Tendon problems - 02/11/18 Flashcards
What is Tendinopathy?
Disease of a tendon – the best term for tendon related pain
What is Tendonitis?
Inflammation of a tendon
What is tendonosis?
Chronic tendon injury with damage to a tendon ECM
What is tenosynovitis?
Inflammation of the tendon sheath
What is Enthesopathy?
Inflammation of the tendon origin or the insertion into bone
What is the function of tendons?
Transmit load from muscle to bone
What are tendons composed of?
Water
Collagen (Type 1 – 85% of dry weight)
Proteoglycans
Do tendons have a good blood supply?
No
What is the organisation of a tendon?
MicrofibrilsSubfibrilsFibrilsFasciclesTendon unit
What can cause tendinopathy?
Intrinsic Age Gender Obesity Pre-disposing diseases e.g Rh A Anatomical factors Mal-alignment LLD Extrinsic Trauma / Injury Repetitive injury Drugs Steroids Antibiotics Sports related factors
What are the principles of management of tendinopathy?
Conservative Rest (R.I.C.E.) Physio – Eccentric strengthening Analgesics Anti-inflammatories Injections Rotator cuff Tennis elbow NOT Achilles tendon or extensor knee mechanism Splinting Achilles tendon
What are the surgical managements of tendinopathy?
Surgical Debridement Removal of diseased tissue Decompression Supraspinatus tendonitis & subacromial decompression Synovectomy Helps to prevent rupture Extensor tendons of wrist (Rhematoid arthritis) Tibialis posterior Tendon transfer Tibialis posterior Extensor pollicis longus
What is the pathophysiology of rotator cuff pathology?
Extrinsic compression + Intrinsic degeneration
Inflammation of subacromial bursa
Who gets rotator cuff pathology?
Athletes
Manual workers
What are the findings of rotator cuff pathology?
Achy pain down arm
Difficulty sleeping on affected side, reaching overhead & on lifting
Painful arc +/- weakness
Positive impingement tests
What is the management of rotator cuff pathology?
Conservative – physio, inject
Surgical – subacromial decompression
Which is greater, tendinosis or inflammation?
Tendinosis
What can cause biceps tendinopathy?
Overuse
Instability
Impingement
Trauma
What are the clinical signs of biceps tendinopathy?
Pain anterior shoulder radiating to elbow
Aggravated by shoulder flexion, forearm pronation and elbow flexion
Snapping with shoulder movements if subluxation
What are the investigations for biceps tendinopathy?
Clinical exam
USS
What are the characteristics of lateral epicondylitis?
Overuse injury
Eccentric overload at common extensor tendon origin
Tendinosis and inflammation at ECRB origin
Peritendinous inflammation angiofibroblastic hyperplasia breakdown/fibrosis
M:F 1:1
1-3% adult annual incidence
Commonly in dominant arm
10-20% bilateral
Pain and tenderness over the lateral epicondyle
Pain with resisted extension of middle finger
Non-inflammatory
Self-limiting, injections
Surgical release and debridement of ECRB origin
What are the characteristics of medial epicondylitis?
Medial elbow pain Origin of the wrist flexors M:F 1:1 5-10 times less common than Tennis elbow Repetitive stress Peritendinous inflammation angiofibroblastic hyperplasia breakdown/fibrosis Associated ulnar neuropathy Self-limiting condition Avoid injecting – ulnar nerve Surgical debridement last resort
What are the characteristics of De Quervains tenosynovitis?
Tendon sheath pathology First extensor compartment APL & EPB Cause unknown. F>M. Pregnancy. Pain whilst using thumb. Tender over compartment. Pain on resisted active thumb extension Finklestein’s test
What are the investigations for DQT?
USS
X-ray
What is the management for DQT?
Splint Rest Physio ANalgesia Injections Surgery
What are the characteristics of RA and eTR?
Autoimmune attack on synovium tendon degeneration rupture
Weakness wrist extension or dropped finger
Can’t repair diseased tendon
tendon transfer
Synovectomy can prevent
What are the characteristics of Extensor tendon rupture?
Most common hand tendon rupture
Occurs a few weeks after typically undisplaced distal radius fractures
1% of all distal radius fracrtures
Pathogenesis uncertain but ischaemia plays a role.
Watershed area of tendon as it passes around Lister’s tubercle. Fracture haematoma hinders perfusion.
Loss of function of thumb extension but not always too big an impact on daily life.
May require tendon transfer (EIP)
what are the characteristics of trigger finger?
Stenosing tenosynovitis fibrocartilaginous metaplasia nodule FDS tendon
Nodule catches on A1 pulley clicking/locking during ext/flxn.
Often most troublesome on waking.
Pain and tenderness over tendon sheath at level of MCPJ
Can lead to fixed flexion contracture exp in diabetics.
Any age (even kids)
Observe, inject (cures 70%), surgical release of A1 pulley.
Contraindicated in RA as it may exacerbate ulnar drift. Synovectomy preferred.
What are the 3 parts of the knee extensor mechanism?
Tendonitis
Rupture
Traction apophysitis
What are the characteristics of Quads and patellar tendon?
Don’t inject tendonitis Tend to be middle aged Clinical findings: Palpable gap No SLR May be high or low patella on xray Ix: XR, USS, MRI Mx: surgical repair
What are the characteristics of Traction apophysitis?
At tibial tubercle = Osgood-Schlatter’s disease
insertion of patellar tendon into tibial tuberosity
adolescent active boys
Leaves prominent bony lump
Can also happen at patella & achilles
What are the characteristics of achilles tendon rupture?
Common, middle aged Sudden acceleration / deceleration – running / squash Feels like being kicked or shot RhA, steroids, tendonitis Clinical findings: Palpable gap Unable to tiptoe stand Simmonds's test +ve Ix: USS, MRI Mx: plaster vs repair
What are the characteristics of tibialis posterior rupture?
Tenosynovitis progressive elongation rupture
Cause usually unclear
Leads to progressive flat foot & valgus hindfoot
NSAIDs, Orthotics / cast, inject, debride
May be helped by tendon transfer
