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MSK > Tendon Problems > Flashcards

Tendon Problems Flashcards

1
Q

what is tendinopathy

A

disease of a tendon

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2
Q

define tendonitis

A

inflammation of a tendon

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3
Q

what is tendonosis

A

chronic tendon injury with damage to a tendon extracellular matrix

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4
Q

define tenosynovitis

A

inflammation of the tendon sheath

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5
Q

what is enthesopathy

A

inflammation of the tendon origin or the insertion into the bone

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6
Q

what is the purpose of a tendon

A

transmit load from muscle to bone

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7
Q

what is the composition of tendons

A

water
collagen (type 1 85% of dry weight)
proteogylcans

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8
Q

what cells produce collagen and proteoglycans

A

fibroblasts

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9
Q

what is the blood supply to tendons like

A

poor- watershed areas (has weakest blood supply) are linked to tendon pathology and rupture

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10
Q

what is the order of components of tendons

A 
microfibrils 
subfibrils 
fibrils 
fascicles 
tendon unit
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11
Q

what is the endotendon

A

surrounds and separates fascicles, contains nerves and small blood vessels

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12
Q

what is the epitenon

A

outer connective tissue layer, covers endotendon, lies within loose areolar tissue (paratenon) or within the tendon sheath

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13
Q

what is the blood supply to tendons

A

comes from:

  • perimyseum
  • periosteal insertion of the tendon
  • paratenon
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14
Q

what are the intrinsic causes of tendinopathy

A

age, gender, obesity, pre disposing diseases (RA)m anatomical factors (mal-alignment)

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15
Q

what are the extrinsic causes of tendinopathy

A

trauma/ injury, repetitive injury, drugs (steroids, antibiotics (fluroquinolones)), sports related factors

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16
Q

what is the basic principles for management for a tendinopathy

A 
Rest (RICE)
physio
analgesics (anti inflammatories)
steriod injectios (for rotator cuff and tennis/ golfers elbow NOT achilles tendon or extensor knee mechanism)
splinting
(some may require surgery)
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17
Q

where do you not do steroid injections- why

A

achilles tendon or extensor knee mechanisms

risk of rupture

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18
Q

what are the types of surgery that can be used to treat tendinopathies

A

debridement- removal of diseased tissue

decompression- used in supraspinatus tendonitis and subacromial decompression

synovectomy- helps prevent rupture, extensors of wrist (RA), tibialis posterior

tendon transfer- tibialis posterior, extensor pollicis longus

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19
Q

what can cause a rotator cuff pathology

A

intrinsic- degeneration, tendon vascularity

extrinsic compression

inflammation of the subacromial bursa

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20
Q

what are the possible clinical findings of a rotator cuff pathology

A

achy pain down arm, difficulty sleeping on affected side/reaching overhead/on lifting, painful arc +/- weakness, positive impingement tests (haekins- kennedy, jpbes, scarf), dull achy pain

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21
Q

what is the management for rotator cuff pathology

A

conservative- physio, inject, rest

surgery- subacromial decompression, rotator cuff repair

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22
Q

what is the gold standard for imaging the rotator cuff

A

US

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23
Q

what causes biceps tendonopathy

A

can be tendonosis, tendonitis, rupture or tenosynovitis- overuse, instability, impingement or trauma

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24
Q

what are the signs of biceps tendinopathy

A

pain in anterior shoulder, radiating to elbow

aggravated by shoulder flexion, forearm pronation and elbow flexion

snapping with shoulder if subluxation

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25
Q

what head of biceps is more commonly affected by inflammation

A

long head- as it passes through the bicipital groove

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26
Q

what are the clinical signs of a biceps rupture

A

popeye sign and extensive bruising

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27
Q

what is the treatment for biceps tendinopathy

A

conservative with rest and physio

surgical repair if manual job

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28
Q

what causes lateral epicondylitis (tennis elbow)

A

overuse injury- eccentric overload at common extensor tendon origin
Tendinosis and inflammation at ECRB origin
(Extensor carpi radialis brevis)

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29
Q

what is the pathophysiology of tennis elbow

A

Tendinosis and inflammation at ECRB origin

Peritendinous inflammation = angiofibroblastic hyperplasia = breakdown/fibrosis

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30
Q

what are the signs of tennis elbow

A

pain and tenderness over latral epicondyle , pain with resisted extension of middle finger (felt in elbow), mills test positive

31
Q

how is tennis elbow treated

A

self limiting (can be up to 4 years), rest, physio steroid injections, surgical release and debridement of ECRB

32
Q

where is golfers elbow pain felt

A

origin of the wrist flexors (medial)

33
Q

what is the pathophysiology of medial epicondylitis

A

reptitive stress= Peritendinous inflammation = angiofibroblastic hyperplasia = breakdown/fibrosis

34
Q

why do you avoid injecting golfers elbow

A

as risk of hitting ulnar nerve

35
Q

what is inflamed in golfers elbow

A

flexor forearm muscles

36
Q

what movement causes pain in golfers elbow

A

wrist flexion and pronation

37
Q

what can some cases of golfer elbow be associated with

A

ulnar neuropathy

38
Q

what is the management for golfers elbow

A

rest, physio, modification of activities, orthotics, or injection of LA and steroid. For refractory cases, surgical release may be required

39
Q

what is de Quervains tenosynovitis

A

tendon sheath pathology in first extensor compartment (APL, EPB), cause unknown- can be repetitive strain injury

40
Q

what are the features of de quervains tenosynovitis

A

pain whilst using thumb, tendor over compartment (radial styloid), pain on resisted active thumb extension, finklesteins test (thumb in fist, ulnar deviation)

41
Q

what should you rule out with XR in de queravains tenosynovitis

A

CMC OA (also do US to investigate)

42
Q

what is the management for de quervains

A

splint, rest, physio, analgesics, injections, surgical decompression

43
Q

how does RA and extensor tendon rupture

A

autoimmune attack on synovium= tendon degeneration= rupture

44
Q

what are the features of extensor tendon rupture in the hand

A

weakness wrist extension or dropped finger

45
Q

can you repair a diseased tendon

A

no need tendon transfer

46
Q

what is the most common hand tendon rupture

A

extensor pollicis longus

47
Q

why does an EPL rupture usually occur

A

a few weeks after (usually) undisplaced distal radium fracture - ischaemia plays a role, watershed area of tendon as it passes around listers tubercle
facture haematoma hinders perfusion

48
Q

what is the effect and treatment for an EPL rupture

A

loss of function of thumb extension but not always too big an impact
may require tendon transfers

49
Q

what is the pathophysiology of trigger finger

A

stenosing tenosynovitis = fibrocartilaginous metaplasia = nodule FDS tendon which catches on the A1 pulley causing clicking/ locking during extension and flexion

50
Q

what are the of trigger finger

A

pain and tenderness over tendon sheath at level of MCPJ

can lead to fixed flexion contracture

51
Q

who gets trigger finger

A

can affect any age

52
Q

what is the treatment for trigger finger

A

observe, injections- 70% heal, surgical release of A1 pulley

53
Q

what trigger finger treatment is contraindicated in RA

A

surgical release of A1 pulley- may exacerbate ulnar drift, synovectomy preferred

54
Q

what makes up the knee extensor mechanism

A

quadriceps muscle, quadriceps tendon, the patella, patella tendon

55
Q

what can knee extensor mechanism tears be associated with

A

blunt/ penetrating trauma, steroid or antibiotic use, diabetes

common in middle age people who play running/ jumping sports

56
Q

what pathologies can affect the knee extensor mechanism

A

tendonitis , rupture (partial or complete), traction apophysitis

57
Q

what are the clinical signs of a knee extensor mechanism

A

may have effusion, inability to straight leg raise, palpable gap, patellar in wrong place (on xray)

58
Q

what investigations to see whether it is a complete or partial tear

A

MRI/ USS

59
Q

what is osgood schlatters

A

traction apophysitis of the tibial tubercle, is inflammation of the patellar ligament at its insertion to the tibial tuberosity

60
Q

what is a general rule for injecting tendons

A

upper body fine, lower limbs bad

61
Q

what is the treatment for a extensor mechanisms rupture

A

surgical repair

small tears may be treated with immobilisation and physio

62
Q

what are the features of osgoods schlatters

A

It is characterized by a painful, bony and prominent bump just below the knee that is worse with activity and better with rest

63
Q

who gets osgood schlatters

A

adolescent active boys

64
Q

where else can osgood schlatter happen

A

patella and achilles

65
Q

what is the treatment for osgood schlatters

A

rest, physio, analgesia

66
Q

who tears their achilles tendon

A

middle aged, after a sudden force (pushing off/ sudden acceleration/ deceleration/ running/ squash)
commoner in patients with RA, on steroids, or who have tendonitis

67
Q

what does tearing your achilles tendon feel like

A

being kicked or shot

68
Q

what are the clinical findings of achilles tendon rupture

A

palpable gap, unable to tiptoe stand, simmonds test +ve, bruising,

69
Q

how do you investigate an achilles tendon rupture

A

USS, MRI

70
Q

what is the treatment for an achilles rupture

A

plaster (equinus cast with serial casts) / boot vs repair

71
Q

what is simmonds / thompsons test

A

squeezing calf causes passing foot plantar flexion in not ruptured

72
Q

what causes a tibialis posterior to rupture

A

tenosynovitis- progressive elongation- rupture

73
Q

what does tibialis posterior elongation and rupture cause

A

progressive flat foot and valgus hindfoot

74
Q

what can help treat tibialis posterior rupture

A

tendon transfer

MSK (71 decks)

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