O: Tendinopathies Flashcards
general aetiology of tendinopathies?
intrinsic: age, gender
extrinsic: trauma, repetitive injury, drugs (steroids, ciprofloxacin)
mx for tendinopathies?
conservative: rest, analgesia, physio, splinting
mx: debridement, synovectomy, tendon transfer
upper limb tendinopathies…
RC tendonosis bicep tendinopathy epicondylitis De Quervain's Tenosynovitis EPL rupture Trigger finger
what are the 4 muscles of the RC?
subscapularis, infraspinatous, supraspinatous, teres minor
s/s of RC tendonosis?
achy pain down arm/neck/ shoulder, difficulty sleeping on affected side, reaching overhead and arc are painful
ix for RC tendonosis?
+ve impingement tests, USS, MRI
aetiology of bicep tendinopathy?
overuse, trauma
which Bicep tendon is more prone to injury?
long head rupture
s/s of bicep tendonopathy?
pain anterior shoulder that radiates to elbow, swelling, possible bulge felt
mx for bicep tendinopathy?
long head= leave alone
distal bicep tendon rupture= surgical
types of epicondylitis
lateral humeral epicondyle (tennis elbow) medial epicondyle (golfers elbow)
pathophysiology of epicondylitis?
site where insertion of tendon into bone becomes inflamed
s/s of epicondylitis?
local tenderness, pain radiates into forearm on using affected muscle
tx for epicondylitis?
self limiting-rest, corticosteroid injections at point of max tenderness, splint
surgical options: release in very advance cases
what is de Quervain’s tenosynovitis (dQT)?
6 extensor compartments in hand- stenosing due to inflammation of 1st extensor dorsal compartment (inflammation within synovial sheath)
what is in the 1st extensor dorsal compartment of the hand?
abductor pollicis longus, extensor pollicis brevis
epi of dQT?
W>M, 30-50yo
aetiology of dQT?
idiopathic, repeated unaccustomed use, inflammatory arthritis, postpartum
types of dQT?
- flexor tenosynovitis: finger pain when gripping
- dorsal tenosynovitis: hourglass swelling from back of hand
- dQT
s/s of dQT?
pain and swelling over radial styloid process, red, pain worsened by flexing thumb into palm
ix for dQT?
thickened sheath may be palpable, tenderness, USS
what is the specialist test for dQT?
Finklestein’s test
mx of dQT?
self-resolves, conservative (thumb spica splint)
surgery- decompression
what is EPL rupture?
rupture of EPL tendon which may be due to RA or a Colles Fracture
s/s of EPL rupture?
substantial loss of function in hand
mx of EPL rupture?
conservative or surgery (tendon transfer using EIP)
pathophysiology of trigger finger?
small nodule present in tendon sheath, nodule catches as finger flexed and tendon gets stuck under A1 pulley
define trigger finger?
trapping of fixed flexed finger
T/F: lower limb tendinopathies should NEVER be injected
T: LL tendiopathies shouldn’t be injected with steroids, upper limb tendinopathies can be
lower limb tendinopathies…
knee extensor tendinopathy, Achilles tendinopathy, tibialis posterior tendinopathy, tendo achilles tendonitis, tendo-achillea rupture, plantar fasciitis, Morton’s neuroma
2 tendons of knee extensions?
quadricep tendon and patellar tendon
s/s of knee extensor tendiopathy?
palpable gap, no straight leg raise, patella Alta/baga
mx of knee extensor tendinopathy?
surgery
sudden acceleration/ deceleration is risk for which tendinopathy?
achilles
what is aetiology/ risk factors for all tendinopathies?
RA, steroids, previous tendiopathies, diabetes, ciprofloxacin (quinolone abx)
s/s of achilles tendinopathy?
feel like being kicked in the heel, palpable gap, can’t tip toe, tender swelling a few cm above tendon insertion
which specialised test for achilles tendinopathy?
Simmond’s test
mx for achilles tendinopathy?
plaster in acute cases, surgery if delayed presentation
achilles bursitis lies where?
anterior to tendon
mx of achilles bursitis but important NOT to do for achilles tendinopathy?
steroid injection
what are s/s of tibialis posterior rupture?
valgus foot, too many toes sign, no medial arch, flat foot
mx of tibialis posterior rupture?
conservative- NSAIDs, orthotics/cast
surgery- decried/ tendon transfer
what is achilles tends-achilles tendonitis
repetitive microtrauma causing failure of collagen repair with loss of fibre structure
aetuiology of tends-achilles tendonitis?
overuse, steroids, connective tissue disease
s/s of tendo-achilles tendonitis?
pain and morning stiffness that eases with heat/walking, tender swelling above tendon insertion
mx tendo-achilles tendonitis?
analgesia, NSAIDs, shockwave therapy
aetiology of tends-achilles rupture?
pre-existing tendinosis, sudden deterioration with resisted calf contraction, repetitive strains, ciprofloxacin, RA
s/s of tends-achilles rupture?
unable to weight bear, weak plantar flexion, palpable gap, simmond’s test +ve
mx of tends-achilles rupture?
operative/ conservative
what is plantar fasciitis
inflammation of inserting of plantar fascia into calcaneum
aetiology of plantar fascia?
physical overload, seronegative arhtropathies, abnormal foot shape, inapporpriate footwear, obese
s/s of plantar fasciitis?
localised pain under heel during walking, tenderness on palpation, start-up pain, plantar medial aspect of heal swollen?
ix for plantar fasciitis?
tinnel’s test +ve for baxter’s nerve, hx of heel pad pain
tx for plantar fasciitis?
conservative- NSAIDs, night splints etc, surgery
self-resolves 18-24months
what is Morton’s neuroma?
degenerative fibrosis of digital nerve near its bifurcation causing irritation and inflammation of nerve
s/s of Morton’s neuroma?
forefoot pain, burning and tingling in toes when walking
where is Morton’s most common?
between 3rd and 4th metatarsal heads
ix for Morton’s neuroma?
exam and USS, Mulder’s click test
mx for Morton’s neuroma?
non-op: insoles, injection, wide-cushioned shoes
operative is excise
