Tendon problems Flashcards
What is a tendinopathy?
Disease of a tendon - tendon related pain
What is tendonitis?
Inflammation of a tendon
What is tendonosis?
Chronic tendon injury with damage to a tendon ECM
What is tenosynovitis?
Inflammation of the tendon sheath
What is enthesopathy?
Inflammation of the tendon origin or the insertion onto a bone
What is the purpose of tendons?
To transmit load from muscle to bone
What is the composition of a tendon?
Water
Collagen type 1
Proteiglycans
What do fibroblasts produce?
Collagen
Proteoglycan
What is the hierarchial structure of tendons?
Microfibrils make up subfibrils which inturn make up fibrils
Hundreds of fibrils make a fasicle
Fasciles are separated by endotenon which is covered by an epitenon
What is the blood supply to tendond?
3 sources:
Perimyseum
Periosteal insertion of the tenson
Paratenon
What are the principles of management of tendon issues?
RICE
PT
Analgesics - NSAIDs
Injections - rotator cuff, tennis elbow but NOT achillles tendon or extensor mechanism
Splinting - achilles
Surgical: depridement, decompression (supraspinatous tendonitis and subacromial decompression)
Synovectomy (prevent rupture, extensor tendons of wrist, tibialis posterior)
Tendon transfer - tibialis posterior, extensor pollicis longus
What are the clinical findings of rotator cuff pathology?
Achy painful arm
Difficulty sleeping on affected side, reaching overhead and on lifting
Painful arc
Weakness on testing of rotator cuffs
Positive impingement tests (hawkins kennedy, jobes, scarf test)
How are rotator cuff pathologies managed?
Conservative - PT, steroid injections
Surgical - subacromial decompression
What is the gold standard for imaging a rotator cuff tear?
USS
What can cause biceps tendinopathy?
Overuse, instability, impingement or trauma
Where will the pain be in biceps tendionpathy?
Pain anterior shoulder radiating to the elbow particularly over the biciptal groove
Aggravated by shoulder flexion
How is biceps teniopathy managed?
Conservative (PT and rest)
Surgical
What are the clinical examination findings or a biceps rupture?
Popeye sign
Extensive brusing
Hook test
What is lateral epicondylitis?
Tendonosis and inflammation at the ECRB origin
Peritendinous inflammation leads to angiofibroblastic hyperplasia leading to breakown and fibrosis
What actions will cause pain in lateral epicondylitis?
Pain and tenderness over the lateral epicondyle
Pain with resisted extension of the middle finger
Non-inflammatory
Worse when stretching muscles e.g. opening a jar
What is the management for lateral epicondylitis?
Self-limting
Injections - can take up to 4 years
Surgical release and debridemnt of ECRB origin
What other associated conditions is medial epicondylitis associated with?
Ulnar neuropathy - paraesthesia of ulnar nerce
Consider decompression of cubital tunnel
Why should steroid injections be involved in medial epicondylitis?
The ulnar nerve is very close by
What are the common clinical findings of a quads or patellar rupture?
Palpable gap
NO SLR
Patella may be high or low depending on what tendon ruptures
How is a quads/ patellar tendon rupture treated?
Surgical repair
What can predispose to a tendon rupture?
Associated with blunt or penetrating trauma
Steroid use
Ciprofloxacin
RhA
What is traction apophysitis??
At the tibial tubercle = osgood-schlatters disaese
Insertion of patellar tendon onto tibial tuberosity leaves a prominet bony lump
What is the classical history of an achilles tendon rupture?
Sudden accelration and then a feeling of being kicked or shot in the back of the leg
What are the clinical findings of achilles tendon rupture?
Palpable gap
Unable to tiptoe stand
Simmonds’s test +ve
How is achilles tendon rupture treated?
Serial equinus cast
Surgical repair
What is a positive simmonds’s test?
When squeezing the calf the foot should plantarflex but in achilles tendon rupture it will not move
What will tibialis posterior tendon dysfunction lead to?
Progressive flat fett
Valgus hindfoot
How can tibialis posterior tendon dysfunction be treated?
NSAIDs Orthotics Cast Inject Debride Tendon transfer (last resort)
