Tendon Problems Flashcards
What defines tendinopathy?
Disease of a tendon, tendon related pain
What defines tendonitis?
Inflammation of a tendon
What defines tendinosis?
Chronic tendon injury with damage to a tendon extracellular matrix
What defines tenosynovitis?
Inflammation of a tendon sheath
What defines enthesopathy?
Inflammation of the tendon origin or insertion into bone
What is the predominant cell in a tendon? What is their function?
Fibroblast: production and maintenance of collagen and and other proteins
What is the function of collagen within a tendon?
Confers flexibility and strength
90% of a tendon is made up of what type of collagen?
Type 1
What is the heirarchial structure of a tendon?
Fibrils divide into sub fibrils which divide into microfibrils
What are the 3 blood supplies to tendons?
Perimysium, periosteal insertion, paratenon
What is a paratenon?
The tissue occupying the space between a tendon and its sheath
Which sex is more likely to be affected by tendon problems?
Males
What are some drugs which may predispose to tendon problems?
Steroids, fluoroquinolones (e.g. ciprofloxacin)
What causes tendinosis?
Histological degeneration of collagen and extracellular matrix
Degeneration of collagen which causes tendinosis occurs as a result of what?
Matrix metalloproteinases which increase with age and repetitive strain
Where is tendinosis most likely to occur?
Areas of poor blood supply
Is tendinosis always painful?
No, it can be present and not painful
What are some general conservative managements for for tendinosis?
Rest, physio, eccentric strengthening, analgesia, anti-inflammatories, injections of local anaesthetic and cortisone
LA and cortisone injections are especially useful for what conditions?
Rotator cuff, tennis elbow
What are some different surgical managements which can be used for tendinopathies?
Debridement, decompression, synovectomy, tendon transfer
What is the purpose of a synovectomy?
Helps to prevent rupture
A tendon is often taken from where to be used for tendon transfers? Why?
An extensor tendon of the index fingers since there are two
Why are steroid injections controversial for tendinosis?
Steroids are toxic to tenocytes
Rotator cuff problems cause a dull, achy pain down the arm. This is referred pain from where?
Axillary nerve
What difficulties can patients with rotator cuff problems have?
Difficulty sleeping on the affected side, reaching overhead and lifting
Most cases of rotator cuff problems will settle without surgery in how long?
1-2 years
What is the gold standard test for imaging of the rotator cuff? What else can be used?
Gold standard is US, MRI can be used to provide more detailed images
Which end of the biceps muscle is affected in biceps tendinopathy? Which head is more likely to be affected?
Can be either end, more likely to be the long head
Where does most inflammation occur in biceps tendinopathy?
As the long head passes through the bicipital groove anterior to the proximal humerus
Inflammation in biceps tendinopathy is usually a result of what?
Friction
What can cause biceps tendinopathy?
Overuse, instability, impingement or trauma
Where will there typically be pain in biceps tendinopathy? What will make it worse?
Anterior to the shoulder- made worse by flexion of the shoulder and pronation of the forearm
What may patients with biceps tendinopathy describe on shoulder movement?
Clicking or snapping sensations
What does snapping in biceps tendinopathy imply?
The distal end of the biceps is affected
What may be visible on examination of biceps tendinopathy?
Popeye sign and extensive bruising
What causes a Popeye deformity in biceps tendinopathy?
The tendon spontaneously ruptures which results in relief of symptoms and a bunched up biceps
What is the mainstay of treatment for biceps tendinopathy?
Rest and physiotherapy
What surgery may relieve symptoms of biceps tendinopathy? What is the risk?
Surgical division of the tendon: risk of neuromuscular complications, especially when involving the distal end
What is the chance of lateral epicondylitis being bilateral?
10-20%
What is lateral epicondylitis characterised by?
Pain and tenderness over the lateral epicondyle at the attachment of the forearm extensors
When will pain from lateral epicondylitis be worse?
Resisted extension of the middle finger and wrist
What does pathology of lateral epicondylitis show?
Micro-tears in the common extensor origin, most likely the origin of ECRB
Which out of lateral and medial epicondylitis is inflammatory?
Medial
How is epicondylitis (medial or lateral) diagnosed?
Mainly clinical diagnosis, US and MRI can be used
Why do lateral and medial epicondylitis occur?
Repetitive strain injury or degenerative enthesopathy
Who is more likely to get lateral epicondylitis?
Tennis players, and those who regularly perform resisted extension at the wrist
What is the management of lateral epicondylitis?
Self-limiting: rest (avoid the activity which makes it worse), physiological, steroid injections, NSAIDs, brace
What is the surgical treatment for lateral epicondylitis? How successful is it?
Division and or excision of some fibres of the common extensor origin. Has variable results.
Which is more common, medial or lateral epicondylitis?
Lateral
What is medial epicondylitis?
Inflammation of the origin of the flexor forearm muscles
Where will there be pain in medial epicondylitis?
Medial elbow, especially over the flexor origins
How is medial epicondylitis treated?
Self-limiting: physiology, rest, NSAIDs
Why should steroid injections not be used in medial epicondylitis?
Too near the ulnar nerve
Some cases of medial epicondylitis may have what associated neurological problems?
Ulnar neuropathy and muscle weakness
If there are any neurological symptoms in medial or lateral epicondylitis, what test should be done?
Nerve conduction studies
What condition causes extensor tendon rupture?
RA
What is an extensor tendon rupture?
An autoimmune attack on the synovium which results in tendon degeneration and rupture
What clinical signs will occur in an extensor tendon rupture?
Weakness in wrist extension or a dropped finger
In RA extensor tendon rupture, the tendon cannot be repaired. What treatment is used?
Tendon transfer
If an RA extensor tendon rupture is caught early, what can prevent it?
Synovectomy
What conditions can cause an extensor pollicis longus rupture?
RA or a Colles fracture
What occurs with an extensor pollicis longus rupture? What is the treatment?
Substantial loss of function, needs a tendon transfer
