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Musculoskeletal > Tendon Problems > Flashcards

Tendon Problems Flashcards

1
Q

What are some features of tendon problems?

A

Most conditions are self-limiting, can be hard to treat, common (30% of MSK consults)

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2
Q

What is a tendinopathy and tendonitis?

A 
Tendinopathy = disease of tendon
Tendonitis = inflammation of the tendon within the collagen
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3
Q

What are tendonosis and tenosynovitis?

A 
Tendonosis = inflammation of tendon (more chronic, changes at cellular level)
Tenosynovitis = inflammation of tendon sheath
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4
Q

What is the definition of enthesopathy?

A

Disease of the origin of the tendon where it attaches to the bone

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5
Q

What is the function of tendons, and what is the predominant cell within them?

A

Linnks muscle to bone

Predominant cell is fibroblast = produces and maintains collagen

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6
Q

What are the main types of collagen?

A

Type 1 = harder structures (bone, tendons)
Type 2 = softer structures (articular cartilage)
Type 3 = fibrocartilage (used in healing)

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7
Q

What are the two main structures that supply blood to the tendons?

A

Paratenon and synovial sheath

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8
Q

What are some intrinsic causes of tendinopathy?

A

Age, gender, obesity, predisposing diseases (e.g RA), anatomical factors (malalignment, LLD)

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9
Q

What are some extrinsic causes of tendinopathy?

A

Trauma/injury, repetitive injury, drugs (steroids, antibiotics), sports related injury

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10
Q

What causes tendonosis?

A

Histological degeneration of collagen and extracellular matrix = likely due to matrix metalloproteinases (MMPs) which increase with age and repetitive injury

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11
Q

Where does tedonosis usually occur?

A

At areas of poor blood supply = can be present and not painful

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12
Q

What are the conservative management options for tendon problems?

A

Rest and physio (eccentric strengthening)
Analgesia = anti-inflammatories
Injections = not for lower limb, good for rotator cuff
Splinting = Achilles tendon

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13
Q

What are some surgical options for tendon problems?

A

Debridement = removal of diseased tissue
Decompression
Synovectomy = helps to prevent further rupture
Tendon transfer = tib. posterior, EPL

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14
Q

What are some controversial tendon problem treatments?

A

Ultrasound, platelet rich plasma (PRP), surgery

Steroid injection = toxic to tenocytes, physio just as effective in tennis elbow and shoulder impingement

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15
Q

Who tends to suffer from rotator cuff pathology?

A

Athletes = throwing events

Manual workers = painters

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16
Q

What are some signs and symptoms of rotator cuff pathology?

A

Achy pain down arm, difficulty sleeping on affected side, reaching overhead and on lifting, painful arc +/- weakness, positive impingement test

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17
Q

How is rotator cuff pathology managed?

A

Physio, injections, subacromial decompression

18
Q

Where can biceps tendinopathy occur and what may cause it?

A

May be proximal or distal

Causes = overuse, instability, impingement, trauma

19
Q

What are some symptoms of biceps tendinopathy?

A

Pain on anterior shoulder radiating to elbow = aggravated by shoulder flexion, forearm pronation and elbow flexion

20
Q

What may occur if there is subluxation of the biceps tendon?

A

Snapping with shoulder movements

21
Q

What imaging can be done for biceps tendinopathy and how is it treated?

A

Can be diagnosed using USS

Treatment is conservative or surgical (for distal attachment pathology)

22
Q

What are some features of lateral epicondylitis (tennis elbow)?

A

10-20% bilateral, pain and tenderness over lateral epicondyle (origin of extensor tendons of wrist), diagnosed by tests that exacerbate pain, injections may help

23
Q

What are some features of medial epicondylitis (golfer’s elbow)?

A

Medial elbow pain (origin of wrist flexors), caused by repetitive stress, self-limiting, avoid injections (due to ulnar nerve), surgical release is last resort

24
Q

Who gets DeQuervain’s tenosynovitis?

A

More common in women aged 30-50, associated with rheumatoid arthritis

25
Q

How does DeQuervain’s tenosynovitis present?

A

Pain over radial styloid process, occurs in first extensor compartment (APL and EPB), positive Finklestein’s test

26
Q

What investigations can be done for DeQuervain’s tenosynovitis?

A

USS

X-ray = to exclude osteoarthritis of the CMC

27
Q

How is DeQuervain’s tenosynovitis treated?

A

Splinatge, rest, physio, injections, analgesia, surgical decompression

28
Q

What causes extensor tendon rupture in rheumatoid arthritis?

A

Autoimmune attack on synovium causes tendon degeneration and subsequent rupture = causes weakness in wrist or dropped finger

29
Q

How is extensor tendon rupture treated?

A

Can’t repair diseased tendon = tendon transfer

Synovectomy can prevent rupture

30
Q

What are some features of extensor pollicis brevis rupture?

A

Associated with RA and Colles fracture, causes substantial loss of function, requires tendon transfer (EIP)

31
Q

What is the pathogenesis of trigger finger?

A

Stenosing tenosynovitis cause fibrocartilaginous metaplasia, creating a nodule on the FDS tendon = nodule catches on A1 pulley causing triggering

32
Q

How is trigger finger treated?

A

Can occur at any age = observe, may give injection

Surgical release = can only release A1 pulley as cutting too many pulleys causes bowstringing

33
Q

What pathologies may affect the extensor mechanism of the knee?

A

Tendonitis, rupture, traction apophysitis

34
Q

Where does traction apophysitis affect?

A

At tibial tubercle = Osgood-Schlatter’s disease
Insertion at patellar tendon into tibial tuberosity
Can also happen at patella and Achilles

35
Q

How does traction apophysitis present?

A

Leaves prominent bony lump, often occurs in adolescent active boys

36
Q

Who gets a ruptured calcaneal (Achilles) tendon?

A

Middle aged people, caused by sudden acceleration/deceleration (running/squash)
Associated with RA, steroids and tendonitis

37
Q

How does Achilles tendon rupture present?

A

Feels like being shot, palpable gap, unable to tiptoe stand, Simmond’s test positive

38
Q

How can Achilles tendon rupture be imaged, and how is it treated?

A

May be imaged using USS or MRI

Treatment = plaster if early presentation, surgery if late presentation

39
Q

What causes tibialis posterior rupture?

A

Tenosynovitis causes progressive elongation, which leads to eventual rupture, cause is unclear

40
Q

What may a rupture tibialis posterior cause?

A

Leads to progressive flat foot and valgus hindfoot

41
Q

How is a ruptures tibialis posterior treated?

A

NSAIDs, orthotics/cast, injection, debridement, may be helped by tendon transfer

Musculoskeletal (57 decks)

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