Tendon and Ligament Injuries Flashcards
Describe the structure of tendons
Longitudinal arrangement of cells (mostly tenocytes) and fibres (collagen type 1 - triple helix)
Long narrow spiralling collagen bundles
Collagen bundles covered by endotenon
Fascicles covered by paratenon
Tendon covered by epitenon
BVs in paratenon
Describe the tendon sheath
e.g. flexor tendons in distal palm and fingers
- tendons connected to sheath by vincula
- synovial lining and fluid for lubrication and nutrition
- thickenings which form annular pulleys
What are the functions of tendons?
- flexible and v strong in tension
- require movement; immobility reduces water content and glycosaminoglycan concentration and strength
How can tendons become injured?
Degeneration, inflammation, tears, laceration, crush, ischaemia, nodules
Describe tendon degeneration
e.g. achilles tendon
- intrasubstance mucoid degeneration
- may be swollen, painful, tender
Describe tendon inflammation
e. g. De Quervain’s tenovaginitis
- swollen, tender, hot
Describe enthesiopathy
Inflammation at bone insertion
Describe avulsion + bone fragment
Where a tendon/ligament pulls off a piece of bone
How is avulsion treated?
Conservative
- limited application; retraction tendon
Operative
- reattach tendon; through bone
- fixation of bone fragment
Describe Simmond’s test
For achilles tendon rupture
Squeeze calf; if tendon intact foot willplantar-flex, if not then no response
What is the treatment for tendon rupture and when are they used?
Conservative
- where ends can be opposed; mobilise/splint/cast
- where healing will occur; not intraarticular
Operative
- high risk re-rupture
- high activity
- ends cannot be opposed
Describe intrasubstance rupture
Due to load exceeding failure strength
Describe mechanisms of intrasubstance rupture
53% pushing off with weight bearing forefoot whilst extending knee joint i.e. sprint starts
17% unexpected dorsiflexion of ankle i.e. slipping into a hole
10% violent dorsiflexion of plantar flexed foot e.g. fall from height
