Tendon Injuries

Question 1

Structure of the tendon

Answer 1

• Longitudinal arrangement of cells (mostly tenocytes) and fibres (collagen type 1 triple helix)
• Fascicles of long narrow spiralling collagen bundles
• Collagen bundles covered by endotendon
• Fascicles covered by paratenon
• Tendon covered by epitenon

Question 2

Blood supply to tendons

Answer 2

Vinculum which is a fine network of blood vessels in the paratenon

Question 3

Tendon Sheath

Answer 3

The tendons are connected to the sheath by the vincula and there is the presence of the synovial lining and fluid (gliding lubrication and nutrition). There is also thickening which form strong annular pulleys

Question 4

Functions of Tendons

Answer 4

Flexible and very strong in tension.

Question 5

Immobility of tendons

Answer 5

Results in reduced water content and glycosaminoglycan concentration and strength

Question 6

Tendon Degeneration

Answer 6

this commonly occurs on the Achilles tendon due to intrasubstance mucoid degeneration. This may be swollen, painful, tendon but may also be asymptomatic. This is a precursor to rupture.

Question 7

Tendon inflammation

Answer 7

de Quervains stenosing tenovaginitis. This is when then tendons of EPB and APL passing through common tendon sheath at the radial aspect of the wrist becomes inflamed. The common symptoms are a swollen, tender, hot and red wrist with a positive finklesteins test.

Question 8

Tendon Enthesioopathy

Answer 8

This is inflammation at the insertion to the bone. This is usually at the muscle origin rather than the tendon insertion and is common to occur at the lateral humeral epicondylitis (tennis elbow). If a ligament is effected, this results in plantar fasciitis.

Question 9

Traction Apophysitis

Answer 9

Osgood Schlatter’s disease – this is the insertion of patellar tendon into the anterior tibial tuberosity and results in adolescent active boys due to recurrent load resulting in inflammation. Damage to the unformed apophysis.

Question 10

Tendon Avulsion

Answer 10

This is failure at the insertion. This occurs due to load exceeding failure strength while the muscle is contracting. An example of this is Mallet finger in which the insertion of the extensor tendon into the dorsum of the base of the distal phalanx of the finger detaches due to forced flexion of extended finger

Question 11

Treatment of Tendon Avulsion

Answer 11

Avulsion can be treated conservatively with retraction of the tendon and limited use. It can also be treated operatively with reattachment of the tendon or fixation of the bone fragment.

Question 12

Intrasubstance Rupture

Answer 12

This is common in the Achilles tendon when load exceed failure strength. The mechanism of the rupture differs but often occurs due to pushing off with weight bearing forefoot whilst extending knee of joint, unexpected dorsiflexion of the ankle or violent dorsiflexion of the plantar flexed foot.

Question 13

Findings of intrasubstance rupture of the achilles tendon

Answer 13

Positive simmonds test

Palpable tender gap

Question 14

Musculotendinous junction tear

Answer 14

This often occurs at the medial head of gastrocnemius at the musculotendinois junction with the Achilles tendon resulting in plantaris syndrome.

Question 15

Tendon Laceration

Answer 15

This occurs in the finger flexors (FDS and FDP) and is common in males. This should be repaired surgically and very early.