Tendon injuries Flashcards
What is the structure of a tendon?
Muscle origin
Muscle belly
Musculotendinous junction
Tendon attaching to bone with Sharpey’s fibres.
Longitudinal arrangement of cells and fibres.
Fascicles of long narrow spiralling collagen bundles.
Collagen bundles are covered by endotendon.
Fascicles are covered by paratenon.
Tenodn is covered by epitenon.
What is the blood supply to a tendon?
Fine network of blood vessels is present in paratenon.
How are tendons connected to the sheath?
Vincula
What are some examples of injury to a tendon?
Degeneration Inflammation Enthesiopathy Traction apophysitis Avulsion +/- bone fragments Tear Laceration/incision Crush Ischaemia Nodules Attrition - sustained attack or pressure, reading strength.
What is an example of tendon degeneration injury?
Intrasubstance mucoid degeneration of achilles tendon.
May be swollen, painful, tender or asymptomatic.
Can be a precursor to rupture.
What is an example of Inflammation of a tendon?
De Quervain’s stenosing tenovaginitis.
What is Enthesiopathy?
Inflammation at the insertion to bone.
What is Osgood Schlatter’s disease?
Insertion of patellar tendon into anterior tibial tuberosity.
Common in adolescent active boys.
Recurrent load
Results in inflammation
What is Avulsion?
Injury in which a body structure is torn off either by trauma or surgery.
What is Mallet finger?
Deformity of the finger caused when the tendon that straightens your finger (the extensor tendon) is damaged.
What are the treatment options for avulsion?
Conservative is limited, may use splints to straighten finger.
Operative - reattachment of tendon through bone, fixation bone fragment.
What are some mechanisms for rupture?
Pushing off with weight bearing forefoot whilst extending knee joint e.g sprint starts or jumping movements. 53%
Unexpected dorsiflexion of ankle e.g slipping into hole. 17%
Violent dorsiflexion of plantar flexed foot e.g fall from height. 10%
What is Simmond’s test?
Tests for Achilles heel tendon rupture. The patient lies face down with feet hanging off the edge of the bed. If the test is positive, there is no movement of the foot (normally plantarflexion) on squeezing the corresponding calf, signifying likely rupture of the Achilles tendon.
What is an example of an musculotendinous junction tear?
Medial head of gastrocnemius at the musculotendinous junction with the achilles tendon. Often partial.
What are the different treatment options for tendon rupture?
Conservative - mobilise if ends can be opposed. Splints/cast.
Operative if ends can not be opposed, high activity of patient. There is high risk of re-rupture.
