Review of Connective Tissue Disorders

Question 1

Where does skeletal muscle act upon the tendon

Answer 1

Myotendinous junction

Question 2

What is tendinitis

Answer 2

Small tears within a tendon cause localised inflammation

Question 3

What causes tendinitis

Answer 3

Overuse

Collagen disorders

Question 4

Name 3 common sites of tendonitis

Answer 4

• Lateral epicondyle
• Achilles tendinits
• Supraspinatus tendinitis

Question 5

How can tendinitis be treated

Answer 5

RICE
Analgesics/ NSAID
Stretching
Surgery if very serious

Question 6

How may partial achilles tendon tears heal

Answer 6

By forming heterotopic calcified regions– heterotopic ossification

Question 7

What signals are involved in conversion from mesenchyma stem cells to hypertophic chondrocytes

Answer 7

COX-2 independent andCOX-2 dependent

Question 8

What signals work on the hypertrophic chondrocytes to form bone cells

Answer 8

VEGF
Cyr61
RANKL

Question 9

What happens when VEGF, Cyr61 and RANKL are activated

Answer 9

Angiogenesis
Osteoclast recruitment
Osteogenesis
Fracture bridging

Question 10

What drugs can inhibit formation of heterotopic calcified regions

Answer 10

NSAIDs

Question 11

What is the consequence of large calcification points forming in the tendon

Answer 11

Becomes more brittle

May rupture/ fracture

Question 12

Why do tendons take a long time to heal

Answer 12

They are avascular

Question 13

How does injury healing occur in extrinsic tendons

Answer 13

By peripheral fibroblasts

Question 14

What is an intrinsic tendon

Answer 14

Any tendon covered by a tendon sheath

Question 15

How are instrinsic tendons healed

Answer 15

Fibroblasts from the tendon shealth themself

Question 16

What are the 2 types of enthesis

Answer 16

Fibrous and fibrocartilaginous

Question 17

What is a fibrous enthesis

Answer 17

Fibrous tissue extending all the way up to the point of bone insertion
Collagen fibres insert into bone

Question 18

What is a fibrocartilaginous

Answer 18

Small section of fibrocartilage at the attachment site

Helps to stiffen to tendon/ ligament and creates a gradual change in mechanical properties

Question 19

If theres little movement of tendon/ ligament, what kind of enthesis will there be

Answer 19

Fibrous

Question 20

Define enthesis

Answer 20

Any point of attachment for tendon/ ligament inserting into bone

Question 21

What is enthesitis

Answer 21

Inflammation of the enthesis

Question 22

What can cause enthesitis

Answer 22

Recurring stress

Autoimmune disease

Question 23

What arthropathies is enthesitis associated with

Answer 23

HLA B27

Question 24

Where do enthesis normally insert into

Answer 24

Porous bone where there are lots of small transcortical vessels

Question 25

What happens when there is a mechanical traume to enthesis

Answer 25

Inflammatory process causes production of osteoblasts causing heterotropic calcification at the insertion point Osteoblasts move into enthesis

Question 26

Name 3 comorbid conditions associated with enthesitis

Answer 26

Inflammatory bowel disease Psoriatic arthritis Ankylosing spondylitis

Question 27

How would enthesitis appear on an x-ray

Answer 27

There is an identifiable bone spur/ nodule at the insertion site

Question 28

How do enthesophytes differ from osteophytes

Answer 28

Originate from joint capsule, tendon or ligament | The articular border is not involved and osteophytes originate from here

Question 29

How should enthesitis be treated from a mechanical perspective

Answer 29

RICE | NSAIDs

Question 30

How should enthesitis be treated from an inflammatory perspective

Answer 30

``` Sulfasalzine/ methotrexate Anti-TNF Radiotherapy Corticosteroid injection Hyperosmolar dextrose injection ```

Question 31

When is anti-TNF used to treat enthesitis

Answer 31

In isolated incidents

Question 32

What is the relation between ankylosing spondylitis and enthesitis

Answer 32

Ankylosing spondylitis is enthesitis of IV disc and anterior longitudinal ligament

Question 33

How can you tell apart achilles tenditiis and achilles enthesitis

Answer 33

Enthesitis is lower down

Question 34

What is the role of the tendon sheath

Answer 34

Cushions tendon Guides tendon Tendon nutrition

Question 35

How are tendons given nutrition by tendon sheath

Answer 35

Synovial fluid from tendosynovial shealth | Vincula blood supply

Question 36

What is De Quervians tenosynovitis

Answer 36

Fibrosis and narrowing of the tendon sheath | Caused by tendons and sheath rubbing over radial styloid process

Question 37

What is trigger finger

Answer 37

Enlargement of tendon within the sheath

Question 38

How is trigger finger treated surgically

Answer 38

Cut theannular ligament

Question 39

How is De Quervians tenosynovitis treated surgically

Answer 39

Shave the radial styloid process

Question 40

What are the signs/ symptoms of systemic lupus

Answer 40

``` Fatigue Fever Weght chances Small joints swell Asymmetrical pain Photosensitivity Neuropsychiatric probs Pulmonary fibrosis GI problem ```

Question 41

What hypersensitivity reaction is responsible for lupus

Answer 41

Mainly 3, a bit of 2

Question 42

Briefly describe the pathophysiology of lupus

Answer 42

- Immune complexes cause damage to blood vessels and connective tissue

Question 43

What % of SLE patients develop arthralgia

Answer 43

90%

Question 44

What is Jaccoud arthropathy

Answer 44

Hand deformities due to tendinitis/ tenosynovitis | Looks like RA but can be moved back into normal position- non erosive and no joint involement

Question 45

What staining is used for lupus diagnosis

Answer 45

anti nuclear antibody staining

Question 46

How can lupus be treated

Answer 46

Biological DMARDS Belumumab Rituximab

Question 47

Mechanism of action of ritiximab

Answer 47

C20 blocker