Tendon Problems

Question 1

Drugs which increase chance of tendinopathy

Answer 1

Ciprofloxacins (ending in -floxacin)

Question 2

Tendinosis

Answer 2

Histologic degeneration of the collagen and ECM
Likely due to MMPs which increase with age and repetitive strain

(Matrix metalloproteinases)

Question 3

Casting method for achilles rupture

Answer 3

Aquinas cast - foot plantarflexed to close rupture

Question 4

Tendinosis management

Answer 4

Debridement of diseased tissue

Subacromial decompression

Synovectomy - helps to prevent rupture - particularly wrists in inflammatory arthritis

Tendon transfer

Question 5

Rotator cuff pathology

Answer 5

Athletes (throwing) + manual workers (painters)

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

Most managed with physiotherapy
Sometimes with subacromial decompression

Question 6

Biceps tendinopathy

Answer 6

Pain anterior shoulder radiating to elbow
- aggravated by shoulder flexion, forearm pronation, and elbow flexion
- **snapping with shoulder movements if there is subluxation

Investigations: clinical exam, ultrasound

Popeye’s sign !!

Managed conservatively - sometimes surgical depending on situation

Question 7

Lateral epicondylitis - tennis elbow

Answer 7

10-20% bilateral
Pain and tenderness over lateral epicondyle (the origin of the extensors)

Question 8

Medial epicondylitis - golfer’s elbow

Answer 8

Medial (origin of the wrist flexors)

Question 9

De Quervain’s Tenosynovitis

Answer 9

First extensor compartment:
Extensor pollicis longus + Extensor pollicis brevis

Pain over radial styloid process

Finklestein’s test
Eichoff’s test

USS, X-Ray, rule of CMC osteoarthritis

Question 10

RA -> extensor Tendon rupture

Answer 10

Autoimmune attack on synovium>Tendon degeneration>rupture

Question 11

Extensor pollicis longus rupture

Answer 11

Can occur with RA or Colles Fracture

Substantial loss of function

Requires tendon transfer

Question 12

Trigger finger

Answer 12

Stenosis tenosynovitis-> fibrocartilaginous metaplasia -> nodule FDS tendon

Nodule catches on A1 pulley -> triggering

Any age

Observe, inject, surgical release

Question 13

Problems with knee extensor mechanism

Answer 13

Perform straight leg raise !!

Caused by:
Tendonitis
Rupture
Traction apophysitis

Younger- patella tendon (Osgood-Schlatter’s disease)
Older (over 50) - quadriceps tendon

Don’t inject for tendonitis!!

Clinical findings:
Palpable gap
No straight leg raise**
May be a high or low patella on xray

Question 14

Tibialis posterior

Answer 14

Tenosynovitis-> progressive elongation -> rupture

Leads to progressive flat foot and valgus hindfoot

NSAIDs, orthotics / cast, inject, debride

Question 15

WHEN TO INJECT

Answer 15

Upper limb - inject
Lower limb - don’t inject