part 1 spcon module 3

● Most abundant and widely distributed in the body

● Provides and maintain form in the body

● Serves to connect and bind cells and organs

● Mechanical support of the body

● Insulator (storage of fats and certain minerals in the bone)

● Repair and healing of wounds

CONNECTIVE TISSUE

Structure of connective tissue

Cells

Extracellular matrix

structural (fibroblast, osteoblast), immunological (plasma cells, leukocytes), defense (macrophage, neutrophils), energy (adipose)

Cells –

ground substance and protein fibers

○ Extracellular matrix –

Types of Fibers?

Collagen

Reticular

Elastic

This is a type of fiber:

most abundant, high tensile strength and flexible

Collagen

This is a type of fiber:

thinner than collagen fibers; provides structural support and framework

○ Reticular –

This is a type of fiber:
thinner than collagen; strong and can be stretched without breaking and are able to return to their original shape ( skin, blood vessel, lungs)

○ Elastic –

Major component of a connective tissue

EXTRACELLULAR MATRIX ○

Self assembly of collagen into fibrils with a characteristics banding pattern into the tissues

Connective tissue biosynthesis ○

This is collagen tissue biosynthesis:

most abundant protein in the body (most tissues)

○ Type I collagen –

This is collagen tissue biosynthesis:

fibrillar collagen of cartilage

○ Type II collagen –

This is collagen tissue biosynthesis:

small amount in tissues (blood vessels)

○ Type III collagen –

● Features of more than 1 rheumatic disease (Mixed CT diseases)

● Overlapping of features (clinical manifestations)

● Can be systemic

● Incidence is unknown (F>M)

● Etiology is unknown

○ Hypothesis : modified antigens or infective agents

CONNECTIVE TISSUE DISEASES

WHAT CONDITION IS THIS?

● Degenerative joint disease

● Slowly evolving articular disease

● Most common joint disorder

● Also known as “wear and tear”

● Elderly

OSTEOARTHRITIS

In OA, this is the most leading chronic disability in developed countries

KNEE OA –

Classifications of OA?

PRIMARY OA

SECONDARY OA

A classification of OA:

idiopathic ; most common form of OA

○ Related to a defect in the articular cartilage

Primary OA –

A classification of OA

attributed to an underlying cause ; pathologically indistinguishable from 1° OA

Secondary OA –

In OA,

○ Shock absorber in terms of bulk properties

○ 1-2mm thick ( protective mechanism provided by subchondral bone and periarticular muscles )

○ Functions:

■ Provide smooth bearing surface with synovial fluid as a lubricant

■ Prevents concentration of stresses so the bones do not shatter when joint is loaded

● Articular cartilage

In OA, what are the 2 major macromolecules substance?

PROTEOGLYCANS

COLLAGEN

This is a major macromolecule substance

• responsible for the compressive stiffness of the tissue and its ability to stand load

Proteoglycans –

This is a major macromolecule substance

• provides the tensile strength and resistance to shear

Collagen –

What is the hallmark of OA?

CARTILAGE DEGENERATION

In OA, this is a prominent sign that plays a role in symptom generation

Inflammation –

characteristic feature of OA

○ Audible crackling/grating sensation

○ Articular and extraarticular surfaces rub together on movement

Bone crepitus –

In OA, this is used to identify presence of bone marrow lesions, synovitis and periarticular inflammation

MRI –

KELLGREN AND LAWRENCE GRADING SYSTEM

Radiographic finding:

• Possible osteophyte; no joint space narrowing

Grade 1

KELLGREN AND LAWRENCE GRADING SYSTEM

Radiographic finding:

• definite osteophytes; possible narrowing of joint space

Grade 2

KELLGREN AND LAWRENCE GRADING SYSTEM

Radiographic finding:

• moderate multiple osteophytes; definite joint space narrowing. Some sclerosis and possibly deformity of bone ends

Grade 3

KELLGREN AND LAWRENCE GRADING SYSTEM

Radiographic finding:

• Large osteophytes; marled joint space narrowing. Severe sclerosis and definite deformity of bone ends

Grade 4

In OA, this involves 3 or more joints

GENERALIZED OA

In OA, this is the mos common frequent area of involvement of OA

TTHUMB BASE

In OA,

● Knee joint

○ Can involve medial and lateral femorotibial compartment

○ Medial compartment : _____ (_____)

○ Lateral compartment : _____ (_____)

○ Patellofemoral OA: (+) _____

In OA,

● Knee joint

○ Can involve medial and lateral femorotibial compartment

○ Medial compartment : varus (bowleg)

○ Lateral compartment : valgus (knock knee)

○ Patellofemoral OA: (+) Shrug sign

In OA, this is the cornerstone of prevention and management

Patient education –

In OA, this medication decrease joint pain and improves mobility

NSAIDS

In OA, this medication is the first line of treatment

acetaminophen –

In OA, this medication depletes local sensory nerve endings of substance P (neuropeptide mediator of pain)

■ Reduce joint pain and tenderness

■ Applied topically

Capsaicin cream

In OA, this medication direct injections (sodium hyaluronate)

Viscosupplementation ■