Y5 - Ankle & foot: achilles tendon injury (tendinosis, rupture)

Question 1

what are common tendinopathies

Answer 1

supraspinatus tendon
wrist extensors (lateral epicondyle)
wrist pronators (medial epidcondylitis)
patellar and quadriceps tendon
achilles tendon

Question 2

what tendinopathies are common in athletes

Answer 2

achilles tendon

patella tendon

Question 3

what tendinopathies are common in the general poulation

Answer 3

achilles tendon
lateral epicondyle (wrist extensors)

Question 4

definition of tendinitis

Answer 4

inflamed and painful tendon

Question 5

definition of tendinosis

Answer 5

localised intrinsic degeneration of unknown aetiology, characterised by localised swollen tendon nodes

Question 6

definition of tendinopathy

Answer 6

impaired tendon healing characterised by pain, swelling, and impaired performance

Question 7

epi

Answer 7

affects millions in athletic and occupational settings, as well as the general population

Question 8

what are half of sports injuries secondary to

Answer 8

over-use

Question 9

who does achilles tendinopathy commonly affect

Answer 9

runners

men >30yrs

Question 10

aetiology

Answer 10

body weight, muscle weakness

repetitive mechanical loading

Question 11

pathophysiology

Answer 11

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)

Question 12

what is the difference between type III and type I collagen

Answer 12

Type III is thinner and less capable of forming bundles

leads to collagen fragmentation and loss of collagen oreintation

Question 13

how do you rule-out an achilles-tendon rupture

Answer 13

thompson test

• patient is prone
• calf muscles are squeezed
• this should intrinsically plantar flex the foot if the achilles is intact

Question 14

presenting symptoms

Answer 14

• presence of RFs (athletic training, poor flexibility, muscular imbalances
• insidious onset
• localised tenderness

Question 15

what is found in later stages of tendinopathy

Answer 15

tendon thickening and nodularity

Question 16

what treatment may increase the risk of achilles tendinopathy

Answer 16

fluoroquinolones

Question 17

investigations

Answer 17

clinical diagnosis

Question 18

what imaging techniques may be used for tendinopathy

Answer 18

ultrasound
MRI
x-ray

Question 19

what would be observed with a degenerative tendon on ultrasound

Answer 19

normal tendons appear echogenic

degenerative tendons may be thickened, blurred, and may exhibit hypoechoic foci

Question 20

what is the best imaging modality for tendon injury

Answer 20

MRI

Question 21

what would be observed with a degenerative tendon on MRI

Answer 21

appears white/grey and thickened

Question 22

what would be observed on xray with tendon degeneration

Answer 22

calcium deposits in calcific tendonopathy

Question 23

management

Answer 23

rest & activity modification
ice & NSAIDs
physiotherapy & corticosteroid injections

Question 24

what is the importance of physiotherapy

Answer 24

to strengthen and stretch

Question 25

what topical medication may help with tendonopathy?

Answer 25

topical glyceryl trinitrate`

Question 26

what is the first line treatment for achilles tendinopathy

Answer 26

rest, activity modification with physiotherapy

Question 27

is diminished dorsiflexion or plantaflexion used to treat achilles tendinopathy

Answer 27

diminished dorsiflexion (with heel lifts)

Question 28

complications

Answer 28

tendon rupture

Question 29

prognosis

Answer 29

majority of patients recover with conservative measures