Tendon Injury Flashcards
What is a tendon?
Flexible but inelastic cord of strong fibrous collagen tissue attaching a muscle to a bone
In what anatomical variations do tendons not cope well, and how do they deal with it?
If a tendon has to go round a right angle they don’t do so well so they add an extra – a sesamoid bone, such as the patella
What is the role of the sheath?
Lubrication and blood supply
What is the role of tendons?
- flexible and very strong in tension
- movement is life; immobility reduces water content & glycosaminoglycan concentration and strength
What are some of the ways tendons can be injured?
- degeneration
- inflammation
- enthesiopathy
- traction apophysitis
- avulsion ± bone fragment
- tear - intrasubstance (rupture)
- tear - musculotendinous junction
- laceration/ incision
- crush / ischaemia / attrition
- nodules
What will degeneration of achilles tendon look like?
- intrasubstance mucoid degeneration
- may be swollen, painful, tender; may be asymptomatic
- ?precursor to rupture
What do inflammed tendons look like?
- Swollen
- Red
- tender
- Hot
What is enthesiopathy?
Inflammation at insertion to bone
Muscle/tendon
- Usually at muscle origin rather than tendon insertion - e.g. lateral humeral epicondylitis (tennis elbow) - common extensor origin
What is traction apophysitis? (Osgood schlatters disease)
If you are young you can grow at different points – how you get knobbly knees.
What is avulsion?
When there is sudden unexpected trauma – tendon is pulled off the bone
What is the treatment for avulsion?
Conservative
- Limited application
- Retraction of tendon
Operative
- Reattachment of tendon
- through bone
- Fixation of bone to ligament
What is intrasubstance rupture?
Rupture halfway along the tendon itself
Causes: load exceeds strength
What are some of the mechanisms of rupture?
- 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
What do people complain of during achilles rupture?
“someone has belted me over the back of the leg”
What is Musculotendinous Junction
Tear?
A tear at the junction between the muscle and the tendon e.g. medial head of gastrocnemius at musculotendinous junction with Achilles tendon
