Tendon problems Flashcards
What is the definition of tendinopathy?
Disease of a tendon
What is the definition of tendinitis?
Inflammation of a tendon
What is the definition of tendinosis?
Chronic tendon injury with cellular damage
What is the definition of tenosynovitis?
Inflammation of the tendon sheath
What is the definition of enthesopathy?
Inflammation of the tendon origin/insertion into bone
What is a tendon?
Structure which anchors muscle to bone
What type of collagen composes a tendon?
Type 1
What is the predominant cell type of a tendon?
Fibroblast
What is the structure of a tendon?
Microfibrils > Subfibrils > Fibrils > Fascicle > Endotendon > Epitendon
Which three sources does the blood supply of a tendon come from?
Perimyseum
Periosteal insertion
Paratendon
Which intrinsic factors contribute to the development of tendinopathy?
Age Gender Rheumatoid arthritis Leg length discrepancy Mal-alignment Obesity Pes cavus
Which extrinsic factors contribute to the development of tendinopathy?
Trauma Injury Steroids Antibiotics Sports
What is the principle management for most tendinopathies?
Rest
Analgesia
Anti-inflammatories
Which tendinopathies might warrant injections? What type of injection?
Tennis elbow (lateral epicondylitis)
Golfer’s elbow (medial epicondylitis)
Rotator cuff injuries
Local anaesthetic and cortisone
Which tendinopathy might warrant splinting?
Achillies tendinopathy
On which tendinopathies must injections not be used? Why?
Extensor knee mechanism problems
Achillies tendinopathy
Risk of rupture too high
What are the types of surgical management that may be indicated for certain tendinopathies?
Debridement
Decompression
Synovectomy
Tendon transfer
For which pathologies might decompression surgery be indicated?
Supraspinatus tendonitis
Subacromial depression
What does synovectomy prevent?
Rupture
For which pathologies might synovectomy be useful?
Extensor tendons of the wrist in rheumatoid arthritis
Tibialis posterior
For which pathologies might tendon transfer be useful?
Tibialis posterior
Extensor pollicus longus
Which types of people tend to develop rotator cuff pathology?
Athletes (throwing events) Manual workers (painters)
How does rotator cuff pathology present?
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)
What are the clinical findings with rotator cuff impingement?
Painful arc
Weakness on resistance tests
Positive impingement tests
What are the four muscles of the rotator cuff?
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
Which is the most common muscle to be affected in rotator cuff pathology?
Supraspinatus
How can rotator cuff pathology be managed conservatively?
Rest
Physiotherapy
Steroid & local anaesthetic injections
How can rotator cuff pathology be managed surgically?
Subacromial decompression
Rotator cuff repair