Nerve and Tendon Injuries Flashcards
What is a sesamoid bone?
Give a common example
In anatomy, a sesamoid bone is a bone embedded within a tendon or a muscle
Patella
What fibres attach tendons to bone?
Sharpey’s fibres
What are tenocytes?
Elongated fibroblast type cells. The cytoplasm is stretched between the collagen fibres of the tendon. They have a central cell nucleus with a prominent nucleolus. Tendon cells have a well-developed rough endoplasmic reticulum and they are responsible for synthesis and turnover of tendon fibres and ground substance.
What type of collagen makes up the structure of tendons along with tenocytes?
Type 1
Collagen bondles arrange into fascicles which arange into tendon.
What covers these three structures?
Collagen bundles covered by endotenon
Fascicles covered by paratenon
Tendon covered by epitenon
What is a vinculum?
a connecting band of tissue, such as that attaching a flexor tendon to the bone of a finger or toe
Fine network of blood vessels exist in which covering of tendon structure?
Paratenon
covers fascicles
Immobility reduces what in joints?
Water content and glycosaminoglycan concentration and strength
What can cause tendon degeneration over time as we age?
Intrasubstance mucoid degeneration
What are the signs and symptoms of tendon degeneration?
May be swollen
Painful
Tender
May be asymptomatic
?Precursor to rupture
Give an example of tendon inflammation
de Quervain’s stenosing tenovaginitis
What is de Quervain’s stenosing tenovaginitis?
What causes it, What is its presentation, What test can you perform?
Tendons of EPB and APL passing through common tendon sheath at radial aspect of wrist
Swollen, tender, hot and red
Positive Finkelstein’s test
What is Finkelstein’s test?
To perform the test, the examining physician or therapist grasps the thumb and ulnar deviates the hand sharply, as shown in the image. If sharp pain occurs along the distal radius, de Quervain’s tenosynovitis is likely
What is Eichhoff’s test?
Why is Finkelstein’s test used more?
Ask patients to flex their thumb and clench their fist over the thumb before ulnar deviation, but with ulnar deviation performed by the practitioner.
Eichhoff’s test is commonly confused with Finkelstein’s test. However the Eichhoff’s test may produce false positive results, while a Finkelstein’s test performed by a skilled practitioner is unlikely to produce a false positive
Where does enthesiopathy give pain?
Give a common example
More usually at muscle origin rather than tendon insertion
Lateral humeral epicondylitis (tennis elbow)
-Common extensor origin
Give a common example of traction apophysitis
Osgood Schlatter’s disease
What is Osgood Schlatter’s disease?
What is it characterised by?
What are the risk factors?
Osgood–Schlatter disease aka apophysitis of the tibial tubercle, is an inflammation of the patellar ligament at the tibial tuberosity.
It is characterized by a painful bump just below the knee and is most often seen in young adolescents.
Risk factors include overuse (especially in sports involving running, jumping and quick changes of direction) and adolescent growth spurts.
What is Sever’s disease?
How does it present?
Traction apophysitis at insertion of TA into os calcis
(inflammation of the growth plate in the heel of growing children, typically adolescents)
The condition presents as pain in the heel and is caused by repetitive stress to the heel and is thus particularly common in active children.
It usually resolves when the bone has completed growth or activity is lessened.
What is an apophysis?
The apophysis is a normal bony outgrowth that arises from a separate ossification centre and fuses with the bone in course of time. The apophysis is a site of tendon or ligament attachment, as compared to the epiphysis which contributes to a joint.
What is an avulsion fracture?
An avulsion fracture is an injury to the bone in a location where a tendon or ligament attaches to the bone. When an avulsion fracture occurs, the tendon or ligament pulls off a piece of the bone.
Give a common example of avulsion fracture
What is it, What does the effected area look like?
Insertion of extensor tendon into dorsum of base of distal phalanx of finger
Forced flexion of extended finger
How do you treat mallet finger?
Mallet splint
-Immobilises so it can heal
How can you examine an achilles tendon rupture?
“Positive” Simmonds (squeeze) test
-Get them to kneel on chair and squeeze calf -> if foot plantar flexes then tendon ok
Palpable tender gap
What is the mechanism of rupture in achilles tendon tear?
Pushing off with weightbearing forefoot whilst extending knee joint (53%)
-e.g. sprint starts or jumping movements
Unexpected dorsiflexion of ankle (17%)
-e.g. slipping into hole
Violent dorsiflexion of plantarflexed foot (10%)
-e.g. fall from height
