Ligament and tendon injuries Flashcards
What is a ligament?
Dense bands of collagenous tisssue Span a joint Anchored to the bone at either end Joint stability through rangeof motion Different portions ligament tensioend at different joint positions Multiple
Describe the structure of a ligament
Collagen fibres (type 1) Fibroblasts Sensory fibres (proprioception, stretch, sensory) Surface vessels Crimping to allow for stretch
What causes a ligament to rupture
Forces exceed the strength of a ligament Expected, unexpected Compatable vs icomplete Stability joint Proprioception loss
What is the haemorrhage stage of ligament healing
Blood clot
Resrobed
Replaced with heavy cellular infiltrate
hypertrophic vascular repsonse
What is the proliferative phase of ligament healing
Production of scar tissue
disorganised collagenous connective tissue
What is the remodelling stage of ligament healing
Matrix becomes more ligament like
Major differences in composition, architecture and function persist
What is typical treatment of ligament injury
Conservtaive- partial, no instability, poor candidate for surgery
Operative- instabilty, expectation, compulsory`
What is a tendon?
insertion from the muscle into the bone
Can be into a long or sesamoid bone
May also come in tendon sheath
Describe the anatomy of a tendon
How is blood supplied to a tendon
Longitudinal arrangement of cells (mostly tenocytes) and fibres (collagen type-1- triple helix)
Tendons are fascicles of long narrow spiralling collagen bundles. these bundles are covered by an endotendon. The fascicles are covered by paratenon, these form the tendons.
fine network of blood vessels in the paratenon.
What is the tendon sheath?
A thickening that bounds flexor tendons in the distal palm and fingers. The tendons are connected to the sheaths by vincula. They contain synovial lining and fluid guiding lubrication and nutrition
What is the function of a tendon?
Flexible and very strong in tension
Immobility reduces water content and glycosaminoglycan concentration allows strength
What causes injury to the tendon?
Degeneration Inflammation Enthesipoathy Traction apophysitis Avulsion Tear- intrasubstance (rupture) Tear- muscolutendinous junction Laceration/incision Crush/ischaemia/attrition nodules
What happens during tendinous degeneration
Instrasubstance mucoid degeneration leads to swollen, painful, tender, or even asymptomatic. Precursor to rupture. E.g. achilles tendon.
What happens during inflammation of a tendon
Swollen, tender, red, hot.
E.g. de quervain’s stenosing tenovaginits, tendons of EPB nd APL become infalmmed
Positive Finklesteins test
What is enthesiopathy
What is this also know as when it occurs to a ligament
Inflammation at insertion point to bone. Usually at muscel origin rather than tendinous insertion. e.g. lateral humeral epicondylitis (tennis elbows), common from extensor origin
Plantar fascitis
What is traction apophysitis?
recurrent load of a tendon leads to inflammation
E.g. osgood schlatter’s disease. Insertion of patellar tendon into anterior tibial tuberosity
What is an avulsion?
Failure at an insertion point. Loading exceeding failure strength while muscle contracting.
E.g. mallet finger (insertion of extensor tendon into dorsum of base of finger) causes froced flexion or extended finger
How do you treat an avulsion?
Conservative- splint
Operative- reattach tendon
Fixation of bone fragment
What is an intrasubstance rupture?
Load exceeds strength causing failure. E.g. achilles tendon tear
Achilles tendon rupture will lead to a positive simmonds squeeze test. There will be a palpable tender gap
How does one typically rupture an achilles tendon
Pushing off weg=ight bearing forefoot while extending knee joint e.g. sprint start
unexpected dorsiflexion
Violent dorsiflexion of planter flexed foot (fall from height)
What is a musculotendinous junction tear?
medial half od gastrocnemius at musculotendinous junction with achilles tendon
plantaris syndrome
How do you treat a musculotendinous tendon?
Conservative- opposing ends, mobilise partial rupture
Operative-high risk rupture, high activity, ends cannot be opposed
Describe what happens during laceration of a tendon
Very common
males more common that females
Technically challenging surgery that needs to be done early
Commonly affects FDS and FDP
