42: Achilles Tendon Pathology - Yoho Flashcards Preview

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Flashcards in 42: Achilles Tendon Pathology - Yoho Deck (26)
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1

At heel contact
the ...
knee
ankle
tibial rotation
subtalar motion

- knee is flexing
- ankle is plantarflexing
- tibia is internally rotating
- subtalar motion is pronating

2

*** forefoot varus is related to ...

compensatory calcaneal valgus (STJ pronation)

3

subtalar joint motion

pronation or supination

4

pathologic supination is compensational for. ..

rearfoot varus
forefoot valgus

5

with which achilles pathology are supination and pronation associated?

insertional achilles tendonitis
non-insertion (2-6 cm proximal in watershed zone)

6

why do people over-pronate?

- equinus
- forefoot varus

7

describe achilles tendon anatomy

- dense pliable tissue
- high tensile strength
- noncontractile
- blood supply (less than the tissues around it - decreased blood flow naturally to tendon b/c not contracting)
tissues)

8

most common area of achilles tendon rupture

watershed area

9

paratenon vs. tendon sheath

- paratenon (straight line) *achilles tendon
- tendon sheath (curved line)(fluid filled)
- both are peritendinosus tissues

10

describe the functional anatomy of achilles tendon

- internally rotates to insertion into the os calcis
- watershed zone 2-6 cm proximal to insertion

11

how much blood flow comes through mesotenon?

1/3
- do not deglove the tendon or you will lose this blood supply

12

where is watershed area?

- The vascular status of the Achilles tendon 2-6 cm proximal to the calcaneal insertion increases the vulnerability of tendon to injury.

- Tendon substance derangement exists prior to catastrophic failure

13

non-insertional achilles tendinitis

- peritendinitis
- peritendinitis with tendinosis
- finally rupture

14

risk factors non-insertional achilles tendinitis

- Overuse/poor training habits
- Mechanical imbalances
- Body weight and height
- Pharmaceuticals
- Systemic diseases
- Age (reduces blood glow)
- Genetic predisposition

15

what drugs pose an achilles tendon risk?

fluorquinolones (because can cause vascuilitis)

corticosteriods also (interfere with healing, hide damage)

16

what happens with overuse?

Repetitive and cumulative microtrauma associated with chronic overcharge causes degenerative changes in tendon

- also, disuse atrophy and behavioral habits are risk factors for Achilles tendon rupture

17

top two reasons for non-insertional achilles damaage

overuse and biomechanical issue

18

genetic predisposition for achilles tendon injry

- blood group O dominance
- HLA-B27 factor

19

PE non-insertional achilles tendinitis

- tenderness over achilles tendon
- crepitus of soft tissues
- fusiform swelling of soft tissue
- thickening of soft tissue/nodules
- occasional palpable defect
- equinus
- hyperpronation ( forefoot varus) (pronation beyond 25% stance gait)

20

thompson test

squeeze gastrocsoleus - if not plantarflex might be rupture of tendon

21

Kager's triangle

It is bordered anteriorly by the flexor hallucis longus (FHL) muscle and tendon, posteriorly by the Achilles tendon, and inferiorly by the calcaneus. The anteroinferior corner of the triangle is related to the posterior ankle joint, while posterolaterally it is related to the retrocalcaneal bursa.

22

non-insertional radiographic and ancillary study findings

- soft tissue swelling
- irregularity in kager's triangle
- intratendinous calcification (type III)

23

tendon healing ***

impact
- activation of complement cascade
- platelet aggregation
- cytokines

inflammatory
- cellular infiltration

proliferative
- fibroblasts and collagen production

remodeling
- systematic organization of collagen bundles

24

non-operative tx

- tx inflammation
- physical medicine (eccentric stretching)
- biomechanical (orthotics)

25

surgical tx options non-insertional achilles tendinitis

- Debridement of affected tissues
- Debridement with tendon augmentation
- Tendon transfer

26

calcification of achilles tendon types

Type I:
continuous with calcaneal insertion (microtrauma, biomechanical
related, SNA)

Type II:
insertion zone, separated from the os calcis (ACC, pseudogout)

Type III:
proximal to insertion zone (trauma, post-surgical, Wilson disease, ischemia