Tendon problems

Question 1

Tendionpathy

Answer 1

Disease of a tendon

Question 2

Tendonitis

Answer 2

Inflammation fo a tendon

Question 3

Tendonosis

Answer 3

Chronic tendon injury with damage to a tendon ECM

histologic degeneration of collagen and ECM

Question 4

Tenosynovitis

Answer 4

Inflammation of the tendon sheath

Question 5

Enthesopathy

Answer 5

Inflammation of the tendon origin or the insertion into bone

Question 6

Tendon is made from

Answer 6

type 1 collagen, helical structures, all in a longitudinal structure

Question 7

Aetiology tendionpathy

Answer 7

Intrinsic-old,male,obesity, pre-disposing factors e.g. Rh a and anatomical factors such as Mal-alignment and LLD

Extrinsic-truma/injury, repetitive injury, drugs (steroids, antibiotics-ciprofloxin) and sports related injury

Question 8

Which antibiotics can cause tendon rupture

Answer 8

ciprofloxacin

Question 9

Principles of conservative management of tendinopathy

Answer 9

• rest
• physio-eccetric strengthening (controlled lengthening)
• analgesics (anti-inflammatory)
• injections ( RC, tennis elbow, not achilles tendon or extensor knee mechanism)
• Splinting (achilles tendon-equines)

Question 10

Principles fo surgical management of tendinpathy

Answer 10

• debridement-removal or diseased tissue
• decompression-supraspinatus tendonitis and subacromial decompression
• Synovectomy-helps to prevent rupture,extensor tendons or wrist(RA) and tibias posterior
• Tendon transfer

Question 11

RC aetiology

Answer 11

athletes

manual workers

Question 12

RC clinical findings

Answer 12

achy pain down arm
difficulty sleeping on affected side,reachign overhead and on lifting
painful arc and weakness
positive impingement tests

Question 13

RC management

Answer 13

• conservative- at least 3 months physiology, 2 steroid injections before…
• surgical (subacromial decompression)

Question 14

Biceps tendinopathy

Answer 14

can be proximal or distal

caused by overuse, instability,impingment or trauma

Question 15

If you rupture the distal tendon what is the effect on supination strength

Answer 15

40% of supination strength is lost

Question 16

What is the pain like for biceps tendinopathy?

Answer 16

Pain anterior shoulder radiating to elbow
-aggravated by shoulder flexion, forearm pronation and elbow flexion

snapping with shoulder movement if subluxation

Question 17

What tests can be done for biceps biceps tendinopathy?

Answer 17

Clinical exam, USS

Question 18

What is lateral epicondylitis known as

Answer 18

tennis elbow

Question 19

What percentage of tennis elbow is bilateral

Answer 19

10-20%

Question 20

What is the pain like for tennis elbow

Answer 20

pain and tenderness over the lateral epicondyle, the origin of the forearm extensors
pain with rested extension of middle finger

Question 21

Biceps rupture treatment

Answer 21

rest and physio

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

Question 22

Lateral epicondylitis treatment

Answer 22

no-inflamamtory and self-limiting

can inject ( although non-inflammatory), surgical release is the last resort for refractory cases

Question 23

What is medial epicondylitis

Answer 23

golfers elbow

inflammation of flexor forearm muscles

medial elbow pain-origin of the first flexors

Question 24

treatment of the medial epicondylitis

Answer 24

avoid injecting- ulnar nerve

surgical release last resort

Question 25

What is golfers elbow caused by?

Answer 25

repetitive stress | self-limiting condition

Question 26

How do you test for De Quervain's tenosynovitis

Answer 26

Finklestein's test

Question 27

What does De Quervain's tenosynovitis present with and why

Answer 27

pain over radial styloid process | first extensor compartment- AP and EPB

Question 28

What is the investigations and management for De Quervain's tenosynovitis

Answer 28

Ix-USS,XR rule out CMC OA Mx-splint,rest,physio,analgesics,inject,surgical decompression

Question 29

What is extensor tendon rupture?

Answer 29

Autoimmune attack on synovial-> tendon degeneration -> rupture weakness wrist extension or dropped finger

Question 30

The best treatment for diseased tendon is repair T/F

Answer 30

F- can't repair diseased tendon | Instead tendon transfer

Question 31

Who is extensor tendon rupture most common in

Answer 31

women aged 30-50 | associated with pregnancy and RA

Question 32

What surgery can prevent extensor tendon rupture?

Answer 32

Synovectomy

Question 33

What can EPL rupture occur with

Answer 33

RA of after colles fracture

Question 34

What is the treatment for EPL rupture

Answer 34

There is substantial LOF | therefore requires tendon transfer (EIP)

Question 35

What is trigger finger progression

Answer 35

Stenosing tenosynovitis-> fibrocartilaginous metaplasia -> nodule FDS tendon

Question 36

What is trigger finger?

Answer 36

nodule catches on A1 pulley --> triggering any age ( even kids) observe, inject, surgical release

Question 37

What is the extensor mechanism of the knee

Answer 37

quadriceps muscle, the quadriceps tendon , the patella and the patella tendon

Question 38

Always inject tendonitis T/F

Answer 38

F- don't inject tendonitis

Question 39

What are the clinical findings for the patellar tendon rupture

Answer 39

Palpable gap No SLR may be high or low patella on X-ray

Question 40

What is the investigation for a patellar tendon rupture

Answer 40

x-ray --> may shoe effusion or patella sitting in the wrong place USS of MRI which may show a partial or complete tear

Question 41

Management of tendon rupture

Answer 41

surgery- with gradual increase in ROM post-operatively as part of the phi regime

Question 42

What is traction apophysitis at tibial tubercle called

Answer 42

Osgood-Schlatter's insertion of patellar tendon into tibial tubersity adolescent active boys leaves prominent bony lump can also happen at patella and achilles

Question 43

Who is achilles tendon ?

Answer 43

middle aged caused by sudden accelaration /decceleration- running/squash,RA,steroids or tendonitis feels like being kicked or shot clinical findings- Palpable gap, unable to tiptoe stand, Simmond's test +ve

Question 44

What investigations and management for Achilles tendon?

Answer 44

Ix- USS,MRI | Mx-plaster vs repair

Question 45

Tibialis posterior what is the progression of problems?

Answer 45

Tenosynovitis progressive elongation rupture

Question 46

What does tibialis posterior rupture lead to

Answer 46

leads to progressive flat foot and values hindfoot

Question 47

Treatment of tibias posterior rupture

Answer 47

NSAIDs orthotics/cast inject debride may be helped by a tendon transfer