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Musculoskeletal System > Soft tissues > Flashcards

Soft tissues Flashcards

1
Q

What is fibrous tissue?

A

Scar tissue

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2
Q

What is bursae?

A

Small sacs of fibrous tissue that are lined with synovial membrane which secrete synovial fluid

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3
Q

What is the function of bursae?

A

Reduce friction where ligaments and tendons pass over bone

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4
Q

What is bursitis?

A

Inflammation of the bursa, which can be idiopathic (unknown reason) or part of a systemic inflammatory disease, or due to gout or infection

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5
Q

Name the 3 common types of bursitis?

A
  1. Olecranon bursitis
  2. Prepatellar bursitis
  3. Trochanteric bursitis
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6
Q

What is olecranon bursitis caused by?

A

-excessive friction at the elbow, for example by resting the elbow on elbow flexion

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7
Q

When are idiopathic and traumatic olecranon bursitis cases usually painful

A

When pressure is applied

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8
Q

What are the clinical symptoms of bursitis and what is the management?

A

Clinical symptoms
- tender and distended (enlargement)
Management:
- bursal fluid should be aspirated to exclude infection and improve symptoms
- Local corticosteroid injections is effective in non- septic

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9
Q

Who is prepatellar or infrapatellar bursitis most common in and what are the symptoms?
How is it investigated?
What is the treatment?

A
  • carpet fitters who spend a lot of time kneeling
  • hot, red, swollen patella
  • joint aspiration: to exclude infection or gout
  • Treatment: rest but in recurrent episodes surgical intervention might be needed, antibiotics should be given for septic arthritis
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10
Q

What happens if the infected bursitis does not go away with antibiotics?

A
  • formal incision and drainage might be needed
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11
Q

What is trochanteric bursitis and what are the symptoms?
What is the treatment?
How is it investigated?

A
  • trochanteric bursa is located lateral to the greater trochanter of the femurs and allows motion of the fascia lata over the trochanter
  • Symptoms: hip pain in trochanter rather than groin area
  • Treatment: physiotherapy, steroidal injections in severe cases and in very persistent cases: surgery
  • By examination and history trochanteric bursitis can be identified
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12
Q

What is carpal tunnel syndrome?

A
  • a syndrome that results from the compression of the median nerve as it passes through the carpal tunnel at the wrist
  • carpal tunnel is formed by the space between the carpal ligaments and carpal bones
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13
Q

How common is CTS?

A
  • common

- more prevalent in women and the elderly

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14
Q

What is the usually cause of CTS?

A
  • idiopathic but can be associated with several underlying conditions
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15
Q

What are the clinical features of CTS?

A
  • pain
  • paraesthesia in the median nerve distribution and can these symptoms can radiate to the elbow
  • pain is often worse at night and they classically wake up from sleep
  • muscle wastage is possible in advanced disease
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16
Q

Name some conditions that predispose you to carpal tunnel syndrome?

A
  • Diabetes mellitus
  • Hyperthyroidism
  • Pregnancy
  • Rheumatoid arthritis
  • Trauma
  • Acromegaly (pituitary gland produces too much growth hormone during adulthood)
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17
Q

How to you examine patients with carpal tunnel syndrome?

A
  • strength muscles should be tested by the thenar test

- the opponens pollicis muscle is tested by thumb and little finger and resist attempts to separate the two

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18
Q

What investigation can be taken for CTS?

A
  • serum glucose and thyroid function tests should be performed to exclude underlying medical conditions
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19
Q

How is CTS managed? `

A
  • surgical decompression of the carpal tunnel by division of the transverse carpal ligament.
  • very effective procedure and can be performed under local anaesthesia
  • less severe cases wrist splints may help nocturnal symptoms
  • corticosteroids might provide some relief
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20
Q

What is chronic fatigue syndrome?

A

Long term illness with a wide range of symptoms mainly extreme fatigue

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21
Q

What is the other name cfs (chronic fatigue syndrome is referred to)

A

ME

- myalgic encephalomyelitis

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22
Q

What is the epidemiology of CFS?

A
  • can affect everyone and also children

- more common in women and tends to develop between mid -20s and mid 40s

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23
Q

Name some symptoms of CFS

A
  • sleep problems
  • muscle or joint pain
  • headaches
  • flu like symptoms
  • feeling dizzy or sick
  • fast or irregular heartbeats
  • problems thinking
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24
Q

How is CFS investigated/diagnosed?

A
  • no specific test but it is diagnosed based on history and ruling out other conditions
  • blood and urine test can be used (to rule out for example anaemia, underreactive thyroid and liver/kidney problems) etc.
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25
Q

How is CFS treated?

A
  • cognitive behavioural therapy
  • structured exercise programme called graded exercise therapy
  • medicine to control pain, nausea, and sleeping problems
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26
Q

What are the causes of CFS?

A
  • viral infections
  • bacterial infections e.g pneumonia
  • problems with immune system
  • hormone imbalance
  • mental health trauma such as stress or emotional trauma
  • your genes
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27
Q

Name the 3 main pathologies that affect tendons

A
  • tendinopathy (tendon pain)
  • tenosynovitis
  • rupture
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28
Q

Name the most common sites and symptoms of tendinopathy

A 
Sites: 
- shoulder 
- elbow 
- Achilles Tendon 
Symptoms: 
- pain worsened by active movement 
- tenderness over tendon 
- soft tissue swelling
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29
Q

Name some examples of tendinopathy

A
  1. Rotator cuff (beneath the acromion is the subacromial space and if this space becomes narrowed, irritation of supraspinatus can occur > leads to tendinopathy
  2. Tennis elbow (lateral epicondyle is tender and pain is exacerbated by resisted wrist extension
  3. Golfer’s elbow - common flexor origin at the medial epicondyle is tender and exacerbated by wrist flexion
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30
Q

How is tendinopathy investigated?

A
  • it can be diagnosed clinically and investigations are often unremarkable
  • radiographs may show abnormalities e.g calcification in chronic rotator cuff disease
  • ultrasound scan and magnetic resonance imaging may also detect changes in tendon and surrounding tissue
31
Q

How is tendinopathy managed?

A
  • rest
  • NSAIDs
  • physiotherapy
  • local corticosteroid injection
  • surgery
32
Q

What is tenosynovitis and what are the main causes of it?

A

It is an inflammation of the tendon
caused by:
- inflammatory arthritis
-trauma (repetitive or unaccustomed movement)

33
Q

What are the clinical features and management of tenosynovitis?

A
  • pain
  • common regions are the abductor pollicis longus and extensor brevis tendon and finger flexors
  • tender and swollen tendon and some crepitus on palpation
  • trigger finger or thumb might develop
34
Q

What is a trigger finger and how is it caused

A

Trigger finger is a condition in which one of your fingers gets stuck in a bent position
Causation:
- nodule develops on the tendon
- nodule catches as it enter or leaves the flexor tendon pulleys and a snapping of flicking movement occurs on flexion and extension
- in severe cases the finger might remain in flexed position and requires other hand to release it from that position

35
Q

How is tenosynovitis treated?

A
  • splinting
  • local corticosteroids injections
  • rest
  • in severe cases surgical decompression
36
Q

What are the clinical features of a tendon rupture?

A
  • loss of movement at the joint

- long head of bicep tendon bulges

37
Q

How is a tendon rupture managed?

A
  • sometimes no intervention required
  • splinting
  • surgery to restore function
38
Q

What are the differences in history taking of a benign vs a malignant tumour?

A 
Benign: 
- Slow rate of growth 
- Painless 
- Local pressure effects 
Malignancy: 
- Fast rate of growth
- Other new masses/ lesions 
- Painful 
- Local invasive effect 
- Associated lumps 
- Associated symptoms of metastases/systemic spread
39
Q

How do you examine a tumour? 6 S’s

A
  • Site
  • Size
  • Shape
  • Surface
  • Substance (consistency, soft, firm, hard)
  • Surrounding structures (local tissue, lymph nodes, nerves, blood vessels, other organs)
40
Q

What are the main findings of benign tumours on examination?

A
  • well defined
  • mobile
  • smooth
  • soft
  • No associated masses
41
Q

What are the main findings of malignant tumours on examination?

A
  • Ill defined
  • Immobile
  • Irregular
  • Hard
  • Associated masses
  • Associated
    organomegaly
  • Associated reduced function
42
Q

What are the main investigations of benign tumours?

A
  • Well defined
  • Capsule
  • No invasion
  • Homogenous signal pattern
43
Q

What are the main investigations of malignant tumours?

A
  • Ill defined
  • No capsule
  • Invasion of local tissue
  • Heterogenous signal pattern
  • Metasteses in organs or lymph nodes
44
Q

What are the main 3 rules to treat patients?

A
  • Establish the diagnosis
  • Establish the extent of the disease
  • Establishes the management
45
Q

What are the signs of an infection

A
  • Rubour: redness
  • Calor: warmth
  • Tumor: Swelling
  • Dolor: pain
46
Q

What are the main mechanism of STI?

A
  • Direct injury
  • Long term wear and tear
  • Unclear? Inflammatory reasons
  • Repetitive injury
47
Q

Name 5 main upper limb soft tissue injuries

A 
Shoulder ACJ dislocation
•Shoulder dislocation
•Shoulder rotator cuff tear
•Long head of biceps tear
•Elbow dislocation
•Distal Biceps tendon tear
•Skiers Thumb
•Small joint dislocations
•Other ligament and tendon ruptures, flexor / extensor tendons
48
Q

Name some lower limb soft tissue injuries

A
  • Knee ACL tear
  • knee Collateral ligaments and meniscus injury
  • Quadriceps tendon rupture
  • Patellar tendon rupture
  • Tendoachilles rupture
  • Ankle sprains
49
Q

How is an achilles tendon rupture treated

A
  • Physio and surgery
50
Q

How is an anterior cruciate ligament injury treated

A
  • Brace and phyisotherapy
  • Surgical reconstruction if needed
  • RICE
  • Analgesia
51
Q

How is a distal bicep rupture treated?

A
  • Sling and physiotherapy
  • Surgical reconstruction
  • Education
52
Q

What special tests are carried out for people with achilles tendon rupture?

A
  • Calf squeeze test: if the feet pronates, the achilles tendon is in tact.
53
Q

What are the special tests used to diagnoses distal biceps ruptures?

A
  • The hook test: test for any ruptures
54
Q

How is the dislocated acromioclavicular joint treated?

A
  • Physiotherapy
  • Sling for 6 weeks
  • Surgery in severe cases
  • Education
55
Q

How do acromioclavicular joints dislocations happen?

A

By falling on an outstretched arm

56
Q

What are the special tests used to diagnoses ACL tears?

A
  • Anterior drawer test

- Lachmans Test

57
Q

What can cause leg/upper limb pain?

A
  • Injury
  • Infection
  • Inflammatory
  • Tumours
58
Q

What kind of skin conditions are often seen in practise?

A 
- Cellulitis (skin infection) 
(usually a margin is drawn around the cellulitis - to see whether the antibiotics are working) 
- Bruising 
- Insect bites 
- Insect burns 
- Haemosiderin  
- Nails 
- Rashes 
- Ulcers
59
Q

Do females or males complain more about bursitis?

A
  • Females because they have shorter legs than men and they have a pelvis that might have given birth (greater trochanteric pain)
60
Q

Why do people develop muscle pain?

A
  • Overuse
  • Viral infections
  • Cramps
  • Claudication (not enough blood flowing through muscle- not enough oxygen)
  • Muscle rupture e.g hamstrings
  • Chronic pain e.g fibromyalgia, myofascial pain syndrome (nerve endings might be the one causing pain)
  • Alcohol and other drugs e.g statins
  • Endocrine causes e.g hypothyroidism
  • Inflammatory diseases e/g polymyositis (causes muscle weakness affecting both sides of your body)
  • Compartment syndrome
61
Q

How are ligament injuries treated?

A
  • RICE (Rest, Ice, Compression, Elevation)
  • Analgesia
  • Physio
62
Q

What are varicose veins?

A
  • usually caused by weak vein valves and walls. -Occurs when the walls of the veins become stretched and lose their elasticity
  • varicose veins happen in the veins near the surface of the skin
63
Q

What causes varicose veins?

A
  • increased blood pressure in veins causes inelasticity
64
Q

What happens in deep vein thrombosis?

A

Blood clot forms inside the veins

65
Q

What is sciatica?

A

Pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg.

66
Q

What is meralgia paraesthetica?

A

neurological condition that causes pain in the outer thigh - caused by compression of a nerve

67
Q

What is lymphoedema?

A

Swelling that generally occurs in arms or legs - it is caused my damage or removal of lymph nodes

68
Q

What is a hernia?

A

Abdominal wall becomes weak so some parts of the bowel push through it and it presents as swelling

69
Q

What is the strength of a muscle determined by?

A

Its size

70
Q

Long fibres are good for …….(1)…….

Short fibres are good for ..(2)…..

A
  1. rapid

2. large

71
Q

During exercise we increase muscle strength by reducing muscle fibre cross- sectional area. TRUE OR FALSE

A

FALSE - we reduce muscle fibres by increasing cross- sectional area

72
Q

What are the two types of contractions a muscle can do?

A

Isometric - contraction against resistance where length of muscle remains the same
Isotonic
- contraction against resistance where length of muscle changes
- concentric: in direction of contraction
- eccentric: opposite to direction of contraction

73
Q

How do you investigate an Achilles tendon tear/rupture?

A

Via the Simmonds test

Normal leg:
Squeeze calfs, foot should move in a downwards direction

Injured leg
Squeeze calf, no foot movement (this is not normal)

74
Q

What are the major complications of an Achilles tendon rupture repair operation?

A

DVT

Musculoskeletal System (14 decks)

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