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Year 2 > Tendon problems > Flashcards

Tendon problems Flashcards

1
Q

What is the definition of tendinopathy?

A

Disease of a tendon

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2
Q

What is the definition of tendinitis?

A

Inflammation of a tendon

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3
Q

What is the definition of tendinosis?

A

Chronic tendon injury with cellular damage

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4
Q

What is the definition of tenosynovitis?

A

Inflammation of the tendon sheath

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5
Q

What is the definition of enthesopathy?

A

Inflammation of the tendon origin/insertion into bone

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6
Q

What is a tendon?

A

Structure which anchors muscle to bone

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7
Q

What type of collagen composes a tendon?

A

Type 1

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8
Q

What is the predominant cell type of a tendon?

A

Fibroblast

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9
Q

What is the structure of a tendon?

A 
Microfibrils >
Subfibrils >
Fibrils >
Fascicle > 
Endotendon >
Epitendon
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10
Q

Which three sources does the blood supply of a tendon come from?

A

Perimyseum
Periosteal insertion
Paratendon

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11
Q

Which intrinsic factors contribute to the development of tendinopathy?

A 
Age
Gender
Rheumatoid arthritis 
Leg length discrepancy 
Mal-alignment 
Obesity
Pes cavus
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12
Q

Which extrinsic factors contribute to the development of tendinopathy?

A 
Trauma
Injury
Steroids
Antibiotics 
Sports
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13
Q

What is the principle management for most tendinopathies?

A

Rest
Analgesia
Anti-inflammatories

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14
Q

Which tendinopathies might warrant injections? What type of injection?

A

Tennis elbow (lateral epicondylitis)
Golfer’s elbow (medial epicondylitis)
Rotator cuff injuries

Local anaesthetic and cortisone

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15
Q

Which tendinopathy might warrant splinting?

A

Achillies tendinopathy

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16
Q

On which tendinopathies must injections not be used? Why?

A

Extensor knee mechanism problems
Achillies tendinopathy

Risk of rupture too high

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17
Q

What are the types of surgical management that may be indicated for certain tendinopathies?

A

Debridement
Decompression
Synovectomy
Tendon transfer

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18
Q

For which pathologies might decompression surgery be indicated?

A

Supraspinatus tendonitis

Subacromial depression

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19
Q

What does synovectomy prevent?

A

Rupture

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20
Q

For which pathologies might synovectomy be useful?

A

Extensor tendons of the wrist in rheumatoid arthritis

Tibialis posterior

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21
Q

For which pathologies might tendon transfer be useful?

A

Tibialis posterior

Extensor pollicus longus

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22
Q

Which types of people tend to develop rotator cuff pathology?

A 
Athletes (throwing events)
Manual workers (painters)
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23
Q

How does rotator cuff pathology present?

A

Gradually developing achy pain of the shoulder
Difficulty sleeping on affected side
Pain when reaching overhead
Pain when lifting items
Shoulder tenderness (glenohumeral and AC joint)

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24
Q

What are the clinical findings with rotator cuff impingement?

A

Painful arc
Weakness on resistance tests
Positive impingement tests

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25
Q

What are the four muscles of the rotator cuff?

A

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

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26
Q

Which is the most common muscle to be affected in rotator cuff pathology?

A

Supraspinatus

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27
Q

How can rotator cuff pathology be managed conservatively?

A

Rest
Physiotherapy
Steroid & local anaesthetic injections

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28
Q

How can rotator cuff pathology be managed surgically?

A

Subacromial decompression

Rotator cuff repair

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29
Q

What imaging is used in suspected rotator cuff pathology?

30
Q

What are the mechanisms of biceps tendinopathy?

A

Overuse
Impingement
Instability
Trauma

31
Q

How does biceps tendinopathy present?

A

Pain anterior to shoulder radiating to elbow
Pain on shoulder and elbow flexion
Pain forearm pronation
Snapping with shoulder movements

32
Q

What imaging modality is preferred for biceps tendinopathy?

33
Q

Which type of people get biceps tendinopathy?

A 
Athletes (throwing events)
Manual workers (painters)
34
Q

How can biceps tendinopathy be managed?

A

Conservative

Surgical

35
Q

What are the clinical signs of biceps tendon rupture?

A

Popeye sign

Extensive bruising

36
Q

What is the biggest risk with biceps tendinopathy?

A

Neurovascular injury

37
Q

20% of lateral epicondylitis’ are bilateral. T/F

38
Q

What is the presentation of lateral epicondylitis?

A

Pain and tenderness over the lateral epicondyle at origin of forearm extensors
Pain worse when stretching muscles

39
Q

What are the investigations used in lateral epicondylitis?

A

USS
MRI
Nerve conduction study

40
Q

How is lateral epicondylitis managed?

A 
Rest
Physiotherapy 
Activity modification
Orthotics
Injection 
Surgery
41
Q

What test is positive in lateral epicondylitis?

A

Mill’s test

42
Q

How does medial epicondylitis present?

A

Medial elbow pain at origin of wrist flexors

43
Q

What is the underlying mechanism which causes epicondylitis?

A

Repetitive strain

44
Q

Is medial epicondylitis self limiting?

45
Q

What is medial epicondylitis associated with?

A

Ulnar neuropathy

Muscle weakness

46
Q

How is medial epicondylitis investigated?

A

X-ray
MRI
Nerve conduction study

47
Q

How is medial epicondylitis managed?

A 
Rest
Physiotherapy
Modify activity
Orthotics
Injection
Surgical release
48
Q

Which muscles does de quervians tenosynovitis effect?

A

Abductor pollicus longus

Extensor pollicus brevis

49
Q

How does de quervians tenosynovitis present?

A

Pain over radial styloid process

50
Q

Which test is positive in de quervians tenosynovitis?

A

Finklestein’s

51
Q

Which imaging modalities are used to identify de quervians tenosynovitis?

A

USS

X-ray to rule out CMC osteoarthritis

52
Q

How is de quervians tenosynovitis managed?

A 
Splinting
Rest
Physiotherapy
Analgesia
Injections
Surgical decompression
53
Q

Who gets de quervians tenosynovitis?

A

Commonly women over 30

54
Q

What is de quervians tenosynovitis associated with?

A

Pregnancy

Rheumatoid arthritis

55
Q

Is an extensor knee mechanism rupture partial or complete?

56
Q

What is extensor knee mechanism rupture associated with?

A

Trauma (running/jumping sports)
Antibiotics
Steroids
Diabetes mellitus

57
Q

What is found on examination with a knee extensor mechanism?

A

Palpable gap

Inability to straight leg raise

58
Q

What imaging modalities are used to investigate knee extensor mechanism problems?

A

X-ray
USS
MRI

59
Q

How are knee extensor mechanisms treated?

A

Surgical + physiotherapy

Immobilisation + physiotherapy (small tears only)

60
Q

What may be seen on the x-ray of someone with a knee extensor mechanism problem?

A

Effusion

Patella in the wrong place

61
Q

What is osgood schlatter’s disease?

A

Inflammation of tendon at insertion of patellar tendon into anterior tibial tuberosity

62
Q

Who gets osgood schlatter’s disease?

A

Adolescent active boys

63
Q

What is Sever’s disease?

A

Traction apophysitis at insertion of tibialis anterior into os calcis (tarsal bone)

64
Q

What is traction apophysitis

A

Inflammation of where tendon attaches to bone due to traction

65
Q

Is calaneal tendon rupture common?

66
Q

What is the mechanism behind calcaneal tendon rupture?

A

Sudden force (running, jumping)

67
Q

What is calcaneal tendon rupture associated with?

A

Rheumatoid arthritis
Steroids
Tendonitis

68
Q

What are the clinical findings with calcaneal tendon rupture?

A

Palpable gap
Unable to tiptoe stand
Bruising

69
Q

Which test is positive in calcaneal tendon rupture?

A

Simmond’s

70
Q

Which imaging modalities are used in calcaneal tendon rupture?

71
Q

How are calcaneal tendons treated?

A

Plaster cast

Surgery

Year 2 (72 decks)

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