MSK growth injury and repair - Tendons and ligaments

Question 1

definition of a ligament

Answer 1

dense bands of collagenous tissue anchored to the bone at either end. Providing joint stability through range of motions.

Question 2

outline the structure of a ligament

Answer 2

collagen fibres (type 1), fibroblasts (communicate), sensory fibres (proprioception, stretch, sensory), vessels (surface), crimping (allow stretch)

Question 3

outline some differences between ligaments and tendons

Answer 3

ligamnets have - less collagen, more proteoglycans and water, less organised collagen fibres, rounder fibroblasts.

Question 4

what is thhe process of healing?

Answer 4

haemorrhage
Proliferative phase
remodelling

Question 5

Tx

Answer 5

conservative or operative.

Question 6

what is the structure of a tendon, function too

Answer 6

longitudinal arrangement of cells (mostly tenocytes) and fibres (collagen type 1- triple helix), connects muscle to bone

Question 7

describe what makes up a tendon and their coverings…

Answer 7

collagen bundles covered by endotenon –> fascicles covered by paratenon –> tendon covered by epitenon

Question 8

what structure connects tendons to the tendon sheath?

Answer 8

Vincula

Question 9

name the methods of tendon injury

Answer 9

degeneration, inflammation, enthesiopathy, traction apophysitis, avulasion, tear, laceration, crush, ischaemia, nodules

Question 10

What is an example fof a Degenration injury and its details?

Answer 10

Achilles tendon - intrasubstance mucoid degeneration, may be swollen, painful, tender; may be asymptomatic?precursor to rupture, (rheumatoid arthritis considered elsewhere)

Question 11

What is an example of inflammaiton of a tendon and its details?

Answer 11

de Quervain’s stenosing tenovaginitis - tendons of EPB + APL passing through common tendon sheath at radial aspect of wrist, swollen, tender, hot, red, positive Finklestein’s test

Question 12

Explain what a enthesiopathy is…

Answer 12

Inflammation at insertion to bone
Muscle/Tendon - Usually at muscle origin rather than tendon insertion - e.g. lateral humeral epicondylitis (tennis elbow) - common extensor origin
Ligament - Plantar Fasciitis

Question 13

Give an example of traction apophysitis and its details?

Answer 13

Osgood Schlatter’s disease - insertion of patellar tendon into anterior tibial tuberosity, adolescent active boys, Recurrent load, Inflammation

Question 14

explain avulsion and give an example of it

Answer 14

Failure at insertion, Load exceeding failure strength while muscle contracting e.g. biceps tendon tear or mallet finger
Mallet finger - insertion of extensor tendon into dorsum of base of distal phalanx of finger, forced flexion of extended finger

Question 15

how is avulsion treated?

Answer 15

operative - tendon reattatchment through the bone, fixation of the bone fragment. OR conservative - limited application and retraction tendon

Question 16

what is an example of an intrasubstance rupture - tear?

Answer 16

achilles tendon - load excdeeds failure, usually caused by dorsiflexion

Question 17

what test is used for an achilles tenodn rupture?

Answer 17

Simmond’s (squeeze test), palpable tender gap.

Question 18

what is an example of a musculotendinous junction tear?

Answer 18

medial head of gastrocnemius at musculotendinous junction with Achilles tendon - “plantaris syndrome” (mis-called), often partial

Question 19

Tx for rupture/tear?

Answer 19

conservative - mobilise, splint/cast. Operative

Question 20

where does laceraiton normally happen?

Answer 20

finger flexors (FDS, FDP)