? | (2) How should it be done?
(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
Why is ice applied and removed cyclically in treatment of a sporting injury?
To prevent a cold injury

Part 3 – PM3B COPY T (33 decks)

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