Tendon

Question 1

What are the causes of tendon ruptures?

Answer 1

• excessive/asymmetric/unexpected/abnormal tensile loading
• high force stretching-shortening activity (jumping/landings, acc/dec, sprints)
• highly reflexive force activation
• forceful “push-off”
• Stretch-shortening cycle with sudden acc

Question 2

Define partial rupture

Answer 2

Small to large, no ruptured fibres, pain and limited function

Question 3

Define complete rupture

Answer 3

total disruption of tendon, pain, and non-function of specific muscle-tendon unit

Question 4

What is the difference between tendon rupture at the distal vs proximal biceps tendon?

Answer 4

Distal requires surgery
proximal can heal on its own. It uses other agonist muscles e.g. brachialis and brachioradialis

Question 5

What is the most commonly ruptured tendon and causes of it?

Answer 5

Achilles Tendon
- stretch-shortening with high loading forces
- age, degeneration and blood supply

There is extreme muscle-to-tendon CSA ratio (300:1)

Question 6

What are the grades for tendon ruptures and what is the common treatment for it?

Answer 6

Grade1: partial ruptures <50% (conservative)
Grade2: complete rupture <3cm gap (anastomosis)
Grade3: complete rupture 3-6cm gap (tendon graft)
Grade 4: complete rupture defect >6cm (tendon graft and gastroc recession

Question 7

How to determine whether Achilles tendon has been ruptured?

Answer 7

Thomsen test –> determines whether Achilles tendon is attached.

Squeezing of the calf muscle and whether the foot twitches.

Question 8

Define tendon avulsion

Answer 8

Detachment of tendon (can pull some bone but it detaches from muscle fibres)

Question 9

Provide examples of tendon avulsions

Answer 9

Jersey finger –> finger caught in someones jersey, they run and it snaps your finger

Mallet finger –> extends and locks the joint of the finger except the distal interphalangeal joint

Question 10

What happens in a hamstring avulsion?

Answer 10

ischial tuberosity detachment
often occurs in developing/immature athlete

Question 11

Define tendon subluxation and provide example

Answer 11

Damaged supportive tissue (ligaments) allow tendon to move around bone freely.
EXAMPLE
Peroneal (fibularis) tendons
- tear of SUP peroneal retinaculum
- ankle DOR force with strong peroneal contraction in hindfoot eversion

MED triceps tendon (snapping triceps syndrome)
- tendon moves over bony structure
- may damage ulnar nerve