Tendon Problems Flashcards

1
Q

what percentage of MSK complaints are tendon related

A

30%

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2
Q

what is tendinopathy?

A

disease of a tendon

term for tendon related pain

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3
Q

what is tendonitis?

A

inflammation of a tendon

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4
Q

what is tendonosis?

A

chronic tendon injury with damage to a tendon’s ECM

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5
Q

what is tenosynovitis?

A

inflammation of the tendon sheath

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6
Q

what is an enthesopathy?

A

inflammation of the tendon origin or insertion into bone

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7
Q

what would you see on histology of tendon problems?

A

nothing

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8
Q

which 2 tendon problems are notorious for not having any signs on histology?

A

tennis elbow

golfers elbow

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9
Q

what is the function of a tendon?

A

link muscle to motor unit to enable joint function

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10
Q

predominant cell in tendons?

A

fibroblast

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11
Q

what do fibroblasts do?

A

produce and maintain collagen + other proteins

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12
Q

what is the main component of a tendon?

A

type 1 collagen

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13
Q

name some intrinsic factors that cause tendon problems?

A

age
gender
obesity
comorbidities eg RA

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14
Q

extrinsic factors that cause tendon problems?

A
trauma
repetitive trauma
steroids
fluoroquinolones eg cipro
sports
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15
Q

what happens in tendinosis?

A

degeneration of collagen and ECM

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16
Q

what causes the degradation in tendinosis?

A

matrix metallinoprteinases

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17
Q

is tendonosis always painful?

A

no, but can be painful in some

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18
Q

most common areas to get tendinosis?

A

areas of poor blood supply

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19
Q

analgesics of choice for managing tendon problems?

A

NSAIDs

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20
Q

what tendon problem in the lower limb is usually treated by splinting?

A

Achilles tendonitis

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21
Q

main treatment pathway for soft tissue inflammatory problems?

A

rest
NSAIDs
steroid injections

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22
Q

surgical treatment of chouce for supraspinatus tendonitis?

A

decompression

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23
Q

why would you do a synovectomy in tendon problems?

A

prevents rupture

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24
Q

most common rotator cuff to become affected?

A

supraspinatous

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25
Q

clinical presentation of rotator cuff pathology?

A

dull achy pain in upper arm that gradually increases

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26
Q

why do patients with rotator cuff pathology feel pain down their arm?

A

shoulder pain refers to axillary dermatome

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27
Q

examination findings of someone with rotator cuff pathology

A

tenderness around GH and AC joint
painful arc
rotator cuff weakness
+ve impingement tests eg Hawkins kennedy, jobe’s, scarf test

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28
Q

treatment for rotator cuff pathology?

A
3 months physio
steroid injections (at least 2 before going to surgery)
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29
Q

biggest muscle of the rotator cuff?

A

subscapularis

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30
Q

where does the supraspinatus run?

A

above clavicle and sits between acromion and humerus

31
Q

gold standard imaging for rotator cuff

A

USS

32
Q

2 types of biceps tendinopathy?

A

distal

proximal

33
Q

clinical presentation of biceps tendinopathy?

A

pain in anterior shoulder radiating to elbow ; get clicking/snapping sensations

34
Q

what movements aggravate a biceps tendinopathy?

A

shoulder flexion
forearm pronation
elbow flexion

35
Q

investigations for biceps tendinopathy?

A

USS

36
Q

clinical signs of biceps rupture?

A

popeye sign

37
Q

treatment for biceps rupture?

A

rest

physio

38
Q

is tennis elbow predominantly bilateral or unilateral?

A

unilateral

39
Q

clinical presentation of tennis elbow?

A

pain/tenderness of lateral epicondyle with resisted extension of middle finger

40
Q

is tennis elbow inflammatory?

A

no

41
Q

is mill’s test +ve or -ve for tennis elbow?

A

+ve

42
Q

treatment for tennis and golfers elbow?

A
rest
physio
injection of LA and steroids
orthotics
surgical release for refractory cases
43
Q

is golfers elbow inflammatory?

A

yes

44
Q

golfers elbow clinical presentation?

A

medial elbow pain that is especially tender over origin of flexor of medial epicondyle

45
Q

what movements make golfers elbow worse?

A

wrist flexion/pronation

grasping

46
Q

most common causes of dequervain’s tenosynovitis?

A

repetitive use of the wrist and radial styloid process eg gaming, texting

47
Q

how to examine for de quervain’s tenosynovitis?

A

finkelsteins test: grip thumb in palm of hand and ulnar deviate

48
Q

investigations for dequervains?

A

USS

X ray

49
Q

why is an x ray done in de quervains?

A

can mimic OA so its to rule it out

50
Q

treatment for dequervains?

A
splint
rest
physio
NSAIDs
steroid injection
surgical decompression
51
Q

cause of an extensor tendon rupture in RA?

A

autoimmune attack on synovium causes tendon degeration until it ruptures

52
Q

treatment for extensor tendon rupture?

A

tendon transfer

53
Q

clinical presentation of extensor tendon rupture?

A

weakness in wrist extension

dropped finger

54
Q

common comorbidities that could cause an EPL rupture?

A

RA

colles fracture

55
Q

treatment for EPL rupture?

A

tendon transfer

56
Q

why is the EPL prone to injury?

A

has a tortuous route

57
Q

what makes up the extensor mechanism of the knee?

A

quadriceps muscle
quadriceps tendon
patella
patellar tendon

58
Q

features on clinical examination of a tendon rupture in the extensor mechanism of the knee?

A

palpable gap

no straight leg raise

59
Q

can you inject the lower limb with steroids?

A

no

60
Q

investigations for kne extensor mechanism tendon rupture?

A

x ray for effusion/displacement

USS/MRI for tear

61
Q

treatment for tendon rupture in knee extensor mechanism?

A

surgical

increase in ROM post op

62
Q

what is an apophysis?

A

growing bone has tendon on side rather than bone

63
Q

pathology behind Osgood schlatters?

A

traction apophysitis AT TIBIAL TUBERCLE

64
Q

who gets Osgood schlatters?

A

teenage boys

65
Q

clinical presentation of Osgood schlatters

A

bony prominent lump at tibial tuberosity or sometimes patella/achilles

66
Q

what does Achilles tendon rupture feel like?

A

kicked shot

67
Q

examination presentation of Achilles tendon rupture?

A

palpable gap
unable to tip toe
positive ismmonds test

68
Q

what is Simmonds tets?

A

squeeze gastrocnemius over Achilles tendon

69
Q

investigation for Achilles tendon rupture?

A

USS

MRI

70
Q

treatment for Achilles tendon rupture?

A

plaster

repair

71
Q

pathology behind tibialis posterior rupture?

A

tenosynovitis causes progressive elongation of muscle until it ruptures

72
Q

what condition can tibialis posterior dysfunction commonly cause?

A

flat feet

73
Q

how to test for flat feet?

A

look at patient from behind, if more than 1 toe visible = flat feet

74
Q

treatment for tib posterior rupture?

A

NSAIDs
cast
inject
debride