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MSK > O: Tendinopathies > Flashcards

O: Tendinopathies Flashcards

1
Q

general aetiology of tendinopathies?

A

intrinsic: age, gender
extrinsic: trauma, repetitive injury, drugs (steroids, ciprofloxacin)

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2
Q

mx for tendinopathies?

A

conservative: rest, analgesia, physio, splinting
mx: debridement, synovectomy, tendon transfer

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3
Q

upper limb tendinopathies…

A 
RC tendonosis 
bicep tendinopathy 
epicondylitis 
De Quervain's Tenosynovitis 
EPL rupture 
Trigger finger
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4
Q

what are the 4 muscles of the RC?

A

subscapularis, infraspinatous, supraspinatous, teres minor

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5
Q

s/s of RC tendonosis?

A

achy pain down arm/neck/ shoulder, difficulty sleeping on affected side, reaching overhead and arc are painful

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6
Q

ix for RC tendonosis?

A

+ve impingement tests, USS, MRI

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7
Q

aetiology of bicep tendinopathy?

A

overuse, trauma

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8
Q

which Bicep tendon is more prone to injury?

A

long head rupture

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9
Q

s/s of bicep tendonopathy?

A

pain anterior shoulder that radiates to elbow, swelling, possible bulge felt

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10
Q

mx for bicep tendinopathy?

A

long head= leave alone

distal bicep tendon rupture= surgical

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11
Q

types of epicondylitis

A 
lateral humeral epicondyle (tennis elbow)
medial epicondyle (golfers elbow)
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12
Q

pathophysiology of epicondylitis?

A

site where insertion of tendon into bone becomes inflamed

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13
Q

s/s of epicondylitis?

A

local tenderness, pain radiates into forearm on using affected muscle

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14
Q

tx for epicondylitis?

A

self limiting-rest, corticosteroid injections at point of max tenderness, splint
surgical options: release in very advance cases

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15
Q

what is de Quervain’s tenosynovitis (dQT)?

A

6 extensor compartments in hand- stenosing due to inflammation of 1st extensor dorsal compartment (inflammation within synovial sheath)

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16
Q

what is in the 1st extensor dorsal compartment of the hand?

A

abductor pollicis longus, extensor pollicis brevis

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17
Q

epi of dQT?

A

W>M, 30-50yo

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18
Q

aetiology of dQT?

A

idiopathic, repeated unaccustomed use, inflammatory arthritis, postpartum

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19
Q

types of dQT?

A
  1. flexor tenosynovitis: finger pain when gripping
  2. dorsal tenosynovitis: hourglass swelling from back of hand
  3. dQT
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20
Q

s/s of dQT?

A

pain and swelling over radial styloid process, red, pain worsened by flexing thumb into palm

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21
Q

ix for dQT?

A

thickened sheath may be palpable, tenderness, USS

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22
Q

what is the specialist test for dQT?

A

Finklestein’s test

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23
Q

mx of dQT?

A

self-resolves, conservative (thumb spica splint)

surgery- decompression

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24
Q

what is EPL rupture?

A

rupture of EPL tendon which may be due to RA or a Colles Fracture

25
Q

s/s of EPL rupture?

A

substantial loss of function in hand

26
Q

mx of EPL rupture?

A

conservative or surgery (tendon transfer using EIP)

27
Q

pathophysiology of trigger finger?

A

small nodule present in tendon sheath, nodule catches as finger flexed and tendon gets stuck under A1 pulley

28
Q

define trigger finger?

A

trapping of fixed flexed finger

29
Q

T/F: lower limb tendinopathies should NEVER be injected

A

T: LL tendiopathies shouldn’t be injected with steroids, upper limb tendinopathies can be

30
Q

lower limb tendinopathies…

A

knee extensor tendinopathy, Achilles tendinopathy, tibialis posterior tendinopathy, tendo achilles tendonitis, tendo-achillea rupture, plantar fasciitis, Morton’s neuroma

31
Q

2 tendons of knee extensions?

A

quadricep tendon and patellar tendon

32
Q

s/s of knee extensor tendiopathy?

A

palpable gap, no straight leg raise, patella Alta/baga

33
Q

mx of knee extensor tendinopathy?

A

surgery

34
Q

sudden acceleration/ deceleration is risk for which tendinopathy?

A

achilles

35
Q

what is aetiology/ risk factors for all tendinopathies?

A

RA, steroids, previous tendiopathies, diabetes, ciprofloxacin (quinolone abx)

36
Q

s/s of achilles tendinopathy?

A

feel like being kicked in the heel, palpable gap, can’t tip toe, tender swelling a few cm above tendon insertion

37
Q

which specialised test for achilles tendinopathy?

A

Simmond’s test

38
Q

mx for achilles tendinopathy?

A

plaster in acute cases, surgery if delayed presentation

39
Q

achilles bursitis lies where?

A

anterior to tendon

40
Q

mx of achilles bursitis but important NOT to do for achilles tendinopathy?

A

steroid injection

41
Q

what are s/s of tibialis posterior rupture?

A

valgus foot, too many toes sign, no medial arch, flat foot

42
Q

mx of tibialis posterior rupture?

A

conservative- NSAIDs, orthotics/cast

surgery- decried/ tendon transfer

43
Q

what is achilles tends-achilles tendonitis

A

repetitive microtrauma causing failure of collagen repair with loss of fibre structure

44
Q

aetuiology of tends-achilles tendonitis?

A

overuse, steroids, connective tissue disease

45
Q

s/s of tendo-achilles tendonitis?

A

pain and morning stiffness that eases with heat/walking, tender swelling above tendon insertion

46
Q

mx tendo-achilles tendonitis?

A

analgesia, NSAIDs, shockwave therapy

47
Q

aetiology of tends-achilles rupture?

A

pre-existing tendinosis, sudden deterioration with resisted calf contraction, repetitive strains, ciprofloxacin, RA

48
Q

s/s of tends-achilles rupture?

A

unable to weight bear, weak plantar flexion, palpable gap, simmond’s test +ve

49
Q

mx of tends-achilles rupture?

A

operative/ conservative

50
Q

what is plantar fasciitis

A

inflammation of inserting of plantar fascia into calcaneum

51
Q

aetiology of plantar fascia?

A

physical overload, seronegative arhtropathies, abnormal foot shape, inapporpriate footwear, obese

52
Q

s/s of plantar fasciitis?

A

localised pain under heel during walking, tenderness on palpation, start-up pain, plantar medial aspect of heal swollen?

53
Q

ix for plantar fasciitis?

A

tinnel’s test +ve for baxter’s nerve, hx of heel pad pain

54
Q

tx for plantar fasciitis?

A

conservative- NSAIDs, night splints etc, surgery

self-resolves 18-24months

55
Q

what is Morton’s neuroma?

A

degenerative fibrosis of digital nerve near its bifurcation causing irritation and inflammation of nerve

56
Q

s/s of Morton’s neuroma?

A

forefoot pain, burning and tingling in toes when walking

57
Q

where is Morton’s most common?

A

between 3rd and 4th metatarsal heads

58
Q

ix for Morton’s neuroma?

A

exam and USS, Mulder’s click test

59
Q

mx for Morton’s neuroma?

A

non-op: insoles, injection, wide-cushioned shoes

operative is excise

MSK (26 decks)

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