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MSK > Tendons and Swellings > Flashcards

Tendons and Swellings Flashcards

1
Q

What is tendinopathy

A

Disease of a tendon

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2
Q

What is tendonitis

A

Inflammation

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3
Q

What is tendinosis

A

Chronic tendon injury with damage to extracellular matrix

No inflammation

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4
Q

What is tenosynovitis

A

Inflammation of the tendon sheath

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5
Q

What is enthesopathy

A

Inflammation of the tendon origin or the insertion into bone

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6
Q

What is the function of a tendon

A

Transmit load from muscle to bone

Enables joint function

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7
Q

What is the composition of a tendon

A

Water
Collagen - type 1
Proteoglycans

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8
Q

What do fibroblasts do in tendons

A

Produce collagen and proteoglycan

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9
Q

Do tendons have a good blood supply

A

No

Many watershed areas that are common sites of pathology

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10
Q

Describe the organisation of a tendon

A

Microfibrils organise into sub fibrils which organise into fibrils
The fibrils are organised to fascicles which form the tendon unit

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11
Q

What is the endotendon

A

Layer of connective tissue that surrounds the fascicles

The blood vessels and nerves lie within it

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12
Q

What is the epitenon

A

outer connective Tissue layer which lies within loose areolar tissue or within tendon sheath.

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13
Q

What intrinsic factors can contribute to tendinopathy

A

Age - degeneration
Obesity
Existing disease - RA
Malalignment

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14
Q

What extrinsic factors can contribute to tendinopathy

A

Trauma or injury
Repeated injury
Drugs - steroids and some antibiotics
Sports

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15
Q

List the common treatments for tendon problems

A 
RICE 
Physio 
Analgesics - anti-inflammatories 
Injections 
Splinting 
Surgery
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16
Q

What is meant by RICE treatment

A

Rest
Ice
Compression
Elevation

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17
Q

What soft tissue injuries can you treat with injections

A

Rotator cuff problems

Tennis elbow

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18
Q

What soft tissue injuries can you not treat with injections

A

Achilles tendon injury
Injury to extensor knee mechanism
Due to risk of rupture

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19
Q

What surgical procedures may be performed for soft tissue injury

A

Debridement
Decompression
Synovectomy - prevents rupture
Tendon transfer

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20
Q

What can cause a rotator cuff problem

A

Overuse of muscle - athletes and manual workers

Age

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21
Q

How do you treat a rotator cuff pathology

A

Physio
Injections
Surgery only used in severe cases

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22
Q

How do you treat a biceps rupture

A 
Usually conservative (rest and physio) 
Surgery can be done but is very risky
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23
Q

What is the proper name for tennis elbow

A

lateral epicondylitis

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24
Q

What causes lateral epicondylitis

A

Overuse
Overload at the extensor tendon origin
Common in tennis
Common in dominant arm

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25
Q

How does lateral epicondylitis present

A

Pain and tenderness over lateral epicondyle

Pain with resisted extension of middle finger

26
Q

How do you treat lateral epicondylitis

A

Self-limiting
Rest, physio
Steroid injection can help pain
Surgical release in severe cases

27
Q

What is the proper name for Golfer’s elbow

A

medial epicondylitis

28
Q

How does medial epicondylitis present

A

Medial elbow pain - over origins of wrist flexors
Made worse by wrist flexion and pronation
Due to repetitive stress

29
Q

How do you treat medial epicondylitis

A

Self-limiting
Rest, physio, activity modification
Avoid injections as close to ulnar nerve
Surgical debridement is last resort

30
Q

What is cellulitis

A

Inflammation and infection of soft tissues

31
Q

How does cellulitis present

A

Generalised swelling
Pain
Erythema

32
Q

How do you manage cellulitis

A 
Rest
Elevation 
Analgesia 
Splint 
IV or oral antibiotics - usually flucloxacillin
33
Q

What is an abscess

A

Discreet collection of pus

34
Q

How does an abscess present

A

Defined swelling
Erythema
Pain
History of trauma

35
Q

How do you treat an abscess

A

Surgical incision and drainage
Rest, elevation, analgesia and splint
Antibiotics to follow up

36
Q

What is septic arthritis

A

Bacterial infection of a joint

Orthopaedic emergency

37
Q

Which organisms are common causes of septic arthritis

A

Staph aureus
Strep
E. coli

38
Q

How does septic arthritis present

A 
Monoarthropathy
Decreased ROM 
Swelling 
Systemic upset 
Raised WCC and inflammatory markers
39
Q

How do you treat septic arthritis

A

Urgent ortho review
Aspiration
Urgent washout and debridement - arthroscopic or open

40
Q

How do ganglia appear

A

Discreet round swelling
Non-tender
Skin mobile

41
Q

Where do ganglia typically appear

A

wrists
feet
knees

42
Q

What is a Baker’s cyst

A

Cyst/ganglion in the popliteal fossa

Associated with OA

43
Q

What is bursitis

A

Inflammation of the synovium lined sacs that protect bony prominences and joints
(bursae)

44
Q

How do you differentiate between bursitis and septic arthritis

A

In bursitis they will still be able to move the joint

45
Q

What causes rheumatoid nodules

A

Seen around joints in patients with severe RA

Associated with repetitive trauma

46
Q

How do you treat rheumatoid nodules

A

Leave alone

Excise if problematic

47
Q

What can cause Dupuytren’s disease

A

Genetic predisposition
Environmental factors - alcohol, diabetes, trauma
Protein expression

48
Q

How does a giant cell tumour of the tendon sheath present

A

Slow enlarging
Firm, discreet swelling
May or may not be tendon
Usually on volar aspect of digits

49
Q

How do you treat giant cell tumours of the tendon sheaths

A

Leave alone if no functional issue

Surgical excision if getting in the way

50
Q

What is osteochondroma

A

Benign bone tumour
Usually occurs near the knee
Growth usually parallels patient

51
Q

How does osteochondroma present

A

Painless, hard lump

Symptoms worse with activity

52
Q

How do you treat osteochondroma

A

Close observation

Surgical excision

53
Q

What is Ewings sarcoma

A

Malignant primary bone tumour of endothelial cells in marrow
Bad prognosis

54
Q

How does Ewing’s sarcoma present

A

Hot, swollen and tender joint

Raised inflammatory markers

55
Q

What does Ewing’s sarcoma present like

A

Infection

Monoarthropathy

56
Q

What is a lipoma

A

Benign neoplastic proliferation of fat

Often subcutaneous

57
Q

How does a lipoma present

A

Can be discreet or ill-defined
Slow growing
Painless
Soft movable mass

58
Q

How do you manage a lipoma

A

Can be left alone

Surgical excision if causing symptoms

59
Q

How do sebaceous cysts present

A

Slow growing
Painless
Discreet
Mobile

60
Q

Where do sebaceous cysts appear

A

Face
Neck
Trunk

61
Q

What is myositis ossificans

A

Abnormal calcification of a muscle haematoma

62
Q

Describe the typical history of myositis ossificans

A

Trauma
Initial soft swelling
Hardness develops over several weeks

MSK (21 decks)

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