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Medicine 2.1 > Rotator Cuff and Tendonopathy > Flashcards

Rotator Cuff and Tendonopathy Flashcards

1
Q

What is the standard structure of a tendon like?

A

-Dense, regularly arranged tissue that connects muscle to bone.
-Highest tensile strength of all connective tissue as it has:
High proportion of collagen and a closely packed paralell arrangement in the direction of force.

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2
Q

What are 3 components in and aroun tendons?

A
  • Tendon itself
  • Bone insertion
  • Muscle tendon junction
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3
Q

What is the composition of tendons like?

A
  • 20% cellular (fibroblasts/tenocytes)

- 80% ECM (70% H2O, 30% solids such as collagen 1 and 3, ground substance and elastin).

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4
Q

What is vascularisation of tendons like?

A
  • Sparsely vascularised

- In rotator cuff, early stages of healing there is neovascularisation

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5
Q

What is the difference betwenn intrinsic and extrinsic processes in tendon healing?

A
  • Extrinsic- cells from outwith tendon come in to help (eg. inflammatory cells)
  • Intrinsic- internal cellular structure aids repair mechanisms
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6
Q

What 3 phases can tendon healing be put into and what are their rough timescales?

A
  • Inflammation (day 0-7)
  • Repair (day 3-60)
  • Organisation (day 28-180)
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7
Q

What molecules control tendon healing?

A

-Cytokines and other mediators such as PDGF (chemotaxis) and TGFB (collagen type).

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8
Q

Describe the process of inflammation in tendon healing?

A

-Inflammation cells migrate from:
Epitendinous tissues (sheath, periosteum, soft tissue)
Epitendon and endotendon
-Defect rapidly filled with granulation tissue, haematoma and tissue debris.
-Matrix proteins laid down as scaffolding for collagen synthesis.

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9
Q

Describe the repair phase of tendon healing?

A
  • Fibroblast/tenocyte migrate to zone of injury and begin to synthesise collagen by day 5.
  • Initially collagen 3 produced and laid down in random orientation.
  • During 4th week intrinsic fibroblasts proliferate and these cells take over the healing process both by synthesising and reabsorbing collage. (Tendon Callus)
  • Switch to production of type 1 collagen, is increasingly orientated along line of force.
  • Vascular ingrowth via collagen/fibroconectin scaffolding.
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10
Q

Describe organisation phase of tendon healing?

A

-Final stability acquired during this phase by the normal physiological use of tendon.
-Accompanied by cross linking between fibrils, further increasing tendon tensile strength.
-Complete regeneration never acheived:
defect remains hypercellular
thinner collagen fibrils

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11
Q

What do tendons do:?

A
  • Connect muscle to bone

- Transmit force

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12
Q

Why is early controlled mobilisation important for muscle/tendon damage?

A
  • Reduce scar adhesions

- Facilitate healing by stimulating remodelling.

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13
Q

What will excessive loading do during tissue repair?

A

-Disrupt tissue repair

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14
Q

What does optimal healing depend on?

A
  • Surgical apposition and mechanical stabilisation
  • Minimal sot tissue damage
  • Optimal mechanical environment for healing
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15
Q

What does patient rehab time often depend on?

A

-Anatomical area

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16
Q

What are some causes of rotator cuff tears?

A
  • Age, more common in >65
  • Multifactorial
  • Bone spurs
  • Acromion shape (bigliani)
  • Trauma (mostly acute)
  • Genetic
  • Repetitive overloading
  • Tendinopathy leading to tears
17
Q

What are some intrinsic risk factors of tendiopathy?

A
  • Systemic diseases (diabetes, obesity)
  • Family history
  • Age
  • Muscle weakness
18
Q

What are some extrinsic factors of tendinopathy?

A
  • Overuse
  • Sudden increase in activity or intensity of activity
  • Lack of adequate recovery
  • Medications (HRT)
  • Poor workplace ergonomics
19
Q

What are some potential treatments of tendinopathy?

A
  • Non-operative: -physio
  • Injection (steroid/local) for pain
  • Operative: -repair tendon to bone
  • Arthroscopic surgery/open surgery
  • Platelet rich plasma injection
20
Q

Compare the surgery options for tendonopathy?

A
  • Arthroscopic: -less invasive, faster recovery, visualise whole joint
  • Open: -more invasive, still good long term results
21
Q

Describe the pathophysiology of tendinopathy?

A
  • Disregulation of ECM
  • Causes immune responses, stromal responses
  • Failure of normal homeostatic responses eventually leads to early tendinopathy with influx of immune cells, stromal cell dysfunction, apoptosis, oxidative stress and matrix dysfunction.
22
Q

What does dysregulation of repair mechanisms lead to in tendonopathy?

A

-Established/chronic tendinopathy with clinical features of poor function, pain and load capacity.

23
Q

How can tendinopathy be diagnosed, discuss symptoms and examination?

A
  • Symptoms/signs: localised pain

- Pain provoking tests specific for tendon involved eg. single leg hopping for achilles tendonopathy.

24
Q

What are the common sites for tendinopathy?

A
  • Shoulder: rotator cuff tendons
  • Hip: gluteal tendons
  • Knee: patellar tendons
  • Foot/ankle: achilles tendon
  • Peroneal or posterior tibial tendons
  • Elbow: common extensor origin, common flexor origin
25
Q

What is the differential diagnosis test for tendinopathy and AC joint pain?

A

-Examine AC joint for instability and labral tests

26
Q

What is the differential diagnosis test for tendinopathy and biceps tendon pain?

A

Speeds and yergassons test.

27
Q

What is the differential diagnosis test for tendinopathy and superior labral anterior to posterior tear?

A

Obriens sign

28
Q

What is the differential diagnosis test for tendinopathy and shoulder instability or glenoid labral tears?

A

-Apprehension test, sulcus signs

29
Q

Describe management process for tendinopathy patients?

A
  • Early diagnosis is key
  • 1st line treatment: individualised tailored loading programme, (presicion tendinopathy management plan).
  • Patient engagement and reevaluation within 3 month period crucial to dtermine progression.
  • Surgical intervention may be considered after failed response after 12 months of personalised loading problem.
30
Q

What are some more diagnostic tests for tendinopathy?

A

-Palpation: oatient complains of pain on palpation
-Empty can test
-Hawkins test
-Jobe test
The last 3 all test certain movements and are positive if patient experiences pain in it.

Medicine 2.1 (29 decks)

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