Tendon Pathology Flashcards by raniya robb

Define a Tendinopathy

Disease of a tendon

How well did you know this?

Not at all

Perfectly

What is a Tendonitis?

Inflammation of a tendon

How well did you know this?

Not at all

Perfectly

What is meant by Tendonosis?

Chronic tendon injury with damage to a tendon ECM

How well did you know this?

Not at all

Perfectly

What is a Tenosynovitis?

Inflammation of the tendon sheath

How well did you know this?

Not at all

Perfectly

What is an Enthesopathy?

Inflammation of the tendon ORIGIN or the INSERTION into bone

How well did you know this?

Not at all

Perfectly

What is the main function of a tendon

Transmit load from muscle to bone

How well did you know this?

Not at all

Perfectly

What are tendons composed of?

Water
Collagen (Type 1 – 85% of dry weight)
Proteoglycans

How well did you know this?

Not at all

Perfectly

Tendons have a poor blood supply. TRUE/FALSE?

TRUE

How well did you know this?

Not at all

Perfectly

What is an endotendon?

Outer layer of CT
Lies within tendon sheath
contain nerves and small blood vessels

How well did you know this?

Not at all

Perfectly

What intrinsic factors can predispose to tendinopathy?

Age
Gender
Obesity
Pre-disposing diseases e.g Rh A
Anatomical factors and Mal-alignment

How well did you know this?

Not at all

Perfectly

What extrinsic factors can predispose to tendinopathy?

Trauma / Injury
Repetitive injury
Sports related factors

Drugs:

Steroids
Antibiotics

How well did you know this?

Not at all

Perfectly

How are tendinopathies conservatively managed?

Rest, Ice, Compression, Elevation (R.I.C.E.)
Physio 
Analgesics (NSAIDs if req'd)
Injections
Splinting

How well did you know this?

Not at all

Perfectly

What position is the foot in for achilles tendinopathy casting and splinting?

Tip toe position

How well did you know this?

Not at all

Perfectly

What are the principles of surgical management for tendinopathy?

Debridement (Remove diseased tissue)
Decompression
Synovectomy (to prevent rupture)
Extensor tendons of wrist
Tendon transfer

How well did you know this?

Not at all

Perfectly

Describe the process by which the rotator cuffs acquire pathology

Extrinsic compression + Intrinsic degeneration

Inflammation of subacromial bursa

How well did you know this?

Not at all

Perfectly

What groups of people are most likely to get rotator cuff pathology?

Athletes (throwing events)
Manual workers (painters)

also grey hair = cuff tear

How well did you know this?

Not at all

Perfectly

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 well did you know this?

Not at all

Perfectly

How are rotator cuff pathologies usually treated?

Conservative – physio, inject

Surgical – subacromial decompression

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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