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MSK Week 5 2017/18 > 11: Tendon problems > Flashcards

11: Tendon problems Flashcards

1
Q

30% of MSK consultations are ___ related.

A

tendon

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2
Q

Tendon problems tend to be (chronic / self-limiting).

A

self-limiting

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3
Q

What is tendinopathy?

A

General term for disease of a tendon

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4
Q

What is tendonitis?

A

Inflammation of a tendon

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5
Q

What is tendonosis?

A

Chronic disease which has damaged a tendon’s ECM

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6
Q

What is tenosynovitis?

A

Inflammation of a tendon sheath

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7
Q

What is enthesopathy?

A

Inflammation of a tendon’s ORIGIN or INSERTION

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8
Q

Many tendon problems don’t show any inflammation on histology. What type of disease refers to this?

What are two examples?

A

Tendinopathy

Tennis and golfer’s elbow

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9
Q

What structures link the origins and insertions of tendons and ligaments?

A

Entheses

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10
Q

What are some types of drug which are known to cause tendinopathy?

A

Steroids

Antibiotics

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11
Q

What components of tendons degenerate in tendinosis?

A

Collagen

ECM

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12
Q

Which enzymes are responsible for the breakdown of tendon ECM in tendonosis?

A

Matrix metalloproteinases

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13
Q

Tendonosis occurs at areas of (good / poor) blood supply.

A

poor blood supply

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14
Q

What are the conservative options for treating tendinopathy?

A

Rest

Physiotherapy

Analgesia , NSAIDs

Injections (be very careful where you do this)

Splinting

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15
Q

What is debridement?

A

Removal of diseased tissue from a wound

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16
Q

What shoulder pathologies is decompression carried out for?

A

Supraspinatus tendonitis

Subacromial compression

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17
Q

What is synovectomy, and in which upper limb disease would it be considered?

A

Removal of inflamed synovium

Wrist RA where there is a risk of tendon rupture

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18
Q

Which tendons are often considered for tendon replacement surgery?

A

Tibialis posterior

Extensor pollicis longus

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19
Q

What is the most common rotator cuff tendinopathy?

A

Supraspinatus tendonitis

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20
Q

Who tends to get rotator cuff tendinopathies?

A

Athletes (particularly throwing events)

Manual workers (e.g painters)

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21
Q

What are the symptoms of rotator cuff tendinopathy?

A

Achy pain in arm

Difficulty sleeping, reaching, raising arm

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22
Q

What are the clinical signs of rotator cuff tendinopathy?

A

Painful arc

+ve Hawkins-Kennedy test

+ve Jobe’s test

+ve Scarf test

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23
Q

How may rotator cuff tendinopathy be treated conservatively?

And surgically?

A

Physiotherapy, analgesia, steroid injections

Subacromial decompression

24
Q

What is the insertion of the short head of biceps brachii?

A

Coracoid process of scapula

25
Q

What is the insertion of the long head of biceps brachii?

A

Supraglenoid tubercle of scapula

26
Q

What is the distal attachment of the short head of biceps brachii?

A

Radial tuberosity

27
Q

What is the distal attachment of the long head of biceps brachi?

A

Bicipital aponeurosis of ulna

28
Q

How does biceps brachii tendinopathy present clinically?

A

Anterior shoulder pain radiating to elbow

29
Q

What movements exacerbate the pain of biceps brachii tendinopathy?

A

Shoulder flexion

Elbow flexion

Forearm pronation

30
Q

What are some distinct signs of biceps brachii rupture?

A

Bruising

Popeye sign

31
Q

Biceps brachii tendinopathy is managed ___ or ___.

A

conservatively or surgically

32
Q

What is lateral epicondylitis?

Where does it occur?

Is it inflammatory?

A

Tennis elbow

Extensor origin of elbow

No (yet -itis for some reason)

33
Q

When is pain felt for patients with lateral epicondylitis?

A

Extension of middle finger

34
Q

What is medial epicondylitis?

Where does it occur?

Is it inflammatory?

A

Golfer’s elbow

Flexor origin of elbow

No

35
Q

What is De Quervain’s tenosynovitis?

Which tendons are involved?

A

Inflammation of tendons of thumb

Abductor pollicis longus

Extensor pollicis brevis

36
Q

Where is the pain of De Quervain’s tenosynovitis felt?

A

Styloid process of radius

37
Q

What is the specific clinical test for De Quervain’s tenosynovitis?

How is it carried out?

A

Finklestein’s test

  1. Thumb in fist
  2. Adduct hand
  3. Pain!
38
Q

What is a hand complication of rheumatoid arthritis?

A

Extensor tendon rupture

39
Q

What are the main symptoms of extensor tendon rupture?

A

Extensor weakness

Dropped finger (perma-flex)

40
Q

What is the management required to prevent extensor tendon rupture secondary to RA?

A

1. RA treatment!!!

2. Synovectomy

41
Q

If extensor tendon rupture secondary to RA has already occurred, what surgical intervention can help restore function?

A

Tendon transfer

42
Q

Which tendon becomes inflamed and caught on the tendon sheath in trigger finger?

A

Flexor digitorum superficialis

43
Q

How is trigger finger treated?

A

Observation

+/- Injection

+/- Surgical release (division of A1 pulley)

44
Q

What aspects of the extensor mechanism of the knee can rupture?

A

Quadriceps tendon

Patellar tendon

45
Q

What is the broad name for the group of diseases including Osgood-Schlatter syndrome?

A

Traction apophysitis

46
Q

Should steroid injections be used for quadriceps, patellar or Achilles tendon ruptures?

A

Nooooo

47
Q

What are some clinical findings of someone with a tendinopathy related to the extensor mechanism of the knee?

A

Palpable gap or swelling

Inability to straight leg raise

Patella may be displaced superiorly or inferiorly

48
Q

How does a ruptured tendon appear on ultrasound or MRI?

A

White blurry mess

49
Q

What is the only option for treating extensor mechanism ruptures?

A

Surgical repair

50
Q

Osgood-Schlatter disease involves the ___ ___ at its insertion on the ___ ___.

A

patellar tendon

tibial tuberosity

51
Q

Who tends to get Osgood-Schlatter disease?

A

Young, active boys

52
Q

What is left on the tibial tubercle after Osgood-Schlatter disease has resolved?

A

Bony lump - normal

53
Q

What may rupture following a sudden deceleration in sports like squash or running?

A

Achilles tendon

54
Q

What other risk factors exist for Achilles tendon rupture?

A

RA

Steroid use

Achilles tendonitis

55
Q

Achilles tendonitis patients will have difficulty ___ the foot.

A

plantarflexing

56
Q

What are the conservative and surgical options for Achilles tendon rupture?

A

Conservative - plaster splinting

Surgical - tendon repair

57
Q

Which tendon, responsible for maintaining the medial arch of the foot, may rupture following tenosynovitis?

A

Tibialis posterior

MSK Week 5 2017/18 (12 decks)

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