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Year 3 - Musculoskeletal > Tendon injuries > Flashcards

Tendon injuries Flashcards

1
Q

Which fibres make up the tendinous insertion into bone?

A

Sharpey’s fibres

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2
Q

What is the anatomical structure of tendons - arrangement?

A

> 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

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3
Q

Which cell type mostly make up tendons?

A

Tenocytes

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4
Q

Which collagen type mostly make up tendons, what is its arrangement?

A

Collagen 1 - arranged in Triple helix

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5
Q

What are collagen bundles covered by?

A

Endotenon

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6
Q

What are fascicles covered by?

A

Paratenon

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7
Q

What are tendons covered by?

A

Epitenon

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8
Q

Tendons receive blood from what?

A

Fine network of blood vessels (Vinculum) in the paratenon

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9
Q

Tendons are connected to a sheath by what?

A

Vincula

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10
Q

What makes up a tendon sheath?

A

> Tendons connected to a sheath by vincula

> Synovial lining + Fluid (Gliding lubrication and nutrition)

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11
Q

Tendon fibres thicken within a tendon sheath to allow formation of what?

A

Strong annular pulleys

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12
Q

What is the function of tendons?

A

> Flexible and very strong under tension

> Allows movement

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13
Q

What is the issue with absence of movement and tendons?

A

Immobility reduces water content and glycosaminoglycan concentration and strength within a tendon

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14
Q

What can lead to injury of a tendon?

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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15
Q

Give an example of a degeneration of a tendon?

A

Achilles tendon

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16
Q

A degeneration of a tendon in the lower leg is likely to be what?

A

Achilles tendon degeneration

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17
Q

Achilles tendon?

A

> Achilles tendon
intrasubstance mucoid degeneration

> May be swollen, painful, tender; may be asymptomatic

> Precursor to rupture

18
Q

A degeneration other than achilles tendon is often due to what?

A

Rheumatoid arthritis

19
Q

Example of an inflammation to a tendon?

A

de Quervain’s stenosing tenovaginitis

20
Q

What is de Quervain’s stenosing tenovaginitis?

A

> 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

21
Q

Which test is used in de Quervain’s stenosing tenovaginitis?

A

Positive Finklestein’s test

22
Q

How does Quervain’s stenosing tenovaginitis present?

A

Swollen, tender, hot, red radial aspect of wrist

23
Q

What is enthesiopathy?

A

Inflammation at insertion to bone

24
Q

Where is enthesiopathy most likely to occur?

A

Usually at muscle origin rather than tendons insertion

E.g. Lateral humeral epicondylitis, tennis elbow

25
Q

Example of an injury to a tendon?

A

Traction apophysitis e.g. Osgood Schlatter’s disease

26
Q

What is Osgood Schlatter’s disease?

A

Injury to the tendon due to Traction Apophysitis (Recurrent load) leading to inflammation

27
Q

Who is most likely to be affected by Osgood Schlatter’s disease?

A

Adolescent active boys

28
Q

Which tendon is affected in Osgood Schlatter’s disease?

A

The patellar tendon as it inserts into the anterior tibial tuberosity

29
Q

What occurs in avulsion of a tendon, what may it be accompanied by?

A

> Failure at insertion (breaks)

> Often accompanied by bone fragment

30
Q

What cause Avulsion of a tendon?

A

Load exceeding failure strength while muscle contracting

31
Q

What is an example of avulsion in a tendon?

A

Mallet finger:
> Insertion of extensor tendon into dorsum of base of distal phalanx of finger

> Forced flexion of extended finger

32
Q

What is Mallet finger?

A

Mallet finger:
> An avulsion of the extensor tendon into dorsum of base of distal phalanx of finger

> Forced flexion of extended finger

33
Q

How do you treat avulsion of a tendon?

A

Conservative:
> Limited application
> Retraction tendon

Operative:
> Reattachment tendon
- Through bone
> Fixation bone fragment

34
Q

What is an intrasubstance rupture of a tendon?

A

A tear example = Achilles tendon

35
Q

What causes an intrasubstance rupture of a tendon?

A

When a load exceeds the failure strength of a tendon

36
Q

What is the types of mechanisms leading to rupture of a achilles tendon?

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

37
Q

Which test(s) is used to indicated Achilles tendon rupture?

A

> Positive Simmond’s (Squeeze) test

> Palpable tender gap

38
Q

What is a musculotendinous junction tear?

A

> Medial head of gastrocnemius at musculotendinous junction with achilles tendon

> Plantaris syndrome
Often partial

39
Q

Treatment for a musculotendinous junction tear?

A 
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

40
Q

Most common sites for a laceration of tendons?

A

Finger flexors (FDS + FDP)

41
Q

Who is most likely to present with lacerations of the finger flexor tendons?

A

Male young adult

42
Q

Treatment for lacerations of the finger flexor tendons?

A

> Repair surgically & early - beware old injuries!

> “technically challenging”!

Year 3 - Musculoskeletal (30 decks)

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