WEEK 4 Soft Tissue Disorders & Osteochondroses Flashcards
What is the term for stretching & tearing of musculotendinous unit?
strain
Which tendon injury reflects a more chronic condition w/ minimal or no inflammatory process detected histologically?
tendinosis or tendinopathy
Changes w/ tendinosis or tendinopathy at the cellular level involve expansion of local cells & thinner _________ fibrils.
collagen
What is the term for bruising w/ intact skin?
muscle contusion
Myofascial compartment syndrome is when there’s increased ________ pressure within closed compartment –> compromising nerves, muscles, vessels.
interstitial
Where does myofascial compartment syndrome usually occur?
- envelopes of lower leg
- forearm
- thigh
- foot
What is the earliest clinical symptom of impending acute compartment ischemia?
disproportionate deep, throbbing pain
In severe compartment syndromes, which objective signs are visible?
swollen extremity w/ smooth, shiny, or red skin
What is the standard intervention of severe compartment syndromes?
surgical decompression
During adolescent growth spurts, the cartilage cells of ________ become more active & prone to injury.
physis
Where does osteochondritis dissecans happen?
articular surface
Where does osgood-schlatter disease happen?
apophysis
What is the term for partial disruption of anatomic relationship within a joint?
sublaxation
What joints are most at risk for sublaxation?
- GH
- AC
- SI
- AA
What joint does dislocation occur most often at?
GH
Where are congenital dislocations most freq seen at?
hip
Movement during the first ___-___ days should be done w/ care to avoid stretching injured muscle.
3-7
B/t ___-___ days, gradually progress to using injured muscle more actively.
7-10
What type of training should be done first? What should it progress to? What’s last?
isometric –> isotonic –> isokinetic
_________ contraction is advocated for chronic tendinopathies.
eccentric
What is the term for bone formation in nonosseous tissues (usually muscles & other soft tissue areas) after trauma?
heterotopic ossification
Where does myositis ossificans occur?
bruised, damaged, or inflamed muscle
What are the 2 most common presenting symptoms of HO?
- muscle pain
- loss of motion
What type of end-feel is seen in individuals 3-6 months in w/ HO?
rigid or abrupt w/ pain
What sites are most affected by HO?
- hip
- elbow
- knee
- shoulder
- TMJ
What is the term for at least 2 connective tissue diseases @ same time or in diff time frames?
mixed connective tissue disease or overlap connective tissue disease
OCTD frequently includes overlapping features of which diseases?
- SLE
- scleroderma
- polymyositis
Who is predominantly affected by connective tissue disease?
adult women
What type of connective tissue disease has clinical & serologic characteristics of multiple autoimmune diseases?
undifferentiated
Which disease is present in 75% of cases of OCTD?
RA
A _________ sensory neuropathy appears to occur much more freq in MCTD/OCTB than in other rheumatic diseases.
trigeminal
What is the disorder marked by diffuse pain & stiffness in multiple muscle groups that primarily affects the shoulder & pelvic girdle?
polymyalgia rheumatica
The initial symptoms of PMR are subtle but a significant # of ppl w/ it also develop giant cell ________.
arteritis
At what age do most cases of PMR occur? Which gender?
over 70, women
PMR painful stiffness lasts more than ___ hour(s) in morning on arising.
1
The symptoms of PMR are often bilateral & (symmetric/asymmetric) affecting the neck, SC jt, shoulders, hip, low back, & buttocks.
symmetric
What is the rapid breakdown of skeletal mm tissue bc of mech, physical, or chem traumatic injury?
rhabdomyolysis
Injury in rhabdomyolysis results in release of _________ _________ enzymes, myoglobin, & other by-products into blood –> renal failure.
creatine phosphokinase
What is the change in urine color associated w/ rhabdomyolysis?
tea or cola colored
Injured muscle in rhabdomyolysis leaks _________ –> disruptions in heart rhythm.
potassium
What is the term for nonspecific muscle weakness secondary to identifiable disease or condition? What about if it’s inflammatory?
- myopathy
- myositis
What is the term for nonnecrotizing myopathy accompanied by fiber atrophy, fatty degeneration of mm fibers, & fibrosis that prolongs ICU stays?
critical illness myopathy
What are the 4 types of acquired myopathies?
- inflammatory
- endocrine
- associated w/ systemic illness
- drug-induced or toxic
Myopathy has more (distal/proximal) muscle weakness while myositis has more (distal/proximal).
- pathy: proximal
- sitis: distal
________-induced myopathy –> respiratory myopathy.
statin
What is the term for hyperirritable spots in a taut band of skeletal muscle that is painful on compression, stretch, overload, or contraction of tissue which usually responds w/ referred pain distal?
trigger points
TrPs are _________ when they cause spontaneous local & referred pain & __________ when they cause pain only on stimulation.
active & latent
Both active & latent TrPs can cause allodynia & primary & secondary hyperalgesia which implies that __________ fibers from TrP nociceptors can make new effective connections w/ dorsal horn neurons.
afferent
TrPs have been reported in all age groups except which?
infants
The current thinking & attention of TrPs has shifted more from mech factors –> __________ factors.
biopsychosocial
What should be the last step in physical examination process?
palpation of relevant muscles
What are the 3 criteria for identification of TrPs?
- taut band in relevant muscle
- presence of TrP in band
- referred pain
The most common metabolic & hormonal factors in myofascial pain are (hyper/hypo)thyroidism, gonadal hormone conditions, protozoal infections, & iron, mag, B12, D, estrogen, test deficiencies.
hypo
Possible side effects of meds such as w/ ________ drugs may induce widespread myalgias.
statin
What muscles are in the superficial layer of PF?
- external anal sphincter
- sexual (bulbocav & ischiocav)
- superficial transverse perineal
What muscles are in the urogential diaphragm (2nd layer) of PF?
- sphincter urethra
- urethrovaginal sphincter
What muscles are in the levator ani (deepest layer)?
- puborectalis
- pubococc
- coccygeus
- ishococc
Which layer participates in urinary continence? Which supports pelvic viscera?
- continence: 2nd
- viscera: deep
Urinary or fecal incontinence & pelvic organ prolapse is due to (under/over)activity of PFM.
under
Obstructive voiding or defecation, dyspareunia, & pelvic pain is due to (under/over)activity of PFM.
over
What is the most common factor of underactivity of PFM?
birth-related trauma
What are the 2 categories of origin of dysfunction of overactivity of PFM? Which one has evidence said is the primary origin?
- tissue-based/nociceptive
- neuropathic/central sensitization*
What is the term for pain related to coccyx & muscles attached there?
coccygodynia
What are the categories of causes of coccydynia?
- MSK
- direct trauma (childbirth or fall)
- inflammation
- infections
- referred pain from visceral sources
- neoplasm
- centralized pain syndrome
What is coccygeal spicule?
hook on end of coccyx
Sacral _________ is a rare, slow-growing tumor that should be considered in diff dx of coccygodynia.
chordoma
What is the term for where 2 pelvic sympathetic trunks converge ending in ganglion @ front of coccyx (which can cause chronic pain w/ overactivity)?
ganglion impar
What is the most susceptible area for osteochondroses?
epiphyses
What is the disorder of 1 or more ossification sites w/ localized subchondral necrosis followed by recalcification?
osteochondritis dissecans (OCD or OD)
In OCD/OD, piece of _________ cartilage & fragment of bone separate & pull away from underlying bone –> loose in joint.
articular
Where are the most common sites of involvement of OCD/OD?
concave surfaces of synovial jts:
- medial femoral condyle
- talar head
- capitellum of humerus
OCD/OD is caused by repetitive __________ resulting in ischemia & disruption of subchondral growth.
microtrauma
What is the term for when pain is increased w/ passive knee extension & tibial IR & relieved w/ tibial ER?
wilson sign
What is the term for death of bone & bone marrow cellular components bc of loss of blood supply in absence of infection?
osteonecrosis (avascular/aseptic)
What is the most common site of osteonecrosis? What is the name for this?
femoral head (chandler disease)
What are other sites in which osteonecrosis is common?
- scaphoid
- talus
- prox humerus
- tibial plateau
- small bones of wrist & foot
What type of gait abnormality is seen w/ osteonecrosis in femur?
antalgic
What type of surgical interventions are done for osteonecrosis?
- core decompression
- hemiarthroplasty
- total jt replacement
What are other names for legg-calve-perthes disease?
coxa plana (flat hip) & osteochondritis deformans juvenilis
Legg-calve-perthes disease is epiphyseal aseptic necrosis of proximal end of __________.
femur
Who does legg-calve-perthes disease occur in the most?
boys b/t 5-8 yrs
Legg-calve-perthes disease has insidious onset w/ intermittent appearance of a limp on involved side & ________ pain w/ soreness, aching, & stiffness.
hip
Pain of legg-calve-perthes disease follows the path of which nerve?
obturator
What disease results from fibers of patellar tendon pulling small bits of immature bone from tibial tub (considered as tendinitis)?
osgood-schlatter
Which age groups in boys & girls is osgood-schlatter seen in? Who is it seen in more often?
- boys: 10-15*
- girls: 8-13
What 3 abnormal alignment conditions can lead to osgood-schlatter?
- genu valgum
- flat-footed
- high-riding patella (patella alta)
Avulsion of _________ ossification center of tibial tub occurs when patellar tendon fibers pull fragments away from tibial epiphysis.
secondary
