Tendons and Ligaments

A bursa, a sac filled with fluid located around a principal joint, is lined with a synovial membrane and contains synovial fluid. This fluid minimizes friction between the tendon and the bone, or between tendon and ligament. Repeated small stresses and ovemse can cause the bursa in the shoulder, hip, knee, or ankle to swell. This swelling and irritation is referred to as bursitis. Some patients experience bursitis in association with tendonitis. Bursitis can usually be reheved by rest and in some cases by using antiinflammatory medications. Some orthopedic surgeons also inject the bursa with additional medication to reduce the inflammation. 

The musculoskeletal system consists of the muscles, bones, joints, tendons, and ligaments. Disorders related to the musculoskeletal system often are classified by etiology. Acute soft-tissue injuries include strains and sprains of muscles and ligaments. Repeated movements in sports, exercise, work, or activities of daily living may lead to repetitive strain injury, where cumulative damage occurs to the muscles, ligaments, or tendons.1-3 While tendonitis and bursitis can arise from acute injury, more commonly these conditions occur as a result of chronic stress.3,4 Other forms of chronic musculoskeletal pain, such as pain from rheumatoid arthritis (see Chap. 54) or osteoarthritis (see Chap. 55), are discussed elsewhere in this text. 

Skeletal muscle consists of muscle fibers linked together by connective tissue. Tendons and ligaments are composed of collagenous fibers that have a restricted capability to stretch. Tendons connect the muscle to the bone, whereas ligaments connect bone to bone (Fig. 57-1). 

Disseminated idiopathic skeletal hyperostosis Excessive bone formation at skeletal sites subject to stress, generally where tendons and ligaments attach to bone. 

The physical properties of various types of cartilage include flexibility, non-compressibilty and slipperyness. These characteristics reflect the roles played by the tissue as tendons and ligaments, lining joints, intervertebral discs, and in several sites within the respiratory system. 

Q72 Gl ucosamine is a natural substance that is present in tendons and ligaments. Glucosamine is used for the symptomatic relief of mild-to-moderate osteoarthritis in combination with chondroitin. 

Vitamin C is essential for the formation of collagen, the principal structural protein in skin, bone, tendons, and ligaments, being a cofactor in the hydroxylation of the amino acids proline to 4-hydroxyproline, and of lysine to 5-hydroxylysine. These hydroxyamino acids account for up to 25% of the collagen structure. Vitamin C is also associated with some other hydroxylation reactions, e.g. the hydroxylation of tyrosine to dopa (dihydroxyphenylalanine) in the pathway to catecholamines (see Box 15.3). Deficiency leads to scurvy, a condition characterized by muscular pain, skin lesions, fragile blood vessels, bleeding gums, and tooth loss. Vitamin C also has valuable antioxidant properties (see Box 9.2), and these are exploited commercially in the food industries. 

Musculoskeletal- Mild to moderate musculoskeletal symptoms, including arthralgia, that occasionally require drug discontinuation and rarely persist after discontinuation (16%) skeletal hyperostosis (see Warnings) calcification of tendons and ligaments premature epiphyseal closure arthritis tendonitis other bone abnormalities decreases in bone mineral density back pain rhabdomyolysis (rare postmarketing reports). 

PIA-Calcium Phosphate-Based Glass Fibers Artificial Tendon and Ligament... 

Type I, II, and III collagens are fibrillar, and are found in tendon, skin, bone, cornea, carti lage, vitreous body, and blood vessels. Types IX and XII are fibril-associated, and are found in cartilage, tendon, and ligaments. Type IV and VII form networks in basement membrane and beneath stratified squamous epithelia. 

Tendon and ligament Epitendineum Fascicle Covers surface Separates units... 

Tendons and ligaments are made up of units termed fascicles that are bound into functional units by a sheath termed epitendineum (Figure 3.22). Individual fascicles are composed of rows of fibroblasts that alternate with bundles of collagen fibrils parallel to the tendon axis. These structures are normally loaded in tension to maintain joint stability. 

Extracellular matrices (ECM) are the primary structural materials found in connective tissue in vertebrates that serve to maintain tissue shape (skin), aid in locomotion (bone), transmit and absorb mechanical loads (tendon and ligament), prevent premature mechanical failure (tendon, ligament, skin, and blood vessel wall), partition cells and tissues into functional units (fascia), act as scaffolds that define tissue and organ architecture (organ parenchyma), act as storage devices for elastic energy (tendon and blood vessel wall), and as the substrate for cell adhesion, growth, and differentiation of a variety of cell types. 

Tendons are bundles of tough connective tissue fibers that connect muscle to bone. They vary in length and size depending on where they are in the body (and whose body it is). Ligaments are short bundles of fibrous tissue in and around joints. They stabilize the joint by keeping the bones in position both during movement and at rest. Both tendons and ligaments have been used as... 

Forster, I.W. (1984). Structural aspects of tendons and ligaments. In Natural and Living Biomaterials (Hastings, G.W. and Ducheyne, P. eds.). CRC Press, Boca Raton, FL. 

The skeletal system is a structural framework providing support, shape, and protection to the human body. Additionally, the skeletal system provides attachment sites for organs. The skeletal system also stores minerals and lipids and forms blood cells. Bones, cartilage, tendons, and ligaments are all organs of the skeletal system. 

Glucosamine is found in abundance in cartilage tissues and also in smaller amounts in tendon and ligament... 

Orthopedic Joint replacements (hip, knee) Bone plate for fracture fixation Bone cement Bony defect repair Artificial tendon and ligament Titanium, Ti-Al-V alloy, stainless steel, polyethylene Stainless steel, cobalt-chromium alloy Poly(methyl methacrylate) Hydroxyapatite Teflon, Dacron ... 

Tendons and ligaments Injury Eibroblasts Collagen Repair, replacement Mechanical durability [32]... 

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