tendon problems

Question 1

what is tendinopathy?

Answer 1

painful tendon

Question 2

what is tendonitis?

Answer 2

inflammation of tendon

Question 3

what is tendonosis

Answer 3

degeneration of tendon

Question 4

what is tenosynovitis?

Answer 4

inflammation of fluid filled sheath

Question 5

what is enthesopathy?

Answer 5

pain at enthesis- attachment of tendon and ligaments to bone

Question 6

what are intrinsic risk factors for tendinopathies?

Answer 6

age, gender, obesity, RA, malalignment, leg length differences

Question 7

what are extrinsic risk factors for tendonopathies?

Answer 7

trauma or injury, repetitive injury, steroids & antibiotcs, sports

Question 8

describe tendonosis

Answer 8

degeneration of collagen and extracellular matrix, not necessarily painful, occurs in areas of poor blood supply

Question 9

what is the treatment for tendonosis?

Answer 9

rest, physio, analgesia, injections in rotator cuff or tennis elbow, splinting in achilles tendon

Question 10

what are surgical options for tendonosis?

Answer 10

debridement- remove diseased tissue
decompression- supraspinatus tendonitis
synovectomy- prevents rupture- extensor tendons of wrist and tibialis posterior
tendon transfer- tibialis posterior and extensor pollicis longus

Question 11

describe rotator cuff problems

Answer 11

seen in athletes and manual workers
ache down arm, difficulty sleeping on side, reaching up and lifting
positive impingement tests

Question 12

what is the management for rotator cuff problems?

Answer 12

physio, steroid injections into shoulder
surgical- subacromial decompression

Question 13

what imaging is used for rotator cuff?

Answer 13

ultrasound

Question 14

describe biceps tendinopathy

Answer 14

pain in anterior shoulder radiating to elbow, worse on shoulder & elbow flexion, forearm pronation
snapping on shoulder movement if subluxation

Question 15

how to diagnose and treat biceps tendinopathy?

Answer 15

clinical exam, ultrasounds
conservative or surgical management

Question 16

what is the clinical sign of biceps rupture?

Answer 16

popeye sign (also extensive bruising)

Question 17

describe tennis elbow (lateral epicondylitis)

Answer 17

pain and tenderness over lateral epicondyle

Question 18

describe golfers elbow (medial epicondylitis)

Answer 18

medial elbow pain from repetitive stress
self- limiting - do not inject as can damage ulnar nerve

Question 19

describe De Quervain’s tenosynovitis and how to diagnose and treat

Answer 19

pain over radial styloid process
do finklestein’s and eichoff’s tests
ultrasound / x-ray to rule out OA
management- splint, rest physio, analgesia, injections, surgical decompression

Question 20

how does extensor tendon rupture occur?

Answer 20

autoimmune attack on synovium leading to tendon degeneration and rupture- dropped finger.
synovectomy prevents this

Question 21

describe EPL rupture

Answer 21

can occur in RA or after Colles fracture
substantial loss of function
treat with tendon transfer

Question 22

describe knee extensor mechanism rupture

Answer 22

caused by a fall onto flexed knee, or almost falling
patellar tendon rupture in younger patients, quadriceps in older
failure to straight leg raise
x-ray, ultrasound, mri to diagnose
don’t inject- treat surgically

Question 23

describe Osgood- Schlatter’s disease

Answer 23

at tibial tubercle- insertion of patellar tendon into tibial tuberosity
seen in adolescent boys
leaves prominent bony lump

Question 24

describe achilles tendon rupture

Answer 24

feels like being kicked in the calf
seen in sudden acceleration or deceleration when running
cant stand on tiptoes, +ve simmond’s test
conservative (cast) or surgical management

Question 25

describe tibialis posterior tendon rupture

Answer 25

tensosynovits –> progressive elongation –> rupture
unclear cause
causes flat foot an valgus hindfoot
treatment- NSAIDs, orthotics, cast, injections, debridement
tendon transfer may help