Tendon injuries Flashcards by Callum Hill

Which fibres make up the tendinous insertion into bone?

Sharpey’s fibres

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Which cell type mostly make up tendons?

Tenocytes

How well did you know this?

Not at all

Perfectly

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

Collagen 1 - arranged in Triple helix

How well did you know this?

Not at all

Perfectly

What are collagen bundles covered by?

Endotenon

How well did you know this?

Not at all

Perfectly

What are fascicles covered by?

Paratenon

How well did you know this?

Not at all

Perfectly

What are tendons covered by?

Epitenon

How well did you know this?

Not at all

Perfectly

Tendons receive blood from what?

Fine network of blood vessels (Vinculum) in the paratenon

How well did you know this?

Not at all

Perfectly

Tendons are connected to a sheath by what?

Vincula

How well did you know this?

Not at all

Perfectly

What makes up a tendon sheath?

> Tendons connected to a sheath by vincula

> Synovial lining + Fluid (Gliding lubrication and nutrition)

How well did you know this?

Not at all

Perfectly

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

Strong annular pulleys

How well did you know this?

Not at all

Perfectly

What is the function of tendons?

> Flexible and very strong under tension

> Allows movement

How well did you know this?

Not at all

Perfectly

What is the issue with absence of movement and tendons?

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Give an example of a degeneration of a tendon?

Achilles tendon

How well did you know this?

Not at all

Perfectly

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

Achilles tendon degeneration

How well did you know this?

Not at all

Perfectly

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”!