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Systems: MSK AB > Tendon Growth and Repair > Flashcards

Tendon Growth and Repair Flashcards

1
Q

How is the composite unit of the muscle and tendon arranged?

A
  • Muscle origin from bone
  • Muscle belly
  • Meuscultendinous junction
  • Tendon (+/- sesamoid bone, tendon sheath)
  • Tendinous insertion into bone (Sharpey’s fibres)
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2
Q

Describe the structure of tendon.

A
  • Longitudinal arrangement of cells (mostly tenocytes) and fibres (collagen type 1-tirple helix)
  • Fascicles of long narrow spiralling collagen bundles
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3
Q

How are tendons composed?.

A
  • Collagen bundles covered by endotenon
  • Fascicles covered by paratenon
  • Tendon covered by epitenon
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4
Q

How are tendons attached to tendon sheaths?

A

Via vinicula

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5
Q

What is a tendon sheath?

A
  • A tendon sheath is a layer of synovial membrane with fluid around a tendon
  • It permits gliding lubrication and nutrition
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6
Q

What do the tendon sheaths in the distal palm and fingers act as?

A

They are thickenings which form strong annular pulleys

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7
Q

What happens if we lose mobility?

A

There is a reduction in water content and glycosaminoglycan concentration and strength

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8
Q

In what ways can tendons be injured?

A
  • Degeneration
  • Inflammation
  • Enthesiopathy
  • Traction apophysitis
  • Avulsion +/-bone fragment *
  • Tear - intrasubstance (rupture) *
  • Tear - musculotendinous junction
  • Laceration/ incision
  • Crush / ischaemia / attrition
  • Nodules
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9
Q

Give an example of a tendon prone to degeneration.

A

Achilles

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10
Q

How does Achilles tendon degeneration present?

A
  • Intrasubstance mucoid degeneration
  • May be swollen, painful, tender or may be asymptomatic
  • Is a precursor to rupture
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11
Q

Give an example of a inflammatory condition of the tendons.

A

De Quervain’s stenosing tenovaginitis

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12
Q

What tendons are susceptible to de Quervain’s stenosing tenovagnitis?

A

Tendons of EPB + APL passing through common tendon sheath at radial aspect of wrist

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13
Q

How does de Quervain’s stenosing tenovaginitis present?

A
  • Swollen, tender, hot, red

- Positive Finklestein’s test

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14
Q

What is enthesiopathy?

A
  • Inflammation at insertion to bone

- Usually at muscle origin rather than tendon insertion

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15
Q

What does enthesiopathy present as in ligaments?

A

Plantar fasciitis

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16
Q

Give an example of traction apophysitis.

A

Osgood Schlatter’s disease

17
Q

How does Osgood Schlatter’s disease?

A
  • Insertion of patellar tendon into anterior tibial tuberosity
  • Adolescent active boys
  • Recurrent load
  • Inflammation
18
Q

What can avulsion +/- bone fragments result in?

A

Mallet finger

  • Insertion of extensor tendon into dorsum of base of distal phalanx of finger
  • Forced flexion of extended finger
19
Q

Why does avulsion +/- bone fragments occur?

A
  • Failure at insertion

- Load exceeding failure strength while muscle contracting

20
Q

How is avulsion treated?

A

Conservative

  • Limited application
  • Retraction tendon

Operative

  • Reattachment tendon through bone
  • Fixation bone fragment
21
Q

Why does intrasubstance rupture occur?

A

Load exceeds failure strength

22
Q

What are the possible mechanisms of rupture?

A
  • Pushing off with weight bearing forefoot whilst extending knee joint (53%) e.g. sprint starts or jumping movements
  • Unexpected dorsiflexion of ankle (17%) e.g. slipping into hole
  • Violent dorsiflexion of plantar flexed foot (10%) e.g. fall from height
23
Q

How does Achilles tendon rupture appear on examination?

A
  • ‘Positive’ Simmond’s squeeze test

- Palpable tender gap

24
Q

Where do tears commonly occur of the musculotendinous junction?

A

Medial head of gastrocnemius at musculotendinous junction with Achilles tendon though often partial

25
Q

How are tendon ruptures treated?

A

Conservative

  • If ends can be opposed: mobilise and splint/cast
  • Where healing will occur : not intraarticular
26
Q

When is surgery considered for tendon ruptures?

A
  • High risk rupture
  • High activity
  • Ends cannot be opposed
27
Q

Where do lacerations commonly occur?

A

Finger flexors (FDS and FDP)

28
Q

Who do lacerations commonly occur in?

A

Males> females

29
Q

How are lacerations treated?

A

Repair surgically and early

Systems: MSK AB (43 decks)

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