Tendon injuries Flashcards
Which fibres make up the tendinous insertion into bone?
Sharpey’s fibres
What is the anatomical structure of tendons - arrangement?
> Longitudinal arrangement of cells (Mostly tenocytes) and fibres (collagen 1 - Triple helix)
1) Tropo collagen –>
2) –> Microfibrils –>
3) –> Subfibril –>
4) —> Fibril
5) –> Fascicles –>
6) –> Tendons
Which cell type mostly make up tendons?
Tenocytes
Which collagen type mostly make up tendons, what is its arrangement?
Collagen 1 - arranged in Triple helix
What are collagen bundles covered by?
Endotenon
What are fascicles covered by?
Paratenon
What are tendons covered by?
Epitenon
Tendons receive blood from what?
Fine network of blood vessels (Vinculum) in the paratenon
Tendons are connected to a sheath by what?
Vincula
What makes up a tendon sheath?
> Tendons connected to a sheath by vincula
> Synovial lining + Fluid (Gliding lubrication and nutrition)
Tendon fibres thicken within a tendon sheath to allow formation of what?
Strong annular pulleys
What is the function of tendons?
> Flexible and very strong under tension
> Allows movement
What is the issue with absence of movement and tendons?
Immobility reduces water content and glycosaminoglycan concentration and strength within a tendon
What can lead to injury of a tendon?
> degeneration > Inflammation > Enthesiopathy > Traction apophysitis avulsion bone fragment * > Tear - intrasubstance (rupture) * > Tear - musculotendinous junction > Laceration/ incision > Crush / ischaemia / attrition nodules
Give an example of a degeneration of a tendon?
Achilles tendon
A degeneration of a tendon in the lower leg is likely to be what?
Achilles tendon degeneration
Achilles tendon?
> Achilles tendon
intrasubstance mucoid degeneration
> May be swollen, painful, tender; may be asymptomatic
> Precursor to rupture
A degeneration other than achilles tendon is often due to what?
Rheumatoid arthritis
Example of an inflammation to a tendon?
de Quervain’s stenosing tenovaginitis
What is de Quervain’s stenosing tenovaginitis?
> An inflammation to a tendons of EPB + APL passing through common tendon sheath at radial aspect of wrist
> Swollen, tender, hot, red
> Positive Finklestein’s test
Which test is used in de Quervain’s stenosing tenovaginitis?
Positive Finklestein’s test
How does Quervain’s stenosing tenovaginitis present?
Swollen, tender, hot, red radial aspect of wrist
What is enthesiopathy?
Inflammation at insertion to bone
Where is enthesiopathy most likely to occur?
Usually at muscle origin rather than tendons insertion
E.g. Lateral humeral epicondylitis, tennis elbow
Example of an injury to a tendon?
Traction apophysitis e.g. Osgood Schlatter’s disease
What is Osgood Schlatter’s disease?
Injury to the tendon due to Traction Apophysitis (Recurrent load) leading to inflammation
Who is most likely to be affected by Osgood Schlatter’s disease?
Adolescent active boys
Which tendon is affected in Osgood Schlatter’s disease?
The patellar tendon as it inserts into the anterior tibial tuberosity
What occurs in avulsion of a tendon, what may it be accompanied by?
> Failure at insertion (breaks)
> Often accompanied by bone fragment
What cause Avulsion of a tendon?
Load exceeding failure strength while muscle contracting
What is an example of avulsion in a tendon?
Mallet finger:
> Insertion of extensor tendon into dorsum of base of distal phalanx of finger
> Forced flexion of extended finger
What is Mallet finger?
Mallet finger:
> An avulsion of the extensor tendon into dorsum of base of distal phalanx of finger
> Forced flexion of extended finger
How do you treat avulsion of a tendon?
Conservative:
> Limited application
> Retraction tendon
Operative:
> Reattachment tendon
- Through bone
> Fixation bone fragment
What is an intrasubstance rupture of a tendon?
A tear example = Achilles tendon
What causes an intrasubstance rupture of a tendon?
When a load exceeds the failure strength of a tendon
What is the types of mechanisms leading to rupture of a achilles tendon?
> 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
Which test(s) is used to indicated Achilles tendon rupture?
> Positive Simmond’s (Squeeze) test
> Palpable tender gap
What is a musculotendinous junction tear?
> Medial head of gastrocnemius at musculotendinous junction with achilles tendon
> Plantaris syndrome
Often partial
Treatment for a musculotendinous junction tear?
Conservative: > Where ends can be opposed: - Mobilise (partial rupture) e.g. med lig knee - Splint/cast > Where healing will occur: - Not intraarticular
Operative:
> High risk rerupture
> High Activity
> Ends cannot be opposed
Most common sites for a laceration of tendons?
Finger flexors (FDS + FDP)
Who is most likely to present with lacerations of the finger flexor tendons?
Male young adult
Treatment for lacerations of the finger flexor tendons?
> Repair surgically & early - beware old injuries!
> “technically challenging”!
