Tendon Pathology Flashcards
Define a Tendinopathy
Disease of a tendon
What is a Tendonitis?
Inflammation of a tendon
What is meant by Tendonosis?
Chronic tendon injury with damage to a tendon ECM
What is a Tenosynovitis?
Inflammation of the tendon sheath
What is an Enthesopathy?
Inflammation of the tendon ORIGIN or the INSERTION into bone
What is the main function of a tendon
Transmit load from muscle to bone
What are tendons composed of?
- Water
- Collagen (Type 1 – 85% of dry weight)
- Proteoglycans
Tendons have a poor blood supply. TRUE/FALSE?
TRUE
What is an endotendon?
- Outer layer of CT
- Lies within tendon sheath
- contain nerves and small blood vessels
What intrinsic factors can predispose to tendinopathy?
- Age
- Gender
- Obesity
- Pre-disposing diseases e.g Rh A
- Anatomical factors and Mal-alignment
What extrinsic factors can predispose to tendinopathy?
- Trauma / Injury
- Repetitive injury
- Sports related factors
Drugs:
- Steroids
- Antibiotics
How are tendinopathies conservatively managed?
Rest, Ice, Compression, Elevation (R.I.C.E.) Physio Analgesics (NSAIDs if req'd) Injections Splinting
What position is the foot in for achilles tendinopathy casting and splinting?
Tip toe position
What are the principles of surgical management for tendinopathy?
Debridement (Remove diseased tissue) Decompression Synovectomy (to prevent rupture) Extensor tendons of wrist Tendon transfer
Describe the process by which the rotator cuffs acquire pathology
Extrinsic compression + Intrinsic degeneration
Inflammation of subacromial bursa
What groups of people are most likely to get rotator cuff pathology?
Athletes (throwing events) Manual workers (painters)
also grey hair = cuff tear
What clinical findings would you possibly see in rotator cuff pathology?
- Achy pain down arm
- Difficulty sleeping on affected side
- Difficulty reaching overhead and on lifting
- Painful arc +/- weakness
- Positive impingement tests
How are rotator cuff pathologies usually treated?
Conservative – physio, inject
Surgical – subacromial decompression
What is biceps tendinopathy?
Either:
- tendonitis
- tendonosis
- rupture
- tenosynovitis
Can occur at proximal OR distal end of bicep
Mainly long head of biceps = affected where it passes through the bicipital groove
What symptoms may a patient with biceps tendinopathy experience?
- Pain anterior shoulder
- radiating to elbow
- Snapping with shoulder movements if subluxation
Aggravated by:
- shoulder flexion
- forearm pronation
- elbow flexion
What groups of people usually get biceps tendinopathy?
- occupations with heavy lifting/overhead work
- athletes involved in throwing events
- swimmers
- gymnasts
What imaging method is used to investigate biceps tendinopathy?
Ultrasound
What are the clinical signs which point towards bicep rupture?
“Popeye” sign (noticeable bicep lump)
Extensive Bruising
Positive Hook Sign (can get finger underneath bicep when asking pt to tense it)
Why are conservative treatments used more in biceps tendinopathy?
Surgery risks damage to NVB especially at distal end
What condition is more commonly known as “Tennis Elbow” ?
Lateral Epicondylitis
What is the lateral epicondyle also known as?
The common extensor origin
What causes Lateral Epicondylitis?
Eccentric overload at common extensor tendon origin
=> Tendinosis and inflammation
- angiofibroblastic hyperplasia
- breakdown/fibrosis
Lateral Epicondylitis usually occurs in the dominant arm. TRUE/FALSE?
TRUE
What symptoms do patients usually present with when they have Lateral Epicondylitis
Pain and tenderness over the lateral epicondyle
Pain with resisted extension of middle finger
How is lateral epicondylitis treated?
Self-limiting
Non-inflammatory process but injections can help
Surgical release and debridement
What is the more common name for Medial Epicondylitis?
Golfer’s Elbow
Medial epicondylitis is more common than lateral epicondylitis. TRUE/FALSE
FALSE
Lateral (Tennis Elbow) is more common
Why should you avoid injecting steroids into the medial epicondyle in Golfer’s Elbow?
Risk of damage to the ulnar nerve
Where is De Quervains tenosynovitis found?
First extensor compartment
What muscles does De Quervains affect?
Abuctor Pollucis Longus and Extensor Pollucis Brevis
What part of rheumatoid arthritis causes extensor tendon rupture?
Autoimmune attack on synovium
=> tendon degeneration and rupture
What symptoms of extensor tendon rupture can be seen in RA?
Weakness wrist extension or dropped finger
What treatment is used if the diseased tendon cant be repaired in an Extensor Tendon rupture?
Tendon transfer
Synovectomy can prevent this
What other pathology can predispose to an extensor pollucis longus rupture?
Undisplaced Radial Fracture
What tendon can be used to do a transfer in an extensor pollucis longus rupture?
EIP (Extensor indicus proprius)
Why is surgical release of the A1 pulley in trigger finger contraindicated in RA?
- may exacerbate ulnar drift
=> Synovectomy preferred
What can cause a rupture in the knee extensor mechanism?
blunt or penetrating trauma
steroids
antibiotic
diabetes
What can be seen on clinical examination of an extensor mechanism rupture?
palpable gap
no straight leg raise
What can be noted on imaging when there is an extensor mechanism rupture?
X-rays may show an effusion
Patella sitting in the wrong place (high or low)
US or MRI may show partial or complete tear
How does Osgood-Schlatter’s disease usually present
- Insertion of patellar tendon into tibial tuberosity
- Leaves prominent bony lump
- common in adolescent active boys
- Can also happen at patella and achilles
What type of action can cause a rupture of the achilles tendon?
Sudden acceleration / deceleration – running / squash
What conditions and medications can cause achilles tendon rupture?
RhA, steroids, tendonitis
What clinical signs can indicate an achilles tendon rupture?
- Palpable gap
- Unable to tiptoe stand
- Simmonds’s test +ve (pinching calf mucles plantar flexes foot)
What can rupture of the Tibialis Posterior lead to?
Progressive flat foot and valgus hindfoot
How is rupture of Tibialis Posterior treated?
NSAIDs Orthotics / cast Inject debride **May be helped by tendon transfer**
Tendon steroid injections are more likely to be used in the lower limb than the upper limb.TRUE/FALSE?
FALSE
they are more likely to be injected in the upper limb
