Y5 - Ankle & foot: achilles tendon injury (tendinosis, rupture) Flashcards
what are common tendinopathies
supraspinatus tendon wrist extensors (lateral epicondyle) wrist pronators (medial epidcondylitis) patellar and quadriceps tendon achilles tendon
what tendinopathies are common in athletes
achilles tendon
patella tendon
what tendinopathies are common in the general poulation
achilles tendon lateral epicondyle (wrist extensors)
definition of tendinitis
inflamed and painful tendon
definition of tendinosis
localised intrinsic degeneration of unknown aetiology, characterised by localised swollen tendon nodes
definition of tendinopathy
impaired tendon healing characterised by pain, swelling, and impaired performance
epi
affects millions in athletic and occupational settings, as well as the general population
what are half of sports injuries secondary to
over-use
who does achilles tendinopathy commonly affect
runners
men >30yrs
aetiology
body weight, muscle weakness
repetitive mechanical loading
pathophysiology
mechanical overuse leads to tendon degeneration and change in cell phenotype (increased numbers of round cells which produce more type III collagen instead of type I)
what is the difference between type III and type I collagen
Type III is thinner and less capable of forming bundles
leads to collagen fragmentation and loss of collagen oreintation
how do you rule-out an achilles-tendon rupture
thompson test
- patient is prone
- calf muscles are squeezed
- this should intrinsically plantar flex the foot if the achilles is intact
presenting symptoms
- presence of RFs (athletic training, poor flexibility, muscular imbalances
- insidious onset
- localised tenderness
what is found in later stages of tendinopathy
tendon thickening and nodularity
what treatment may increase the risk of achilles tendinopathy
fluoroquinolones
investigations
clinical diagnosis
what imaging techniques may be used for tendinopathy
ultrasound
MRI
x-ray
what would be observed with a degenerative tendon on ultrasound
normal tendons appear echogenic
degenerative tendons may be thickened, blurred, and may exhibit hypoechoic foci
what is the best imaging modality for tendon injury
MRI
what would be observed with a degenerative tendon on MRI
appears white/grey and thickened
what would be observed on xray with tendon degeneration
calcium deposits in calcific tendonopathy
management
rest & activity modification
ice & NSAIDs
physiotherapy & corticosteroid injections
what is the importance of physiotherapy
to strengthen and stretch
what topical medication may help with tendonopathy?
topical glyceryl trinitrate`
what is the first line treatment for achilles tendinopathy
rest, activity modification with physiotherapy
is diminished dorsiflexion or plantaflexion used to treat achilles tendinopathy
diminished dorsiflexion (with heel lifts)
complications
tendon rupture
prognosis
majority of patients recover with conservative measures
