Soft tissue

Question 1

How does achilles tendon rupture present?

Answer 1

Achilles tendon rupture should be suspected if the person describes the following whilst playing a sport or running; an audible ‘pop’ in the ankle, sudden onset significant pain in the calf or ankle or the inability to walk or continue the sport.

Question 2

What is Simmond’s triad?

Answer 2

In achilles tendon rupture test - Lie with feet over the bed look for abnormal angle of declination - greater dorsiflexion of the injured foot, feel for a gap in the tendon and squeeze calf muscle and in rupture the injured foot will stay in the neutral position

Question 3

How should acute achilles tendon rupture be managed?

Answer 3

orthopaedic specialist

Question 4

How does achilles tendinopathy present?

Answer 4

gradual onset of posterior heel pain that is worse following activity
morning pain and stiffness are common
calf muscle eccentric exercises - this may be self-directed or under the guidance of physiotherapy

The management is typically supportive including simple analgesia and reduction in precipitating activities

Question 5

What predisposes individuals to achilles tendon disorders?

Answer 5

quinolone use (e.g. ciprofloxacin) is associated with tendon disorders
hypercholesterolaemia (predisposes to tendon xanthomata)

Question 6

How would Golfer’s elbow present?

Answer 6

Epicondylitis is caused by repeated strain leading to inflammation of the common extneso tendon in the epicondyle Golfer’s elbow or medial epicondylitis produces tenderness over the medial epicondyle and medial wrist pain on resisted wrist pronation.

Question 7

How would tennis elbow present

Answer 7

lateral epicondylitis produces tenderness over the lateral epicondyle and lateral elbow pain on resisted wrist extension.

Question 8

How would radial tunnel syndrome present?

Answer 8

Most commonly due to compression of the posterior interosseous branch of the radial nerve. It is thought to be a result of overuse.

Features
symptoms are similar to lateral epicondylitis making it difficult to diagnose
however, the pain tends to be around 4-5 cm distal to the lateral epicondyle
symptoms may be worsened by extending the elbow and pronating the forearm

Question 9

How does cubital tunnel syndrome present?

Answer 9

Due to the compression of the ulnar nerve.

Features
initially intermittent tingling in the 4th and 5th finger
may be worse when the elbow is resting on a firm surface or flexed for extended periods
later numbness in the 4th and 5th finger with associated weakness

Question 10

how does olecranon bursitis present?

Answer 10

Swelling over the posterior aspect of the elbow. There may be associated pain, warmth and erythema. It typically affects middle-aged male patients.