Tendon Problems Flashcards
what percentage of MSK complaints are tendon related
30%
what is tendinopathy?
disease of a tendon
term for tendon related pain
what is tendonitis?
inflammation of a tendon
what is tendonosis?
chronic tendon injury with damage to a tendon’s ECM
what is tenosynovitis?
inflammation of the tendon sheath
what is an enthesopathy?
inflammation of the tendon origin or insertion into bone
what would you see on histology of tendon problems?
nothing
which 2 tendon problems are notorious for not having any signs on histology?
tennis elbow
golfers elbow
what is the function of a tendon?
link muscle to motor unit to enable joint function
predominant cell in tendons?
fibroblast
what do fibroblasts do?
produce and maintain collagen + other proteins
what is the main component of a tendon?
type 1 collagen
name some intrinsic factors that cause tendon problems?
age
gender
obesity
comorbidities eg RA
extrinsic factors that cause tendon problems?
trauma repetitive trauma steroids fluoroquinolones eg cipro sports
what happens in tendinosis?
degeneration of collagen and ECM
what causes the degradation in tendinosis?
matrix metallinoprteinases
is tendonosis always painful?
no, but can be painful in some
most common areas to get tendinosis?
areas of poor blood supply
analgesics of choice for managing tendon problems?
NSAIDs
what tendon problem in the lower limb is usually treated by splinting?
Achilles tendonitis
main treatment pathway for soft tissue inflammatory problems?
rest
NSAIDs
steroid injections
surgical treatment of chouce for supraspinatus tendonitis?
decompression
why would you do a synovectomy in tendon problems?
prevents rupture
most common rotator cuff to become affected?
supraspinatous
clinical presentation of rotator cuff pathology?
dull achy pain in upper arm that gradually increases
why do patients with rotator cuff pathology feel pain down their arm?
shoulder pain refers to axillary dermatome
examination findings of someone with rotator cuff pathology
tenderness around GH and AC joint
painful arc
rotator cuff weakness
+ve impingement tests eg Hawkins kennedy, jobe’s, scarf test
treatment for rotator cuff pathology?
3 months physio steroid injections (at least 2 before going to surgery)
biggest muscle of the rotator cuff?
subscapularis
where does the supraspinatus run?
above clavicle and sits between acromion and humerus
gold standard imaging for rotator cuff
USS
2 types of biceps tendinopathy?
distal
proximal
clinical presentation of biceps tendinopathy?
pain in anterior shoulder radiating to elbow ; get clicking/snapping sensations
what movements aggravate a biceps tendinopathy?
shoulder flexion
forearm pronation
elbow flexion
investigations for biceps tendinopathy?
USS
clinical signs of biceps rupture?
popeye sign
treatment for biceps rupture?
rest
physio
is tennis elbow predominantly bilateral or unilateral?
unilateral
clinical presentation of tennis elbow?
pain/tenderness of lateral epicondyle with resisted extension of middle finger
is tennis elbow inflammatory?
no
is mill’s test +ve or -ve for tennis elbow?
+ve
treatment for tennis and golfers elbow?
rest physio injection of LA and steroids orthotics surgical release for refractory cases
is golfers elbow inflammatory?
yes
golfers elbow clinical presentation?
medial elbow pain that is especially tender over origin of flexor of medial epicondyle
what movements make golfers elbow worse?
wrist flexion/pronation
grasping
most common causes of dequervain’s tenosynovitis?
repetitive use of the wrist and radial styloid process eg gaming, texting
how to examine for de quervain’s tenosynovitis?
finkelsteins test: grip thumb in palm of hand and ulnar deviate
investigations for dequervains?
USS
X ray
why is an x ray done in de quervains?
can mimic OA so its to rule it out
treatment for dequervains?
splint rest physio NSAIDs steroid injection surgical decompression
cause of an extensor tendon rupture in RA?
autoimmune attack on synovium causes tendon degeration until it ruptures
treatment for extensor tendon rupture?
tendon transfer
clinical presentation of extensor tendon rupture?
weakness in wrist extension
dropped finger
common comorbidities that could cause an EPL rupture?
RA
colles fracture
treatment for EPL rupture?
tendon transfer
why is the EPL prone to injury?
has a tortuous route
what makes up the extensor mechanism of the knee?
quadriceps muscle
quadriceps tendon
patella
patellar tendon
features on clinical examination of a tendon rupture in the extensor mechanism of the knee?
palpable gap
no straight leg raise
can you inject the lower limb with steroids?
no
investigations for kne extensor mechanism tendon rupture?
x ray for effusion/displacement
USS/MRI for tear
treatment for tendon rupture in knee extensor mechanism?
surgical
increase in ROM post op
what is an apophysis?
growing bone has tendon on side rather than bone
pathology behind Osgood schlatters?
traction apophysitis AT TIBIAL TUBERCLE
who gets Osgood schlatters?
teenage boys
clinical presentation of Osgood schlatters
bony prominent lump at tibial tuberosity or sometimes patella/achilles
what does Achilles tendon rupture feel like?
kicked shot
examination presentation of Achilles tendon rupture?
palpable gap
unable to tip toe
positive ismmonds test
what is Simmonds tets?
squeeze gastrocnemius over Achilles tendon
investigation for Achilles tendon rupture?
USS
MRI
treatment for Achilles tendon rupture?
plaster
repair
pathology behind tibialis posterior rupture?
tenosynovitis causes progressive elongation of muscle until it ruptures
what condition can tibialis posterior dysfunction commonly cause?
flat feet
how to test for flat feet?
look at patient from behind, if more than 1 toe visible = flat feet
treatment for tib posterior rupture?
NSAIDs
cast
inject
debride
