Bishop Func, Injury, Inflammatory Process, Repair, And Properties Of Connective Tissue

Front 1

_______ are insoluble, extracellular glycoproteins found in all animals

they are the most abundant proteins in the human body

Back 1

collagens

Front 2

what are essential structural components of all connective tissues, such as
cartilage, bone, tendons, ligaments, fascia, skin?

Back 2

collagen

Front 3

26 types of ______ have been found in humans

Back 3

collagens

Front 4

What type of collagen is the chief component of tendons, ligaments, and bones?

Back 4

Type 1

Front 5

what type of collagen represents more than 50% of the protein in cartilage?

Back 5

Type 2

Front 6

what type of collagen strengthens the walls of hollow structures like arteries, the intestine, and the uterus?

Back 6

type 3

Front 7

what type of collagen forms the basal lamina of epithelia (aka basement membrane). a meshwork of this type of collagen provides the filter for the blood capillaries and the glomeruli of the kidneys

Back 7

Type 4

Front 8

collagen
are the fibers short or long?
does it have little or a lot of GAG (glycoaminoglycans) aka ground substance?

Back 8

long dense fibers

not a lot of ground substance

recall that ground substance is the filler. collagen is very dense and stiff.

Front 9

elastin

are the fibers short or long?
does it have little or a lot of GAG aka ground substance?

Back 9

the fibers are short

lots of ground substance

stretchy

Front 10

ground substance is made of what 2 things?

Back 10

glycoproteins and proteoglycans

Front 11

what are proteoglycans made of (2 things)

Back 11

GAG and protein

Front 12

periosteum at the edge of cartilage is _______ vascular and has _______

Back 12

highly vascular

chondroblasts

Front 13

___________ is a dialysate of blood plasma

does it have clotting factors? hyalurate? glycoproteins?

Back 13

synovium

it has no clotting factors

it has hyalurate and glycoproteins

Front 14

what is the 2 roles of synoviocytes?

Back 14

1. phagocytic
2. fibroblast like

Front 15

in the menisci, the outside is _____

Back 15

vascular

meaning the outer heals well, but injury to inner does not heal well

Front 16

menisci - the peripheral 1/3 is _____ and is called the ____ zone

Back 16

vascular

peripheral 1/3 is the red zone

Front 17

90% of bone is type ___ collagen

Back 17

type 1

Front 18

osteoporosis is decreased _______

Back 18

bone formation

Front 19

osteomalacia is decreased ______

Back 19

calcium per matrix unit

Front 20

bone is formed two ways. what are they and explain.

Back 20

1. intramembranous - direct mineralization of bone matrix

2. endochondral - deposition of bone matrix onto COLLAGEN

Front 21

explain intramembranous bone formation

Back 21

flat bones
1 degree ossification centers form
new matrix calcifies
areas of 1 degree ossification meet

Front 22

explain endochondral bone formation

Back 22

hyaline cartilage resembles final bone

starts w/ intermembranous
rapid growth of LONG BONE
epiphyseal plates

Front 23

growth and remodeling

growth associated w/ resorption ______ faster in children

bone longer by ____ plate
wider by apposition in periosteum

Back 23

200x

epiphyseal

Front 24

osteoblasts when active secrete what 3 things?

when resting, what do osteoblasts regulate?

Back 24

1. matrix
2. structural proteins
3. proteoglycans

regulate collagenaze

Front 25

osteoclasts are regulated by ______ activity

Back 25

osteoblast activity

Front 26

what are the 2 types of insertions?

Back 26

1. direct - becomes part of bone haversion system

2. indirect - deep layer of fibers attach into bone; no fibrocartilage zone; Immob for 12 wks have substantial bone loss

Front 27

what in order are the 3 basic stages of healing?

Back 27

1. inflammation
2. proliferative
3. remodeling - maturation

Front 28

what are the 3 purposes of the inflammatory stage?

Back 28

1. dispose of damaged tissue
2. supply necessary nutrients
3. prepare the wound for repair

Front 29

what are some causative factors for the inflammatory stage?

Back 29

1. immunologic reactions
2. anoxia
3. metabolic/genetic derangements
4. physical agents
5. biological agents
6. trauma

Front 30

what are some influences on the inflammatory response?

Back 30

1. blood supply
2. diet - strawberries and shrimp
3. age
4. constitution
5. drugs - corticosteroids INHIBIT macrophages and neutrophils to inflammatory site, and INHIBIT prostaglandins. blood thinners can affect inflammatory response

Front 31

what are the Cardinal signs for the inflammatory stage?

Back 31

1. redness
2. heat
3. edema
4. pain

loss of function - associated w/ pain AT REST (NOT MOVING) or w/ active motion

Front 32

________ response to inflammatory stage

mediators
neurogenic
chemical - histamine ______;
-serotonin
-kinins and prostaglandins ____ vessel permeability

Back 32

histamine vasodilates

kinins and prostaglandins INCREASE vessel permeability

Front 33

vascular changes during inflammatory change.

within seconds of the injury, what happens?

Back 33

vasoconstriction!
neurogenic and chemical causes
may last seconds to minutes depending on severity of the injury

Front 34

vascular changes during inflammatory stage

what happens immediately after vasoconstriction?

Back 34

vasodilation!
produces congestion and hyperemia (hemoconcentration); venous outflow slowed; increased hydrostatic pressure

Front 35

vascular changes during inflammatory stage.

first vasoconstriction, then vasodilation. whats the 3rd step?

Back 35

increased vascular permeability
-further congestion and widening of epithelial junctions
-caused by chemical mediators and increased hydrostatic pressure.

Front 36

vascular changes during inflammatory response.

first vasoconstriction, then vasodilation, then increased vascular permeability. now what?

Back 36

fluid escapes vessel walls into the interstitial tissue

loss of protein rich fluid from plasma reduces vascular concentration of protein and fluid is osmotically driven into the interstitium

Front 37

cellular response during inflammatory stage

macrophages at ______ days are removing cell debris and necrotic tissue

Vitamin A ______ macrophage activity

Steroids decrease ______ activity

Back 37

5-7 days

vitamin A increases activity

steroids decrease activity

Front 38

Hemostatic response during inflammatory stage

platelet activation and ______
aggregation (hemostatic plug)

fibrin production and clotting (soluble protein fibrinogen)

Back 38

adherence

Front 39

acute inflammation

Back 39

brief stimulus
prominent vascular changes
few connective tissue changes
24-36hrs (mild)

Front 40

chronic inflammation

Back 40

stimulus persists - chronic irritation
less obvious vascular canges

Front 41

after the inflammatory stage is the _____ stage

Back 41

proliferative phase
epithelialization - reestablish epidermis; fibroblasts and endothelial cells, capillary budding, vasodilation. weak initial scar strenght.

Front 42

maturation - ________ are specialized cells which contract would edges.

Back 42

myofibroblasts

Front 43

remodeling phase is after proliferative phase

______ collagenase

mechanical strength - _______ effect

Back 43

increased collagenaze during the remodeling phase

piezoelectric effect

Front 44

capsule and ligament
_____ from internal and external sources
acute inflammation for _____ hours
collagen synthesis in the first week

Back 44

fibroplasia

72 hours

Front 45

strain is what?

Back 45

the length the muscle is streched

in a normal knee compared to a immobilized knee, the strain is the same, but the stress (force in newtons) is greater for the normal knee, and smaller in the immobilized knee. remember that strain is the same!

Front 46

capsule and ligament

majority of mass after _____ weeks
25-35% normal tensile strength
untreated scar is only 40% after 1 year
tension stimulates normal function

Back 46

8 weeks

Front 47

capsule and ligament
(after tissue has scarred together)
_____ strength in 100 days
_____ strength in 280 days
______ strength in 1 year

Back 47

50-60% strength in 100 days
70% strength in 280 days
90% strength in 1 year

Front 48

Tendon

healing similar to ligament, but affected by presence of a ____

with absent or uninjured sheath, very similar course to ligament

damaged sheath will lead to _____

Back 48

sheath

adhesions

Front 49

articular cartilage

intra-articular deficit does not heal

subchondral bone involvement will result in the development of _______

Back 49

fibrocartilage

Front 50

bone remodeling

inflammation - _____ provides the scaffold for mineralization

soft callus - fibrous union; pain and swelling subside

hard callus - hard union of site; time depends on age, severity

Back 50

scar

Front 51

neuropraxia

Back 51

temporary interruption of conduction without loss of axonal continuity

Front 52

neurotmesis

Back 52

complete disruption of the nerve fiber

Front 53

axonotmesis

Back 53

loss of axonal integrity w/ preservation of the endoneurium

Front 54

time for Wallerian degeneration

Back 54

12-48 hours

Front 55

time for axons to break into fragments

Back 55

48-72 hours

Front 56

what is the main role of Schwann cells?

Back 56

to guide the regeneration of peripheral nerves, to provide conduits for the ensuing axonal growth

Front 57

regeneration of peripheral nerves has 4 phases:
1. neuron recovers and axon growth begins
2. axon growth is slowed by the presence of scar tissue at injury
3. axons cross the scar and reach the distal branch
4. restoration of normal function

Back 57

blank

Front 58

peripheral nerve rate of regeneration (how fast it grows back)

what is the pattern?

Back 58

the closer to the spinal cord, the faster the nerve grows (mm/day)

nerve root grows 6 mm/day
hand grows 1-1.5 mm/day

Front 59

definition of elasticity

Back 59

a materials ability to return to its original state following deformation

Front 60

definition of stress

Back 60

stress equals the magnitude of force applied to an object per unit area
stress = force/area

Front 61

definition of strain

Back 61

a change in length of a structure

tensile stress = tensile force/cross sectional area

strain is the amount of elongation and narrowing (deformation) strain is measured as a % or resting length

Front 62

the stress/strain curve in which stress (load) is plotted againts deformation (% change in length) has 3 regions. what are they?

Back 62

1. Toe region - fibers are stretched and straightened from a resting zig-zag pattern (amount of slack)
2. linear region - represents the ELASTIC CAPABILITY of the tissue. the SLOPE of this relationship equals the elastic modulus
3. failure zone

these properties will change w/ reduced use, age, STEROID USE, but increase w/ chronic exercise

Front 63

force relaxation

Back 63

hold tissue at a constant length and observing the force that develops in the tissue

the force increases to a point, then decreases and plateus

Front 64

tissue creep

Back 64

by holding the tissue at a constant force or tension and observing changes in length

dynasplint