Tendon problems - 02/11/18 Flashcards by K M

What is Tendinopathy?

Disease of a tendon – the best term for tendon related pain

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What is Tendonitis?

Inflammation of a tendon

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What is tendonosis?

Chronic tendon injury with damage to a tendon ECM

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What is tenosynovitis?

Inflammation of the tendon sheath

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What is Enthesopathy?

Inflammation of the tendon origin or the insertion into bone

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What is the function of tendons?

Transmit load from muscle to bone

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What are tendons composed of?

Water
Collagen (Type 1 – 85% of dry weight)
Proteoglycans

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Do tendons have a good blood supply?

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What is the organisation of a tendon?

MicrofibrilsSubfibrilsFibrilsFasciclesTendon unit

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What can cause tendinopathy?

Intrinsic
Age
Gender
Obesity
Pre-disposing diseases e.g Rh A
Anatomical factors
Mal-alignment
LLD
Extrinsic
Trauma / Injury
Repetitive injury
Drugs
Steroids
Antibiotics
Sports related factors

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What are the principles of management of tendinopathy?

Conservative
Rest (R.I.C.E.)
Physio – Eccentric strengthening
Analgesics
Anti-inflammatories
Injections
Rotator cuff
Tennis elbow
NOT Achilles tendon or extensor knee mechanism
Splinting 
Achilles tendon

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What are the surgical managements of tendinopathy?

Surgical
Debridement
Removal of diseased tissue
Decompression
Supraspinatus tendonitis &amp; subacromial decompression
Synovectomy
Helps to prevent rupture
Extensor tendons of wrist (Rhematoid arthritis)
Tibialis posterior
Tendon transfer
Tibialis posterior
Extensor pollicis longus

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What is the pathophysiology of rotator cuff pathology?

Extrinsic compression + Intrinsic degeneration

Inflammation of subacromial bursa

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Who gets rotator cuff pathology?

Athletes

Manual workers

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What are the findings of rotator cuff pathology?

Achy pain down arm
Difficulty sleeping on affected side, reaching overhead & on lifting
Painful arc +/- weakness
Positive impingement tests

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What is the management of rotator cuff pathology?

Conservative – physio, inject

Surgical – subacromial decompression

Which is greater, tendinosis or inflammation?

Tendinosis

What can cause biceps tendinopathy?

Overuse
Instability
Impingement
Trauma

What are the clinical signs of biceps tendinopathy?

Pain anterior shoulder radiating to elbow
Aggravated by shoulder flexion, forearm pronation and elbow flexion
Snapping with shoulder movements if subluxation

What are the investigations for biceps tendinopathy?

Clinical exam

USS

What are the characteristics of lateral epicondylitis?

Overuse injury
Eccentric overload at common extensor tendon origin
Tendinosis and inflammation at ECRB origin
Peritendinous inflammation  angiofibroblastic hyperplasia  breakdown/fibrosis
M:F 1:1
1-3% adult annual incidence
Commonly in dominant arm
10-20% bilateral
Pain and tenderness over the lateral epicondyle
Pain with resisted extension of middle finger
Non-inflammatory
Self-limiting, injections
Surgical release and debridement of ECRB origin

What are the characteristics of medial epicondylitis?

Medial elbow pain
Origin of the wrist flexors
M:F 1:1
5-10 times less common than Tennis elbow
Repetitive stress
Peritendinous inflammation  angiofibroblastic hyperplasia  breakdown/fibrosis
Associated ulnar neuropathy
Self-limiting condition
Avoid injecting – ulnar nerve
Surgical debridement last resort

What are the characteristics of De Quervains tenosynovitis?

Tendon sheath pathology
First extensor compartment 
APL &amp; EPB
Cause unknown. F>M. Pregnancy.
Pain whilst using thumb.
Tender over compartment.
Pain on resisted active thumb extension
Finklestein’s test

What are the investigations for DQT?

USS

X-ray

What is the management for DQT?

``` Splint Rest Physio ANalgesia Injections Surgery ```

What are the characteristics of RA and eTR?

Autoimmune attack on synovium  tendon degeneration  rupture Weakness wrist extension or dropped finger Can’t repair diseased tendon  tendon transfer Synovectomy can prevent

What are the characteristics of Extensor tendon rupture?

Most common hand tendon rupture Occurs a few weeks after typically undisplaced distal radius fractures 1% of all distal radius fracrtures Pathogenesis uncertain but ischaemia plays a role. Watershed area of tendon as it passes around Lister’s tubercle. Fracture haematoma hinders perfusion. Loss of function of thumb extension but not always too big an impact on daily life. May require tendon transfer (EIP)

what are the characteristics of trigger finger?

Stenosing tenosynovitis  fibrocartilaginous metaplasia  nodule FDS tendon Nodule catches on A1 pulley  clicking/locking during ext/flxn. Often most troublesome on waking. Pain and tenderness over tendon sheath at level of MCPJ Can lead to fixed flexion contracture exp in diabetics. Any age (even kids) Observe, inject (cures 70%), surgical release of A1 pulley. Contraindicated in RA as it may exacerbate ulnar drift. Synovectomy preferred.

What are the 3 parts of the knee extensor mechanism?

Tendonitis Rupture Traction apophysitis

What are the characteristics of Quads and patellar tendon?

``` Don’t inject tendonitis Tend to be middle aged Clinical findings: Palpable gap No SLR May be high or low patella on xray Ix: XR, USS, MRI Mx: surgical repair ```

What are the characteristics of Traction apophysitis?

At tibial tubercle = Osgood-Schlatter’s disease insertion of patellar tendon into tibial tuberosity adolescent active boys Leaves prominent bony lump Can also happen at patella & achilles

What are the characteristics of achilles tendon rupture?

``` Common, middle aged Sudden acceleration / deceleration – running / squash Feels like being kicked or shot RhA, steroids, tendonitis Clinical findings: Palpable gap Unable to tiptoe stand Simmonds's test +ve Ix: USS, MRI Mx: plaster vs repair ```

What are the characteristics of tibialis posterior rupture?

Tenosynovitis  progressive elongation  rupture Cause usually unclear Leads to progressive flat foot & valgus hindfoot NSAIDs, Orthotics / cast, inject, debride May be helped by tendon transfer