Soft Tissue Conditions Flashcards
What is the boundary between skeletal muscle and a tendon called
Myotendinous junction
Why do tendons repair poorly
Relatively avascular
What is the difference between tendinitis and tendinosis
Tendinitis is acute
Tendinosis is chronic
Tendinitis
Small tears in a tendon causing localised inflammation
Tendinosis
Chronic tendon degeneration in response to chronic injury and failed healing leading to disordered collagen
Tendinitis and tendinosis causes
Overuse
Collagen disorders
Renal dialysis
How is renal dialysis linked to tendon problems
Kidney failure effect collagen
Pt may be put on steroids
Tendinitis and tendinosis treatment
RICE
analgesia + NSAIDs
Stretching
Surgery
What does RICE stand for
Rest
Ice
Compression
Elevation
Heterotopic calcification
Bone formation in soft tissues
Can occur in tendon injuries
How are COX2 and prostaglandins involved in formation of heterotopic bone
COX2 causes chondrocyte differentiation from mesenchymal stem cells
prostaglandins causes chondrocyte hypertrophy
Process of heterotopic bone formation
Chondrocyte differentiation -> chondrocyte hypertrophy -> osteoclast recruitment + osteogenesis + angiogenesis
Which type of drugs decreases hypertropic bone formation by >50% and how
NSAIDs
Prevent chondrocyte differentiation by inhibiting COX2- 1st step in heterotopic bone formation
Why is calcification of a tendon harmful
Tendon more brittle
More prone to rupture
Do exposed or sheathed tendons heal more easily and why
Exposed heal more easily - can recruit systemic repair cells, sheathed tendons can only recruit cells within tendon sheath
Which type of tendon healing improved by cast immobilisation
Tendon-to-bone healing
Detrimental to flexor tendon healing
Which type of tendon healing is improved by passive motion
Flexor tendon healing
Detrimental to tendon-to-bone healing
Difference between extrinsic and intrinsic tendon healing
Extrinsic - peripheral fibroblasts - in exposed tendons
Intrinsic - fibroblasts from within tendon - in sheathed tendons
Is immobilisation generally good for tendon healing
No - healing usually takes longer + more long term damage
Enthesis
site of attachment of tendon, ligament, fascia, or capsule to bone
2 types of enthesis
Fibrous
Fibrocartilaginous
Difference between fibrous and Fibrocartilaginous enthesis
Fibrous - fibrous tissue extends all the way up to bone
Fibrocartilage - section of fibrocartilage at attachment site
Are fibrous or Fibrocartilaginous enthesis better at dissipating stress
Fibrocartilagenous
Sharpey fibres
Collagen bundles from a tendon which travel through the periosteum and insert into bone
Which type of enthesis has a more gradual change in material properties
Fibrocartilage
Ethesitis
Inflammation of the enthesis
Enthsitis causes
Recurring stress
Autoimmune disease
Which autoimmune conditions are associated with enthesitis
Spondyloarthritides
HLA B27 arthopathies
How does mechanical trauma cause pathogenesis of enthesitis
Transcortical vessels in bone at enthesis insertion point become infkammed causing influx of immune cells and formation of osteobkasts
Why does enthesitis cause bone spur formation and how do bone spurs make enthsitis worse
Transcortical vessel inflammation causes oesteoblasts to form bone
Bone spurs rub against and irritate tendons
What is the main immune cell in enthesitis
Neutrophils
Difference between enthesophytes and osteophytes
Enthesophytes originate from insertion of joint capsule, ligament, or tendons
Osteophytes originate from border of articular cartilage
Are enthesophytes or Osteophytes found at the articular border
Osteophytes
Enthesitis treatment
RICE
NSAIDs
Sulfasalazine, methotrexate - treat associated arthritis
Anti TNF - severe autoimmune enthesitis only
Local radiotherapy
Corticosteroid injections
Hyperosmolar dextrose injections
Why is local radiotherapy used in enthesitis
Kill heterotrophic chondrocytes
How does Hyperosmolar dextrose injections help enthesitis
Initiate proliferation of intrinsic fibroblasts increasing the ration of fibroblasts to osteoblasts
Ankylosing spondylitis
Enthesitis of IVDs and anterior longitudinal ligament
Difference in location of tendinitis and enthesitis
Tendinitis in belly of tendon
Enthesitis in insertion point of tendon
Function of tendon sheath
Cushions tendons
Guides tendons
Provides nutrition to tendons - synovial fluid + vincula blood supply
Tenosynovitis
Inflammation of the synovium around a tendon
De Quervains tenosynovitis
Fibrosis and narrowing of the tendon sheath caused by tendons and sheath rubbing over radial styloid process
Which tendons are involved in de quervains tenosynovitis and where is pain felt
EPB + EPL
lateral wrist + 1st dorsal compartment of hand
Trigger finger
Enlargement of a tendon in the hand within the sheath locking the finger in flex ion
What pathology does ficklesteins test test for
De quervains tenosynovitis
How is ficklesteins test performed and what if a positive result
Pt holds hand in fist and doctor moves fist in ulnar deviation
Positive - pain up medial arm
Tenosynovitis treatment
RICE
splinting
Anti inflammatories
Corticosteroid injections
Surgery
How is trigger finger treated surgically
Cut annular ligament
How is de quervains treated surgically
Shave down radial styloid process or cut sheath
What type of condition are trigger finger and de quervains
Tenosynovitis
Systemic lupus erythematosus
Multisystem chronic disorder caused by ANA antibodies against intranuclear proteins
SLE signs and symptoms
Fatigue
Fever
Arthralgia
Weight chages
Migratory asymmetrical pain
Malar facial rash in butterfly pattern
Discoid lesions
Slope is
Renal nephrotic disease
Neuropsychiatric problems
Pulmonary problems
GI problems
Cardiac problems
Haematological problems
What type of antibodies cause SLE
anti nuclear antibodies
What tissues are damaged by immune complexes in SLE
Blood vessels
CT
SLE pathogenesis
DNA released in response to damage -> taken up by APCs -> autoimmune response
Jaccoud arthropathy
Chronic non erosive joint disorder caused by inflammation of the joint capsule and subsequent fibrotic retraction, causing ulnar deviation of the fingers
Usually caused by lupus
What joint condition do 90% of SLE pts develop
Arthritis
Why is jaccoud arthropathy reducible
No bony deformity
2 main patterns of ANAs in SLE
Homogenous
Speckled
SLE treatment
Prevent trigger exposure
NSAIDs
DMARDs
Corticosteroid for flares
IV immunoglobulins
Potential SLE triggers
UV light
Viruses
Belimumab MOA for SLE treatment
Inhibits BAFF
( BAFF causes B cells to mature and make antibodies)
Rituximab MOA for SLE
CD20 blocker
(CD20 found on B cells - causes B cells to apoptose)
