tendon and ligament injuries

Question 1

tendinous insertion

Answer 1

sharpey fibres

Question 2

structure

Answer 2

longitudinal arrangement
tenocytes
fibres (collagen type 1 triple helix)
fascicles of long narrow spiralling collagen bundles
endotenon
paratenon (fascicles)
epitenon

Question 3

tendon sheath

Answer 3

flexor tendons in distal palm and fingers eg
connected to tendons by vincula
synovial lining +fluid

Question 4

function

Answer 4

flexible very strong in tension

movement is life, immobility reduces water content& glycoaminoglycan concentration and strength

Question 5

injury

Answer 5

degeneration
inflammation
enthesiopathy inflammation of tendon insertion
avulsion

Question 6

degeneration

Answer 6

intrasubstance mucoid degeneration

rheumatoid arthritis

Question 7

traction apophysitis

Answer 7

insertion of patellar tendon into anterior tibial tuberosity

recurrent load inflammation

Question 8

treatment of avulsion

Answer 8

conservative, operative

Question 9

intrasubstance rupture

Answer 9

load exceeds failure strength

Question 10

achilles tendon rupture

Answer 10

positive simmond’s squeeze test

palpable tender gap

Question 11

lacerations

Answer 11

finger flexors

Question 12

ligaments

Answer 12

dense bands of collagenous tissue
spans a joint
anchored to bone at either end
joint stability through range motion

Question 13

ligament structure

Answer 13

collagen fibres (type 1)
fibroblasts 
sensory fibres proprioception stretch sensory
vessels
crimping (allow stretch)

Question 14

ligament rupture

Answer 14

force exceeds strength

Question 15

healing

Answer 15

haemorrhage-
blood clot, replaced with heavy cellular infiltrate
Proliferative phase-
scar tissue
disorganized collagenous tissue
remodelling
matrix become more ligament like
major differences in composition, architechture, function persist

Question 16

treatment

Answer 16

conservative: 
partial 
no instability
poor candidate surgery
operative
instability
expectation
compulsory (knee dislocation)