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129 Cards in this Set
- Front
- Back
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Locations of fibrocartilage
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Insertion of tendon and ligaments to bone, healing articular cartilage
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Locations of elastic cartilage
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trachea
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Tissue type in meniscus
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Fibroelastic cartilage
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Primary modulator of chondrocyte metabolism
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Mechanical stimulation
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Composition of cartilage
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65-80% H20; 10-20% collagen; 10-15% PG; 5% chondrocytes
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H20 content with OA
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increases
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Primary collagen in cartilage
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Type II
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Collagen changes in OA
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Increased type VI
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Type X collagen
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unique to enchondral ossification. Physis, fracture callus, HO, calcified cartilaginous tumors.
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Type XI collagen
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adhesive- holds collagen lattice together
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Effects of aging on cartilage
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1. dec H20 2. dec PG synth/deg 3. dec chondroitin 4 sulfate 4. inc karatin sulfate 5. inc chondrocyte size 6. dec chondrocyte number 7. inc modulus of elasticity
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Effects of OA on cartilage
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1. inc H20 2. dec PG conc 3. inc PG synth/deg 4. inc chondroitin 4 sulfate 5. dec karatin sulfate 6. dec chondrocyte size 7. dec modulus of elasticity
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Location of Type I collagen
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Bone tendon meniscus annulus skin
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Location of Type II collagen
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articular cartilage nucleus pulposus
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Location of Type III collagen
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skin, blood vessels
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Location of Type IV collagen
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basal lamina of basement membrane
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Aggrecan
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GAG +protein core.
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PG composition
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Aggrecan molecules bound to HA via link proteins
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Articular cartilage layers
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1. Gliding zone (superficial) 2. transitional zone (middle) 3. radial zone (deep) 4. Tidemark zone 5. calcified zone
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Superficial zone articular cartilage
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low metabolic activity, tangential orientation. Works vs shear
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Transitional zone articular zone articular cartilage
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high metabolic activity, oblique orientation. Works vs compression
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radial (deep) zone articular cartilage
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Thickest. High collagen size. Vertical orientation. Works vs compression
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Tidemark zone articular cartilage
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thinnest. Undulating barrier. Tangential orientation. Works vs shear
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Calcified zone articular cartilage
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Hydroxyapatite crystals. Works as anchor
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Zone of articular cartilage with highest concentration of collagen
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tangential zone
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Zone of articular cartilage with greatest tensile strength
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superficial zone
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TGF-beta effects on cartilage
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stimulates PG synthesis, suppresses type II collagen synthesis. Stimulates TIMP
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FGF effects on cartilage
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stimulates DNA synthesis
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Primary mechanism of lubrication of articular cartilage
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elastohydrodynamic lubrication
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Boundary lubrication
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surfaces non-deformable. Lubrication only partially separates surfaces.
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Boosted lubrication
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concentration of lubricating fluids in pools trapped by regions of bearing surfaces making contact
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hydrodynamic lubrication
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fluid separates surfaces when one surface is sliding on the other
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weeping lubrication
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fluid shifts out of articular cartilage in response to load
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Source of fibrocartilage scar in articular cartilage
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undifferentiated marrow mesenchymal stem cells- differentiate into cells capable of making fibrocartilage
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Effects of immobilization on articular cartilage
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decreased ratio of PG/collagen. Returns to normal after 8wks of mobilization
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Most common cause of UE neuropathic arthropathy
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Syringomyelia
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Reiter's Syndrome
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Young patients. M>F. Weight bearing joints. Si/Sx: urethral discharge/ conjunctivitis. Lab: HLA-B27. RAD: MT head erosions, periostitis. Tx: NSAIDS/ sulfa
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Acute Rheumatic Fever
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Peds. Assymetric migratory arthritis of large joints. PE: red/tender/rash. Lab: ASO titer. RA: nml. Systemic: erythema marginatum. Carditis. Tx: Symptomatic
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Ankylosing Spondylitis
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Symmetric arthritis of SI/spine/hip. PE: rigid spine. Chinon chest deformity. Lab: alk phos/CPK/HLA-B27. RAD: SI arthropathy, bamboo spine. Systemic: urethritis.
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Psoriatic arthritis
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Young patients. Assymetric arthritis of small joints/ DIPJ.PE: rash, sausage digits, nail pitting. Lab: HLA-B27. RAD: DIPJ pencil in cup deformity.
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Lyme disease
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Young patients. Assymetric. Affects any joint. PE: acute effusion. Lab: culture/ ELISA. RAD: nml. Systemic: rash/neuro/cardiac. Tx: PCN/Tetracycline
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Fungal septic arthritis
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Any joint. Indolent infection. Minimal RAD changes. Immunocompromised patients. Tx: 5-FU, amphotericin
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XR finding of hemophilic arthropathy
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squared off patella
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Best indicator of when to stop total contact casting
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Skin temperature = contralateral side
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Onochrosis
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Degenerative arthritis secondary to alkaptonuria-->excess homogentisic acid deposition. + degenerative discs/ black urine. RAD: ossification of annulus.
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TNF-alpha effects on cartilage
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Increases chondrocyte secretion of matrix metalloproteinase-->degradation of cartilage and matrix
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Rheumatoid factor
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IgM vs IgG
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Felty's syndrome
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RA, splenomegaly, leuokopenia
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Still's disease
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acute JRA +fevers/rash/splenomegaly
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Synovectomy in RA patients
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Decreased pain/swelling. No change in RAD progression/ROM/need for TKA
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SLE arthritis
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acute, red, tender swelling of PIP/MCP/carpus/knee/etc.. Less destructive than RA.
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Polymyalgia Rheumatica
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Elderly. Aching/stiffness of pelvic/shoulder girdles. Malaise/HA/anorexia. PE: nml. Lab: markedly elevated ESR/anemia/inc alk phos. Tx: steroids if refractory. Associated with temporal arteritis.
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Seropositive JRA
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pos RF. Higher incidence of chronic active and progressive disease
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Early onset JRA
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Onset before teens
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Polyarticular JRA
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at least 5 joints involved. Seropositive type 5x frequency in girls. Desctructive DJD which frequently progresses to adult RA
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Pauciarticular JRA
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less than 4 joints involved. Early onset type associated with iridocyclitis.
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Relapsing polychondritis
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Episodic inflammation and diffuse/self-limiting arthritis, proegressive cartilage desctruction. Associated with thickening of auricle/inflammatory eye d/o, Tx: supportive
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C-spine injury in AS
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Fracture with low energy. High rate of epidural hemorrhage. 75% neuro involvement
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Allopurinol
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Xanthine oxidase inhibitor- inhibits conversion of xanthine to uric acid
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Causes of chondrocalcinosis
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1. CPPD 2. ochronosis 3. hyper-PTH 4. hypothyroidism 5. hemochromatosis
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CPPD
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Short, rhomboid positively birefringent crystals. Neutrophilic aspirate. XR: calcification of menisci/fibrocartilage. Tx: NSAIDS
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Calcium hydroxyapatite crystal deposition
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destructive arthropathy of shoulder/knee
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Milwaukee shoulder:
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basic calcium phosphate deposition + rotator cuff tear
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Hemophilia
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X linked defect in factor VIII (type A) or IX (type B). Mild: 5-25% levels. Mod: 1-5%. Severe: <1%.
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Perioperative Factor management in hemophilia
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100% during 1st week. 50-75% during second week.
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Factor inhibitor
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IgG vs clotting factor-->no response. Relative contraindication to surgery. 5-25% inciddence
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Epimysium
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surrounds muscle bundles
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Perimysium
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surrounds muscle fascicles
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Endomysium
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surrounds muscle fibers
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Sarcomere
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Thick filaments= myosin. Thin filaments = actin
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H band
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only thick
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I band
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only thin
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Z lines
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boundary of adjacent sarcomeres
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Myasthenia gravis
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deficiency of Ach receptors
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Botulinum toxin
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blocks Ach release at end plate
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Non-Depolarizing drugs
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Curare/pancuronium/vecuronium. Competitive inhibitors of Ach receptors. Long-acting paralytics
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Depolarizing drugs
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Succinylcholine. Binds to Ach receptor-->temporary depolarization. Short-active paralytic.
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Anticholinesterases
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Neostigmine/edrophonium. Acts at autonomic ganglia. Prevents breakdown of Ach--> reverses action of non-depolarizing drugs. Also blocks muscarinic effects
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Isotonic contraction
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Equal tension. Measure of dynamic strength
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Isometric contraction
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Equal length.
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Isokinetic contraction
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Equal speed. Require specialized equipment
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Slow twitch fibers
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Oxidative/aerobic. High mitochondria. Low glycogen/ATPase. Endurance activities. First lost without rehab
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Fast twitch fibers
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Anearobic. Contract quickly. Large/stronger. Less efficient. High intensity/short-duration activities- sprinting
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Endurance training
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Decreased tension/ increased repetitions-->hypertrophy of ST/inc mitochondria
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Strength training
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Increased tension/ decreased repetitions--> increased number and cross section of FT fibers. Isokinetic>isotonic
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Plyometric exercises
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Bounding. Muscle stretch followed immediately by rapid contraction. Most efficient way to improve power.
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Best fluid replacement regimen
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oslmolarlity <10%--> enhanced absorption. Glucose polymers minimize osmolality
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Return to play after concussion
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Grade I: when asymptomatic. Grade II: (persistent retrograde amnesia): may return after one week without symptoms . Grade III: months. 3 grade I/ 2 grade II or 1 grade III--> months until return to play
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Spinal cord reflex
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Sensory organ-->interneuron-->motoneuron. Most polysynaptic
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Nerve regeneration
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1 monthe delay then proximal axonal budding then regenerates at 1mm/day (3-5mm in kids). Influenced by contact guidance, neurotrophism. Pain first sensation to exist.
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Neurapraxia
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Reversible conduction block. Local eschemia and selective demyelination.
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Axonotmesis
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Disruption of axon/myelin sheath. Intact epineurium
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Neurotmesis
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Complete nerve division (including epineurium)
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blood supply sheathed tendon
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Mesotenon (vincula) carries vessel to supply one segment. Avasculr regeions get nutrition via diffusion
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blood supply paratenon covered tendon
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many vessels supplying rich capillary system
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Tendon repair strength
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Weakest at 7-10 days. Maximal strength at 6 months.
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Ligament failure
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Most common: sequential rupture of collagen bundles. Midsubstance: adults. Avulsions: kids- usually bet unmineralized and mineralized fibrocartilage layers
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Blood supply to cruciate ligaments
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middle genicular artery
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Ligament healing
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Heals with type III collagen then converted to type I collagen. Weaker with immobilization.
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Cell mediated immune response
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T lymhpocytes present foreign antigens
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Humoral mediated immune reponse
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B lymhpocytes-->plasma cells
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IgA
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Mucosal surfaces
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IgM
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Produced earliest
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IgD
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Receptor
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IgE
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Allergic response
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Oncogenes
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Growth control genes. Improper expression-->unregulated growth
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P glycoproteins
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Cell wall pump--> eliminates toxins/chemotherapeutic agents
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Sequestra
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Dead bone with surrounding granulation tissue
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Involucrum
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Periosteal new bone surrounding sequestrum
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Osteomyelitis in newborn
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S. aureas/Gram -/ Group B strep. Tx: naficillin/oxacillin + 3rd gen cephalosporin. Local signs best predictors of osteomyelitis.
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Osteomyelitis in kids >4yo
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S.aureus/ group A strep. Tx: oxacillin/nafcillin.
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Osteomyelitis in sickle cell
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S. aureus most common/ Salmonella more likely- may seed from cholecystitis. Tx: fluroquinolones
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Human bite wounds
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S. viridans/bacteroides/Eikenella. Tx: unasyn/timentin/zosyn
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Dog bite wounds
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S. aureus/ pasteurella/capnocytophagia. Tx: augmentin/clindamycin
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Cat bite
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pasteurella
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Rat bite
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s. monoliformis. Tx: augmentin/doxycycline
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Marine infections
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Culture: 30deg C. Micro: vibrio vulnificus/atypical mycobacteria. Tx: ceftazidime/docycycline.
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Chronic sclerosing osteomyelitis
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Involves diaphysis of adolescents. Intense proliferation of periosteum. Cause: anaerobic organisms. Must r/o CA.
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Cause of epiphyseal osteomyelitis
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Almost exclusively S. aureus
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Serratia osteomyelitis
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IVDU. Axial skeleton. Tx: cotrimoxazole
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Newborn septic arthritis
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S. aureus/ Group B strep.
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Intra-articular metaphyses
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Proximal femur/proximal humerus/radial neck/distal fibula
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Chronic monoarticular septic arthritis
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Brucella, Nocardia, mycobacteria, fungi
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Bacteria assocaited with total joint infection after dental procedure
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Peptostreptococcus.
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Organism from puncture wound through shoe
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Pseudomonas. 1-2% incidence of infection
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Diagnosis of AIDS
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CD4 <200 or opportunistic infection
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Risk of seroconversion from needle stick
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0.30%
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Cat scratch fever
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Bartonella henselae. Erythematous/painful lymphadenitis. Tx: azathyoprine vs supportive tx. Do not I/D lesions
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Marjolins ulcer
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squamous cell carcinoma from chronic draining sinus tract
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