Tendon Problems

Question 1

What is tendinosis?

Answer 1

Chronic tendon injury with injury to the tendon at cellular level

Question 2

What is tenosynovitis?

Answer 2

Inflammation of the tendon sheath

Question 3

What is ensinopathy?

Answer 3

inflammation of the tendon origin or the insertion into bone

Question 4

Which mesoderm plate do tendons arise from?

Answer 4

Tendons arise from the lateral plate mesoderm

Question 5

Predominant cells in tendons

Answer 5

Fibroblast (responsible for production and maintenance of collagen)

Question 6

Tendon is composed mainly of which type of collagen?

Answer 6

Type 1 (90%)

Question 7

Drugs that can affect tendons

Answer 7

Antibiotics, steroids

Question 8

Which tendon problems could you treat with injection?

Answer 8

Rotator Cuff, Tennis Elbow

NOT ACHILLES TENDON OR EXTENSOR KNEE MECHANISM

Question 9

What could you use decompression for?

Answer 9

Supraspinatous tendonitis

Subacromial decompression

Question 10

Muscle most commonly affected in rotator cuff pathology?

Answer 10

Supraspinatous

Question 11

Tenderness over which joints in rotator cuff pathology?

Answer 11

Glenohumeral and AC joint

Question 12

Which head of the biceps is predominantly torn in biceps tendinopathy?

Answer 12

The long head

Question 13

What can cause biceps tendinopathy?

Answer 13

Overuse, instability, impingement or trauma

Question 14

Which movements aggravate biceps tendinopathy?

Answer 14

Shoulder flexion
Forearm pronation
Elbow flexion

Question 15

Where is the pain felt in biceps tendinopathy? And where does it radiate to?

Answer 15

Anterior to the shoulder radiating to the elbow

Question 16

When is biceps tendinopathy common?

Answer 16

It is common in occupations where heavy lifting or overhead work is typical

Question 17

Clinical signs of biceps rupture

Answer 17

Clinical signs of a biceps tendon rupture include a popeye sign and extensive bruising

Question 18

Risks of bicep rupture repair surgery

Answer 18

Surgical repair can be carried out but runs a high risk of neurovascular complications especially the distal end

Question 19

What is golfer’s elbow?

Answer 19

Inflammation of the flexor forearm muscles

Question 20

Aggravation of Golfer’s elbow (medial epicondylitis)

Answer 20

The pain is aggravated by wrist flexion and pronation

Also worse e.g. when grasping jar

Question 21

What is Golfer’s elbow associated with?

Answer 21

Ulnar neuropathy/muscle weakness

Question 22

Treatment for Golfer’s elbow

Answer 22

rest, physio, modification activities, orthotics, inject or surgical release

Question 23

Main test for Golfer’s elbow

Answer 23

Sore upon wrist flexion and pronation

Also when grasping jar

Question 24

When is pain worse in tennis elbow?

Answer 24

When stretched e.g. opening jar

Question 25

Who is De Quervains Tenosynovitis common in and what is it associated with?

Answer 25

Most common in women aged 30-50 and is associated with pregnancy and rheumatoid arthritis

Question 26

What test could you do for De Quervains Tenosynovitis?

Answer 26

Finklesteins test

Question 27

What should you rule out when investigating De Quervains Tenosynovitis?

Answer 27

OA of the CMC joints (do X-ray to rule this out)

Question 28

What kind of patients are more susceptible to achilles tendinopathy?

Answer 28

Rheumatoid arthritis Those on steroids Patients with tendonitis

Question 29

Which test could you use to help confirm achilles tendinopathy?

Answer 29

Simmonds test (squeeze calf and leg moves)

Question 30

Clinical findings of achilles tendinopathy

Answer 30

Palpable gap Unable to stand on tiptoes Bruising Simmonds test positive

Question 31

Predominant cell in a tendon

Answer 31

Fibroblast

Question 32

Blood supply to the tendon

Answer 32

Perimysium Periosteal insertion of the tendon Paratenon

Question 33

What is paratenon?

Answer 33

The fatty material between a tendon and its sheath

Question 34

Tendon transfer

Answer 34

Tibialis posterior | Extensor pollicis longus

Question 35

Pain in anterior shoulder radiating to elvow

Answer 35

Biceps tendinopathy

Question 36

When is biceps tendinopathy aggravated?

Answer 36

Shoulder flexion Elbow flexion Forearm pronation

Question 37

How would you diagnose biceps tendinopathy?

Answer 37

Clinical exam and ultrasound

Question 38

Clinical signs of biceps rupture?

Answer 38

Popeye sign and extensive bruising

Question 39

How do you aggravate medial epicondylitis?

Answer 39

Wrist flexion and forearm pronation

Question 40

Medial epicondyle pain worse on grasping (e.g. opening jar)

Answer 40

Medial epicondylitis | lateral epicondylitis can also hurt when opening jar

Question 41

Investigation for medial epicondylitis if diagnosis is uncertain?

Answer 41

MRI or USS

Question 42

Test for lateral epicondylitis?

Answer 42

Mills test

Question 43

Test for De Quervain's tenosynovitis?

Answer 43

Finkelstein's test

Question 44

What is De Quervain's tenosynovitis associated with?

Answer 44

Pregnancy and RA

Question 45

Pain over radial styloid process?

Answer 45

De Quervain's tenosynovitis

Question 46

Finklestein's test?

Answer 46

Patient makes fist over thumb and hand is ulnar deviated to reproduce pain Can be used in De Quervain's tenosynovitis

Question 47

Drugs which could cause extensor knee problems?

Answer 47

Antibiotics, steroids | Also associated with diabetes

Question 48

What might x-ray show if you have extensor knee problems?

Answer 48

Effusion or the patela sitting in the wrong place :(

Question 49

Treatment for extensor knee problems

Answer 49

Surgery

Question 50

Surgical repair of quadriceps and patellar tendon

Answer 50

Typically done using sutures with bony anchors | -Open approach

Question 51

Clinical findings of achilles tendinopathy

Answer 51

Palpable gap unable to tiptoe stand bruising Simmonds test/thomsons test