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MSK lectures > Tendon problems - 02/11/18 > Flashcards

Tendon problems - 02/11/18 Flashcards

1
Q

What is Tendinopathy?

A

Disease of a tendon – the best term for tendon related pain

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2
Q

What is Tendonitis?

A

Inflammation of a tendon

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3
Q

What is tendonosis?

A

Chronic tendon injury with damage to a tendon ECM

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4
Q

What is tenosynovitis?

A

Inflammation of the tendon sheath

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5
Q

What is Enthesopathy?

A

Inflammation of the tendon origin or the insertion into bone

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6
Q

What is the function of tendons?

A

Transmit load from muscle to bone

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7
Q

What are tendons composed of?

A

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

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8
Q

Do tendons have a good blood supply?

A

No

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9
Q

What is the organisation of a tendon?

A

MicrofibrilsSubfibrilsFibrilsFasciclesTendon unit

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10
Q

What can cause tendinopathy?

A 
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
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11
Q

What are the principles of management of tendinopathy?

A 
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
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12
Q

What are the surgical managements of tendinopathy?

A 
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
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13
Q

What is the pathophysiology of rotator cuff pathology?

A

Extrinsic compression + Intrinsic degeneration

Inflammation of subacromial bursa

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14
Q

Who gets rotator cuff pathology?

A

Athletes

Manual workers

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15
Q

What are the findings of rotator cuff pathology?

A

Achy pain down arm
Difficulty sleeping on affected side, reaching overhead & on lifting
Painful arc +/- weakness
Positive impingement tests

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16
Q

What is the management of rotator cuff pathology?

A

Conservative – physio, inject

Surgical – subacromial decompression

17
Q

Which is greater, tendinosis or inflammation?

A

Tendinosis

18
Q

What can cause biceps tendinopathy?

A

Overuse
Instability
Impingement
Trauma

19
Q

What are the clinical signs of biceps tendinopathy?

A

Pain anterior shoulder radiating to elbow
Aggravated by shoulder flexion, forearm pronation and elbow flexion
Snapping with shoulder movements if subluxation

20
Q

What are the investigations for biceps tendinopathy?

A

Clinical exam

USS

21
Q

What are the characteristics of lateral epicondylitis?

A

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

22
Q

What are the characteristics of medial epicondylitis?

A 
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
23
Q

What are the characteristics of De Quervains tenosynovitis?

A 
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
24
Q

What are the investigations for DQT?

A

USS

X-ray

25
Q

What is the management for DQT?

A 
Splint
Rest
Physio
ANalgesia
Injections
Surgery
26
Q

What are the characteristics of RA and eTR?

A

Autoimmune attack on synovium  tendon degeneration  rupture
Weakness wrist extension or dropped finger
Can’t repair diseased tendon
 tendon transfer
Synovectomy can prevent

27
Q

What are the characteristics of Extensor tendon rupture?

A

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)

28
Q

what are the characteristics of trigger finger?

A

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.

29
Q

What are the 3 parts of the knee extensor mechanism?

A

Tendonitis
Rupture
Traction apophysitis

30
Q

What are the characteristics of Quads and patellar tendon?

A 
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
31
Q

What are the characteristics of Traction apophysitis?

A

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

32
Q

What are the characteristics of achilles tendon rupture?

A 
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
33
Q

What are the characteristics of tibialis posterior rupture?

A

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

MSK lectures (50 decks)

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