Tendons and Swellings Flashcards
What is tendinopathy
Disease of a tendon
What is tendonitis
Inflammation
What is tendinosis
Chronic tendon injury with damage to extracellular matrix
No inflammation
What is tenosynovitis
Inflammation of the tendon sheath
What is enthesopathy
Inflammation of the tendon origin or the insertion into bone
What is the function of a tendon
Transmit load from muscle to bone
Enables joint function
What is the composition of a tendon
Water
Collagen - type 1
Proteoglycans
What do fibroblasts do in tendons
Produce collagen and proteoglycan
Do tendons have a good blood supply
No
Many watershed areas that are common sites of pathology
Describe the organisation of a tendon
Microfibrils organise into sub fibrils which organise into fibrils
The fibrils are organised to fascicles which form the tendon unit
What is the endotendon
Layer of connective tissue that surrounds the fascicles
The blood vessels and nerves lie within it
What is the epitenon
outer connective Tissue layer which lies within loose areolar tissue or within tendon sheath.
What intrinsic factors can contribute to tendinopathy
Age - degeneration
Obesity
Existing disease - RA
Malalignment
What extrinsic factors can contribute to tendinopathy
Trauma or injury
Repeated injury
Drugs - steroids and some antibiotics
Sports
List the common treatments for tendon problems
RICE Physio Analgesics - anti-inflammatories Injections Splinting Surgery
What is meant by RICE treatment
Rest
Ice
Compression
Elevation
What soft tissue injuries can you treat with injections
Rotator cuff problems
Tennis elbow
What soft tissue injuries can you not treat with injections
Achilles tendon injury
Injury to extensor knee mechanism
Due to risk of rupture
What surgical procedures may be performed for soft tissue injury
Debridement
Decompression
Synovectomy - prevents rupture
Tendon transfer
What can cause a rotator cuff problem
Overuse of muscle - athletes and manual workers
Age
How do you treat a rotator cuff pathology
Physio
Injections
Surgery only used in severe cases
How do you treat a biceps rupture
Usually conservative (rest and physio) Surgery can be done but is very risky
What is the proper name for tennis elbow
lateral epicondylitis
What causes lateral epicondylitis
Overuse
Overload at the extensor tendon origin
Common in tennis
Common in dominant arm
How does lateral epicondylitis present
Pain and tenderness over lateral epicondyle
Pain with resisted extension of middle finger
How do you treat lateral epicondylitis
Self-limiting
Rest, physio
Steroid injection can help pain
Surgical release in severe cases
What is the proper name for Golfer’s elbow
medial epicondylitis
How does medial epicondylitis present
Medial elbow pain - over origins of wrist flexors
Made worse by wrist flexion and pronation
Due to repetitive stress
How do you treat medial epicondylitis
Self-limiting
Rest, physio, activity modification
Avoid injections as close to ulnar nerve
Surgical debridement is last resort
What is cellulitis
Inflammation and infection of soft tissues
How does cellulitis present
Generalised swelling
Pain
Erythema
How do you manage cellulitis
Rest Elevation Analgesia Splint IV or oral antibiotics - usually flucloxacillin
What is an abscess
Discreet collection of pus
How does an abscess present
Defined swelling
Erythema
Pain
History of trauma
How do you treat an abscess
Surgical incision and drainage
Rest, elevation, analgesia and splint
Antibiotics to follow up
What is septic arthritis
Bacterial infection of a joint
Orthopaedic emergency
Which organisms are common causes of septic arthritis
Staph aureus
Strep
E. coli
How does septic arthritis present
Monoarthropathy Decreased ROM Swelling Systemic upset Raised WCC and inflammatory markers
How do you treat septic arthritis
Urgent ortho review
Aspiration
Urgent washout and debridement - arthroscopic or open
How do ganglia appear
Discreet round swelling
Non-tender
Skin mobile
Where do ganglia typically appear
wrists
feet
knees
What is a Baker’s cyst
Cyst/ganglion in the popliteal fossa
Associated with OA
What is bursitis
Inflammation of the synovium lined sacs that protect bony prominences and joints
(bursae)
How do you differentiate between bursitis and septic arthritis
In bursitis they will still be able to move the joint
What causes rheumatoid nodules
Seen around joints in patients with severe RA
Associated with repetitive trauma
How do you treat rheumatoid nodules
Leave alone
Excise if problematic
What can cause Dupuytren’s disease
Genetic predisposition
Environmental factors - alcohol, diabetes, trauma
Protein expression
How does a giant cell tumour of the tendon sheath present
Slow enlarging
Firm, discreet swelling
May or may not be tendon
Usually on volar aspect of digits
How do you treat giant cell tumours of the tendon sheaths
Leave alone if no functional issue
Surgical excision if getting in the way
What is osteochondroma
Benign bone tumour
Usually occurs near the knee
Growth usually parallels patient
How does osteochondroma present
Painless, hard lump
Symptoms worse with activity
How do you treat osteochondroma
Close observation
Surgical excision
What is Ewings sarcoma
Malignant primary bone tumour of endothelial cells in marrow
Bad prognosis
How does Ewing’s sarcoma present
Hot, swollen and tender joint
Raised inflammatory markers
What does Ewing’s sarcoma present like
Infection
Monoarthropathy
What is a lipoma
Benign neoplastic proliferation of fat
Often subcutaneous
How does a lipoma present
Can be discreet or ill-defined
Slow growing
Painless
Soft movable mass
How do you manage a lipoma
Can be left alone
Surgical excision if causing symptoms
How do sebaceous cysts present
Slow growing
Painless
Discreet
Mobile
Where do sebaceous cysts appear
Face
Neck
Trunk
What is myositis ossificans
Abnormal calcification of a muscle haematoma
Describe the typical history of myositis ossificans
Trauma
Initial soft swelling
Hardness develops over several weeks
