11: Tendon problems Flashcards
30% of MSK consultations are ___ related.
tendon
Tendon problems tend to be (chronic / self-limiting).
self-limiting
What is tendinopathy?
General term for disease of a tendon
What is tendonitis?
Inflammation of a tendon
What is tendonosis?
Chronic disease which has damaged a tendon’s ECM
What is tenosynovitis?
Inflammation of a tendon sheath
What is enthesopathy?
Inflammation of a tendon’s ORIGIN or INSERTION
Many tendon problems don’t show any inflammation on histology. What type of disease refers to this?
What are two examples?
Tendinopathy
Tennis and golfer’s elbow
What structures link the origins and insertions of tendons and ligaments?
Entheses
What are some types of drug which are known to cause tendinopathy?
Steroids
Antibiotics
What components of tendons degenerate in tendinosis?
Collagen
ECM
Which enzymes are responsible for the breakdown of tendon ECM in tendonosis?
Matrix metalloproteinases
Tendonosis occurs at areas of (good / poor) blood supply.
poor blood supply
What are the conservative options for treating tendinopathy?
Rest
Physiotherapy
Analgesia , NSAIDs
Injections (be very careful where you do this)
Splinting
What is debridement?
Removal of diseased tissue from a wound
What shoulder pathologies is decompression carried out for?
Supraspinatus tendonitis
Subacromial compression
What is synovectomy, and in which upper limb disease would it be considered?
Removal of inflamed synovium
Wrist RA where there is a risk of tendon rupture
Which tendons are often considered for tendon replacement surgery?
Tibialis posterior
Extensor pollicis longus
What is the most common rotator cuff tendinopathy?
Supraspinatus tendonitis
Who tends to get rotator cuff tendinopathies?
Athletes (particularly throwing events)
Manual workers (e.g painters)
What are the symptoms of rotator cuff tendinopathy?
Achy pain in arm
Difficulty sleeping, reaching, raising arm
What are the clinical signs of rotator cuff tendinopathy?
Painful arc
+ve Hawkins-Kennedy test
+ve Jobe’s test
+ve Scarf test
How may rotator cuff tendinopathy be treated conservatively?
And surgically?
Physiotherapy, analgesia, steroid injections
Subacromial decompression
What is the insertion of the short head of biceps brachii?
Coracoid process of scapula
What is the insertion of the long head of biceps brachii?
Supraglenoid tubercle of scapula
What is the distal attachment of the short head of biceps brachii?
Radial tuberosity
What is the distal attachment of the long head of biceps brachi?
Bicipital aponeurosis of ulna
How does biceps brachii tendinopathy present clinically?
Anterior shoulder pain radiating to elbow
What movements exacerbate the pain of biceps brachii tendinopathy?
Shoulder flexion
Elbow flexion
Forearm pronation
What are some distinct signs of biceps brachii rupture?
Bruising
Popeye sign
Biceps brachii tendinopathy is managed ___ or ___.
conservatively or surgically
What is lateral epicondylitis?
Where does it occur?
Is it inflammatory?
Tennis elbow
Extensor origin of elbow
No (yet -itis for some reason)
When is pain felt for patients with lateral epicondylitis?
Extension of middle finger
What is medial epicondylitis?
Where does it occur?
Is it inflammatory?
Golfer’s elbow
Flexor origin of elbow
No
What is De Quervain’s tenosynovitis?
Which tendons are involved?
Inflammation of tendons of thumb
Abductor pollicis longus
Extensor pollicis brevis
Where is the pain of De Quervain’s tenosynovitis felt?
Styloid process of radius
What is the specific clinical test for De Quervain’s tenosynovitis?
How is it carried out?
Finklestein’s test
- Thumb in fist
- Adduct hand
- Pain!
What is a hand complication of rheumatoid arthritis?
Extensor tendon rupture
What are the main symptoms of extensor tendon rupture?
Extensor weakness
Dropped finger (perma-flex)
What is the management required to prevent extensor tendon rupture secondary to RA?
1. RA treatment!!!
2. Synovectomy
If extensor tendon rupture secondary to RA has already occurred, what surgical intervention can help restore function?
Tendon transfer
Which tendon becomes inflamed and caught on the tendon sheath in trigger finger?
Flexor digitorum superficialis
How is trigger finger treated?
Observation
+/- Injection
+/- Surgical release (division of A1 pulley)
What aspects of the extensor mechanism of the knee can rupture?
Quadriceps tendon
Patellar tendon
What is the broad name for the group of diseases including Osgood-Schlatter syndrome?
Traction apophysitis
Should steroid injections be used for quadriceps, patellar or Achilles tendon ruptures?
Nooooo
What are some clinical findings of someone with a tendinopathy related to the extensor mechanism of the knee?
Palpable gap or swelling
Inability to straight leg raise
Patella may be displaced superiorly or inferiorly
How does a ruptured tendon appear on ultrasound or MRI?
White blurry mess
What is the only option for treating extensor mechanism ruptures?
Surgical repair
Osgood-Schlatter disease involves the ___ ___ at its insertion on the ___ ___.
patellar tendon
tibial tuberosity
Who tends to get Osgood-Schlatter disease?
Young, active boys
What is left on the tibial tubercle after Osgood-Schlatter disease has resolved?
Bony lump - normal
What may rupture following a sudden deceleration in sports like squash or running?
Achilles tendon
What other risk factors exist for Achilles tendon rupture?
RA
Steroid use
Achilles tendonitis
Achilles tendonitis patients will have difficulty ___ the foot.
plantarflexing
What are the conservative and surgical options for Achilles tendon rupture?
Conservative - plaster splinting
Surgical - tendon repair
Which tendon, responsible for maintaining the medial arch of the foot, may rupture following tenosynovitis?
Tibialis posterior
