Tendon Problems Flashcards
What is tendinosis?
Chronic tendon injury with injury to the tendon at cellular level
What is tenosynovitis?
Inflammation of the tendon sheath
What is ensinopathy?
inflammation of the tendon origin or the insertion into bone
Which mesoderm plate do tendons arise from?
Tendons arise from the lateral plate mesoderm
Predominant cells in tendons
Fibroblast (responsible for production and maintenance of collagen)
Tendon is composed mainly of which type of collagen?
Type 1 (90%)
Drugs that can affect tendons
Antibiotics, steroids
Which tendon problems could you treat with injection?
Rotator Cuff, Tennis Elbow
NOT ACHILLES TENDON OR EXTENSOR KNEE MECHANISM
What could you use decompression for?
Supraspinatous tendonitis
Subacromial decompression
Muscle most commonly affected in rotator cuff pathology?
Supraspinatous
Tenderness over which joints in rotator cuff pathology?
Glenohumeral and AC joint
Which head of the biceps is predominantly torn in biceps tendinopathy?
The long head
What can cause biceps tendinopathy?
Overuse, instability, impingement or trauma
Which movements aggravate biceps tendinopathy?
Shoulder flexion
Forearm pronation
Elbow flexion
Where is the pain felt in biceps tendinopathy? And where does it radiate to?
Anterior to the shoulder radiating to the elbow
When is biceps tendinopathy common?
It is common in occupations where heavy lifting or overhead work is typical
Clinical signs of biceps rupture
Clinical signs of a biceps tendon rupture include a popeye sign and extensive bruising
Risks of bicep rupture repair surgery
Surgical repair can be carried out but runs a high risk of neurovascular complications especially the distal end
What is golfer’s elbow?
Inflammation of the flexor forearm muscles
Aggravation of Golfer’s elbow (medial epicondylitis)
The pain is aggravated by wrist flexion and pronation
Also worse e.g. when grasping jar
What is Golfer’s elbow associated with?
Ulnar neuropathy/muscle weakness
Treatment for Golfer’s elbow
rest, physio, modification activities, orthotics, inject or surgical release
Main test for Golfer’s elbow
Sore upon wrist flexion and pronation
Also when grasping jar
When is pain worse in tennis elbow?
When stretched e.g. opening jar
Who is De Quervains Tenosynovitis common in and what is it associated with?
Most common in women aged 30-50 and is associated with pregnancy and rheumatoid arthritis
What test could you do for De Quervains Tenosynovitis?
Finklesteins test
What should you rule out when investigating De Quervains Tenosynovitis?
OA of the CMC joints (do X-ray to rule this out)
What kind of patients are more susceptible to achilles tendinopathy?
Rheumatoid arthritis
Those on steroids
Patients with tendonitis
Which test could you use to help confirm achilles tendinopathy?
Simmonds test (squeeze calf and leg moves)
Clinical findings of achilles tendinopathy
Palpable gap
Unable to stand on tiptoes
Bruising
Simmonds test positive
Predominant cell in a tendon
Fibroblast
Blood supply to the tendon
Perimysium
Periosteal insertion of the tendon
Paratenon
What is paratenon?
The fatty material between a tendon and its sheath
Tendon transfer
Tibialis posterior
Extensor pollicis longus
Pain in anterior shoulder radiating to elvow
Biceps tendinopathy
When is biceps tendinopathy aggravated?
Shoulder flexion
Elbow flexion
Forearm pronation
How would you diagnose biceps tendinopathy?
Clinical exam and ultrasound
Clinical signs of biceps rupture?
Popeye sign and extensive bruising
How do you aggravate medial epicondylitis?
Wrist flexion and forearm pronation
Medial epicondyle pain worse on grasping (e.g. opening jar)
Medial epicondylitis
lateral epicondylitis can also hurt when opening jar
Investigation for medial epicondylitis if diagnosis is uncertain?
MRI or USS
Test for lateral epicondylitis?
Mills test
Test for De Quervain’s tenosynovitis?
Finkelstein’s test
What is De Quervain’s tenosynovitis associated with?
Pregnancy and RA
Pain over radial styloid process?
De Quervain’s tenosynovitis
Finklestein’s test?
Patient makes fist over thumb and hand is ulnar deviated to reproduce pain
Can be used in De Quervain’s tenosynovitis
Drugs which could cause extensor knee problems?
Antibiotics, steroids
Also associated with diabetes
What might x-ray show if you have extensor knee problems?
Effusion or the patela sitting in the wrong place :(
Treatment for extensor knee problems
Surgery
Surgical repair of quadriceps and patellar tendon
Typically done using sutures with bony anchors
-Open approach
Clinical findings of achilles tendinopathy
Palpable gap
unable to tiptoe stand
bruising
Simmonds test/thomsons test
