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Year 2 Clinical > Tendon Problems > Flashcards

Tendon Problems Flashcards

1
Q

Definition of tendinopathy?

A

Disease of a tendon (not all of these involve inflammation)

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2
Q

Definition of tendonitis?

A

Inflammation of a tendon

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3
Q

Definition of a tendonosis?

A

Chronic tendon injury with damage to a tendon at the cellular level

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4
Q

Definition of a tenosynovitis?

A

Inflammation of the tendon sheath

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5
Q

Definition of enthesopathy?

A

Disorder inv. the attachment or origin of a tendon into bone

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6
Q

Definition of enthesitis?

A

Inflammation of the tendon origin or insertion into bone (usually assoc. with spondyloarthropathies)

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7
Q

Function of tendons?

A

Link muscles to bones for joint motion

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8
Q

Shape of tendons?

A

Cylindrical in shape with widening/flattening at the musculotendinous junction and their bony insertions

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9
Q

Structure of tendons?

A

Hierarchial structure:
• Microfibrils make up subfibrils, which constitute fibrils

Many fibrils are within a fascicle; fascicles are separated by endotenon, which is covered by epitenon

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10
Q

Cells of a tendons?

A

Fibroblasts (predominantly) produce and maintain collagen and other proteins, which confer flexibility and tensile strength of tendons

Collagen is the primary component of tendons (mainly type I collagen)

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11
Q

Blood supply to tendons?

A

3 sources:
• Perimyseum
• Periosteal insertion of the tendon
• Paratenon

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12
Q

Intrinsic risk factors for tendon problems?

A

Age

Gender (females)

Obesity

Pre-disposing disease, e.g: RA

Anatomical factors, e.g: limb malalignment, pes cavus, hyperpronation and leg lenth discrepancy

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13
Q

Extrinsic risk factors for tendon problems?

A

Trauma, e.g: dislocations

Repetitive injury

Drugs:
• Steroids
• Antibiotics, e.g: Ciprofloxacin

Sports-related factors

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14
Q

Management of tendon problems?

A

Many are self-limiting and management is conservative:
• Rest
• Analgesics, e.g: anti-inflammatories for tendonitis

Injections:
• Rotator cuff pathology
• Tennis elbow
• Cannot be used for the achilles tendon or extensor knee mechanism (risk of rupture)

Splinting:
• Achilles tendon tears
Some may require surgical repair

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15
Q

Surgical methods used for tendon problems?

A

Debridement:
• Removal of diseased tissue

Decompression:
• Supraspinatus tendonitis & subacromial decompression

Synovectomy:
• Helps to prevent rupture
• Extensor tendons of wrist (RA)
• Tibialis posterior

Tendon transfer:
• Tibialis posterior
• Extensor pollicis longus

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16
Q

Muscles of the rotator cuff?

A

Supraspinatus (usually affected in rotator cuff pathology), infraspinatus, subscapularis and teres minor

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17
Q

Risk factors for rotator cuff pathology?

A

Intrinsic risk factors, e.g: degeneration, tendon vascularity

Extrinsic factors, e.g: morphology of the acromion and biomechanical factors, lie kinetics and performance:
• Athletes (throwing events)
• Manual workers (painters)

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18
Q

Symptoms and signs of rotator cuff pathology?

A

Aching pain (pain in the 4 tendons of the rotatory cuff)

Shoulder tenderness, around the GH and AC joints

Difficulty sleeping on the affected side, reaching overhead and lifting

Painful arc with rotator cuff weakness

+ve impingement tests, e.g: • Hawkins-Kennedy
• Scarf test
• Jobe’s test

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19
Q

Management of rotator cuff pathology?

A

Conservative (tend to be self-limiting) - rest, physiotherapy, steroids + local anaesthetic injections

Surgical - either arthroscopic OR open subacromial decompression and rotator cuff repair

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20
Q

Imaging of the rotator cuff?

A

US can show rotator cuff tears (gold standard) and a dynamic scan can detect impingement too

MRI can show rotator cuff tears

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21
Q

Types of biceps tendinopathy and causes?

A

Tendonitis, tendonosis, rupture or tenosynovitis

Causes inc. overuse, instability, impingement or trauma

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22
Q

Where does most inflammation of the biceps brachii occur?

A

Long head of the biceps, which passes through the BICIPITAL groove, located anteriorly on the proximal humerus

Inflammation here is usually friction-related

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23
Q

Occurrence of biceps tendinopathy?

A

Common in occupations where heavy lifting or overhead work is typical

Higher incidence in athletes inv. in throwing events, swimmers or gymnasts

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24
Q

Symptoms of biceps tendinopathy?

A

Anterior shoulder pain aggravated by:
• Shoulder flexion
• Forearm pronation
• Elbow flexion

Clicking/snapping sensations with shoulder movement

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25
Q

Ix of biceps tendinopathy?

A

Before Ix, do an examination

USS

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26
Q

Management of biceps tendinopathy?

A

Conservative

Surgical

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27
Q

Clinical signs of biceps rupture?

A

May rupture at the top of the bicipital groove OR at the biceps tuberosity

  • POP-eye sign (proximal rupture)
  • Extensive bruising (distal rupture)
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28
Q

Management of biceps ruptures?

A

Conservative (mainstay treatment) - rest and physiotherapy

Surgical - repair but there is high risk of neurovascular complications, esp. at the distal end of the tendon, stiffness or a flexor contracture

29
Q

What is the most powerful supinator of the forearm?

A

Biceps brachii (weakness affects the screwdriver motion)

30
Q

Describe lateral epicondylitis

A

AKA tennis elbow (which can be a repetitive strain injury); causes pain and tenderness over the lateral epicondyle, which is the origin of the forearm extensors

The pain is worse when stretching muscles, e.g: opening a jar

31
Q

Clinical examination of tennis elbow?

A

+ve Mill’s test (pain is reproduced by resisted wrist extension, with the palm pronated whilst moving sideways in the direction of the thumb)

Pain is usually unilateral but it can be bilateral

32
Q

Ix for tennis elbow?

A

Diagnosis is clinical but USS, MRI and nerve conduction studies (if there are nerve symptoms) can be carried out

33
Q

Management of tennis elbow?

A
  1. Rest + physio
  2. Modify activities
  3. Orthotics
  4. Inject
  5. Surgical release
34
Q

What is medial epicondylitis?

A

AKA Golfer’s elbow; inflammation of the flexor forearm muscles that causes medial elbow pain, with a tendow point over the origin of the flexors of the forearm (medial epicondyle)

Can be caused by repetitive stress at the muscle-tendon junctions, e.g: golf

35
Q

Signs of medial epicondylitis?

A

Pain aggravated by wrist flexion and pronation and also upon grasping, e.g: opening a jar

Some cases are assoc. with ulnar neuropathy/muscle weakness

36
Q

Occurrence of medial epicondylitis?

A

Peak incidence between 40-50 years

37
Q

Ix for medial epicondylitis?

A

Diagnosis is clinical but USS, MRI and nerve conduction studies (if there are nerve symptoms) can be carried out

38
Q

Management of medial epicondylitis?

A

Self-limiting conditions and the management is the same as for Tennis elbow/lateral epicondylitis

EXCEPT: avoid injection in medial epicondylitis, as the ulnar nerve may be damaged

39
Q

What is DeQuervain’s tenosynovitis?

A

AKA Blackberry thumb, gamer’s thumb and mother’s wrist, etc

This is tenosynovitis affecting the 1st compartment, which contains APL and EPB; typically presents as a repetitive strain injury

40
Q

Symptoms and signs of DeQuervain’s tenosynovitis?

A

Pain over the RADIAL STYLOID PROCESS at the wrist

+ve Finklestein’s test (patient makes a fist over the thumb and the hand is ulnar deviated to reproduce pain)

41
Q

Occurrence of DeQuervain’s tenosynovitis?

A

Most common in women between 30-50 years

Assoc. with pregnancy and RA

42
Q

Ix for DQ tenosynovitis?

A

USS

X-ray (to rule out CMC joint OA, which can mimic DQ)

43
Q

Management of DQ tenosynovitis?

A

Conservative - splint, rest, physiotherapy and analgesics

Inject

Surgical decompression

44
Q

How can RA cause extensor tendon rupture?

A

Autoimmune attack on the synovium causes tendon degeneration and rupture, leading to weakness of wrist extension

45
Q

Signs of extensor tendon rupture?

A

DROP FINGER

46
Q

Management of extensor tendon rupture?

A

Cannot repair a diseased tendon so a tendon transfer is done

Synovectomy can prevent extensor tendon rupture, e.g: if RA treatments are not prevent tendon degeneration, this can be used to prevent rupture

47
Q

Causes of EPL rupture?

A

RA

After a Colles fracture

48
Q

Signs of EPL rupture?

A

Drop thumb (loss of function)

49
Q

Management of EPL rupture?

A

Tendon transfer (using EIP, i.e: extensor indicis proprius, which is one of the 2 tendons in the adjacent finger)

50
Q

Pathophysiology of trigger finger?

A

Stenosing tenosynovitis produces a fibrocartilaginous metaplasia, leading to the formation of a nodule under the a flexor tendon

The nodule catches on the pullet, often A1, and causes triggering

51
Q

Occurrence of trigger finger?

A

Any age (even children)

52
Q

Management of trigger finger?

A

Tends to be self-limiting

Injection

Surgical release

53
Q

Components of the extensor mechanism of the knee?

A

Quadriceps muscle
Quadriceps tendon
Patella
Patellar tendon

54
Q

Cause of extensor knee problems?

A

Injury to any one of the components causes difficulty/inability to straight leg raise (SLR)

Tendonitits, rupture or traction apophysitis

55
Q

Occurrence of extensor knee ruptures?

A

Tend to be partial or complete

More common in the middle-aged population, who play running/jumping sports

56
Q

Clinical examination findings of extensor knee problems?

A

Palpable gap

No SLR (must always check this with an acute knee injury)

57
Q

Ix for extensor knee problems?

A

X-rays (may show an effusion with the patella sitting in the wrong place)

USS or MRI (show a partial/complete tear)

58
Q

Management of extensor knee problems?

A

Mostly surgical, with gradual increase in range of movement post-operatively with physiotherapy

Small partial tears of the quadriceps can be managed with immobilisation + physiotherapy

59
Q

What is traction apophysitis?

A

E.g: Osgood-Schlatter’s disease

Inflammation of the patellar ligament as it inserts into the anterior tibial tuberosity

60
Q

Occurrence of Osgood-Schlatter’s disease?

A

Adolescent active boys most commonly

61
Q

What is Sever’s disease?

A

AKA calcaneal apophysitis; this is a type of traction apophysitis at the insertion of the tibialis anterior into the os calis

62
Q

Scenario of an Achilles/calcaneal tendon rupture?

A

Common injury that occurs after a sudden force, such as a forceful push off the foot while running/jumping, etc

63
Q

Occurrence of Achilles tendon rupture?

A

More common in patients with RA, tendonitis and steroid use

64
Q

Clinical examination findings of Achilles tendon rupture?

A

Bruising

Palpable gap

Patient cannot tip-toe stand

+ve Simmond’s test (patient lies prone with feet hanging off the edge of the bed; on squeezing the corresponding calf, the foot should normally plantarflex - if not, Achilles tendon rupture is likely)

65
Q

Ix for Achilles tendon rupture?

A

USS and MRI

66
Q

Management of Achilles tendon rupture?

A

Conservative (plaster cast)

Surgical repair (rehab and early ROM are better following surgical repair and it may decrease re-rupture rate)

67
Q

Pathophysiology of rupture of the tibialis posterior tendon?

A

Tenosynovitis causes progressive elongation of the tendon and eventual rupture

68
Q

Signs of tibialis posterior tendon rupture?

A

Secondary flat foot

Valgus hindfoot (“too many toes” sign)

69
Q

Management of tibialis posterior tendon rupture?

A
  • NSAIDs
  • Orthotics
  • Injection
  • Debridement
  • May be helped by a tendon transfer

Year 2 Clinical (119 decks)

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