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MSK > Tendon Problems > Flashcards

Tendon Problems Flashcards

1
Q

what can cause a rotator cuff pathology

A

extrinsic compression
intrinsic degeneration
inflammation of subacromial bursa

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2
Q

what are the clinical findings in a rotator cuff pathology?

A

achy pain down the arm
difficulty sleeping on affected side, reaching overhead etc
painful arc +/- weakness
tenderness over shoulder around glenohumeral joint and AC joint
positive impingement tests (Hawkins-Kennedy, Jobes and scarf tests)

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3
Q

how is rotator cuff pathology managed?

A

conservative - physio, injections

surgical - subacromial decompression

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4
Q

what is the gold standard imaging for rotator cuff pathology?

A

US

MRI and arthroscopy also used

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5
Q

what causes biceps tendinopathy?

A 
tendinosis leads to inflammation
overuse
instability
impingement
trauma
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6
Q

what are the possible types of biceps tendinopathy?

A

tendonitis
tendonosis
rupture
tenosynovitis

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7
Q

what are the symptoms of biceps tendinopathy?

A

pain in the anterior shoulder radiating to the elbow

  • aggravated by shoulder flexion, forearm pronation and elbow flexion
  • snapping sensation with shoulder movements if subluxation
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8
Q

which head of the biceps is most commonly affected by tendinopathy?

A

long head where it passes through the bicipital groove on the anterior proximal humerus - where most inflammation/friction occurs

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9
Q

how is biceps tendinopathy diagnosed?

A

clinical exam

US

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10
Q

how is biceps tendinopathy managed?

A

conservative or surgical

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11
Q

what is the clinical sign of biceps rupture?

A

popeye sign

bulge at opposite end of muscle

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12
Q

how biceps rupture managed?

A

mainstay = conservative with rest and physio

surgical repair if conservative doesn’t work but carries high risk

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13
Q

what is lateral epicondylitis?

A

“tennis elbow”

eccentric overload at common extensor tendon origin due to overuse causing tendinosis and inflammation at ECRB origin

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14
Q

what is the pathophysiology of tennis elbow?

A

peritendinous inflammation > angiofibroblastic hyperplasia > breakdown/fibrosis

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15
Q

what are the clinical features of tennis elbow?

A

commonly in dominant arm
pain and tenderness over lateral epicondyle (worse when stretching muscles)
pain with resisted extension of middle finger

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16
Q

how is tennis elbow managed?

A

self limiting - rest, physio, steroid injections

surgical release and debridement of ERCB origin

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17
Q

how is tennis elbow diagnosed?

A

mainly clinical - mills sign positive

US and MRI can be needed

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18
Q

what is medial epicondylitis?

A

“golfers elbow”
inflammation of the flexor forearm muscles
repetitive stress leads to peritendinous inflammation > angiofibroblastic hyperplasia > breakdown/fibrosis
at origin of wrist flexors at medial epicondyle

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19
Q

what are the features of golfers elbow?

A

medial elbow pain - tender point over origin of the flexors
- aggravated by wrist flexion and pronation and using muscles (opening a jar)
can have associated ulnar neuropathy/weakness

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20
Q

how is golfers elbow managed?

A

conservative - rest, physio, modification of activities
avoid injections - ulnar nerve
debridement surgery can be used in refractory cases

21
Q

what is De Quervains Tenosynovitis and what causes it?

A

pathology of first extensor compartment (APL and EPB) of the tendon sheath
caused unknown but more common in females - possible pregnancy related

22
Q

what are the features of De Quervains tenosynovitis?

A

pain whilst using thumb
tender over compartment
pain on resisted active thumb extension
positive finklesteins test

23
Q

how is De Quervains diagnosed?

A

US

X ray

24
Q

how is De Quervains managed?

A 
splint
rest
physio
anagesics
injections
surgical decompression
25
Q

what can cause an extensor tendon rupture?

A

RA

autoimmune attack on synovium > tendon degeneration > rupture

26
Q

what are the features of RA extensor tendon rupture and how is it treated?

A

weak wrist extension or dropped finger
tendon transfer
(can be prevented by synovectomy)

27
Q

what is the most common hand tendon rupture?

A

EPL rupture

occurs a few weeks after an undisplaced distal radius fracture

28
Q

what happens in an EPL rupture?

A

watershed area of tendon as it passes around Lister’s tubercle
fracture haematoma hinders perfusion
causes loss of function of thumb extension, but not always too bad

29
Q

how is EPL rupture managed?

A

may need tendon transfer

30
Q

how does trigger finger occur?

A

stenosing tenosynovitis > fibrocartilaginous metaplasia > nodule on FDS tendon > nodule catches on A1 pulley > clicking and locking during flexion/extension of finger

31
Q

what are the features of trigger finger?

A

pain and tenderness over tendon sheath at level of MCPs

can have fixed flexion contracture (esp. in diabetics)

32
Q

how is trigger finger managed?

A

observe
inject (cures most)
surgical release of A1 pulley
- not in RA as can exacerbate ulnar drift so use synovectomy instead

33
Q

rule for quads, patellar and achilless tendons tendonitis?

A

don’t inject!

34
Q

how does a quads or patella tendon rupture present?

A

palpable gap
cant do straight leg raise
may be high or low patella on X ray

35
Q

how is quads or patella tendon rupture managed?

A

surgical repair through open approach

36
Q

what is Osgood schlatters disease?

A

traction apophysitis at the tibial tubercle
(inflammation of the bony prominence at the growth plate due to chronic traction of the tendon at its insertion at the growth plate)

37
Q

what are the features of traction apophysitis?

A

leaves prominent bony lump
growing pains
usually in active adolescent boys

38
Q

how does an achilles tendon rupture usually present?

A

middle aged
sudden acceleration/deceleration
feels like being kicked or shot

39
Q

what are the risk factors for achilles tendon rupture?

A

RA
steroids
tendonitis

40
Q

what are the clinical findings in achilles tendon rupture?

A

palpable gap
unable to plantarflex
+ve Simmonds test

41
Q

how is achilles tendon rupture diagnosed?

A

clinical examination usually enough but may need US or MRI if complex

42
Q

how is an achilles tendon rupture managed?

A

serial plater casts

surgical repair

43
Q

how does tibialis posterior rupture occur and what can it lead to?

A

tenosynovitis > progressive elongation > rupture > progressive flat foot and valgus hindfoot

44
Q

how is tibialis posterior rupture managed?

A 
NSAIDs
orthotics/casts
injections
debridement
may be helped by tendon transfer
45
Q

what is the function of tendons and how are they made up?

A

link muscle to bone to enable joint function
microfibrils > subfibrils > fibrils > fascicles > tendon unit
tendon unit surrounded by endotendon which contains nerves and small blood vessels
endotendon surrounded by epitenon - connective tissue, within the tendon sheath

46
Q

what are tendons composed of?

A

water
type 1 collagen
proteoglycans

47
Q

what cells are present in tendons?

A

fibroblasts - produce collagen and proteoglycan

48
Q

what is the blood supply to tendons?

A

poor supply

watershed areas linked to tendon pathology and rupture

49
Q

what are the 5 types of tendon disease?

A 
tendinopathy = disease of a tendon
tendonitis = inflammation of a tendon
tendonosis = chronic tendon injury with damage to a tendon ECM
tenosynovitis = inflammation of the tendon sheath
enthesopathy = inflammation of the tendon origin or insertion into bone

MSK (66 decks)

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