Tendon Problems

Question 1

what percentage of MSK complaints are tendon related

Answer 1

30%

Question 2

what is tendinopathy?

Answer 2

disease of a tendon

term for tendon related pain

Question 3

what is tendonitis?

Answer 3

inflammation of a tendon

Question 4

what is tendonosis?

Answer 4

chronic tendon injury with damage to a tendon’s ECM

Question 5

what is tenosynovitis?

Answer 5

inflammation of the tendon sheath

Question 6

what is an enthesopathy?

Answer 6

inflammation of the tendon origin or insertion into bone

Question 7

what would you see on histology of tendon problems?

Answer 7

nothing

Question 8

which 2 tendon problems are notorious for not having any signs on histology?

Answer 8

tennis elbow

golfers elbow

Question 9

what is the function of a tendon?

Answer 9

link muscle to motor unit to enable joint function

Question 10

predominant cell in tendons?

Answer 10

fibroblast

Question 11

what do fibroblasts do?

Answer 11

produce and maintain collagen + other proteins

Question 12

what is the main component of a tendon?

Answer 12

type 1 collagen

Question 13

name some intrinsic factors that cause tendon problems?

Answer 13

age
gender
obesity
comorbidities eg RA

Question 14

extrinsic factors that cause tendon problems?

Answer 14

trauma
repetitive trauma
steroids
fluoroquinolones eg cipro
sports

Question 15

what happens in tendinosis?

Answer 15

degeneration of collagen and ECM

Question 16

what causes the degradation in tendinosis?

Answer 16

matrix metallinoprteinases

Question 17

is tendonosis always painful?

Answer 17

no, but can be painful in some

Question 18

most common areas to get tendinosis?

Answer 18

areas of poor blood supply

Question 19

analgesics of choice for managing tendon problems?

Answer 19

NSAIDs

Question 20

what tendon problem in the lower limb is usually treated by splinting?

Answer 20

Achilles tendonitis

Question 21

main treatment pathway for soft tissue inflammatory problems?

Answer 21

rest
NSAIDs
steroid injections

Question 22

surgical treatment of chouce for supraspinatus tendonitis?

Answer 22

decompression

Question 23

why would you do a synovectomy in tendon problems?

Answer 23

prevents rupture

Question 24

most common rotator cuff to become affected?

Answer 24

supraspinatous

Question 25

clinical presentation of rotator cuff pathology?

Answer 25

dull achy pain in upper arm that gradually increases

Question 26

why do patients with rotator cuff pathology feel pain down their arm?

Answer 26

shoulder pain refers to axillary dermatome

Question 27

examination findings of someone with rotator cuff pathology

Answer 27

tenderness around GH and AC joint painful arc rotator cuff weakness +ve impingement tests eg Hawkins kennedy, jobe's, scarf test

Question 28

treatment for rotator cuff pathology?

Answer 28

``` 3 months physio steroid injections (at least 2 before going to surgery) ```

Question 29

biggest muscle of the rotator cuff?

Answer 29

subscapularis

Question 30

where does the supraspinatus run?

Answer 30

above clavicle and sits between acromion and humerus

Question 31

gold standard imaging for rotator cuff

Answer 31

USS

Question 32

2 types of biceps tendinopathy?

Answer 32

distal | proximal

Question 33

clinical presentation of biceps tendinopathy?

Answer 33

pain in anterior shoulder radiating to elbow ; get clicking/snapping sensations

Question 34

what movements aggravate a biceps tendinopathy?

Answer 34

shoulder flexion forearm pronation elbow flexion

Question 35

investigations for biceps tendinopathy?

Answer 35

USS

Question 36

clinical signs of biceps rupture?

Answer 36

popeye sign

Question 37

treatment for biceps rupture?

Answer 37

rest | physio

Question 38

is tennis elbow predominantly bilateral or unilateral?

Answer 38

unilateral

Question 39

clinical presentation of tennis elbow?

Answer 39

pain/tenderness of lateral epicondyle with resisted extension of middle finger

Question 40

is tennis elbow inflammatory?

Answer 40

no

Question 41

is mill's test +ve or -ve for tennis elbow?

Answer 41

+ve

Question 42

treatment for tennis and golfers elbow?

Answer 42

``` rest physio injection of LA and steroids orthotics surgical release for refractory cases ```

Question 43

is golfers elbow inflammatory?

Answer 43

yes

Question 44

golfers elbow clinical presentation?

Answer 44

medial elbow pain that is especially tender over origin of flexor of medial epicondyle

Question 45

what movements make golfers elbow worse?

Answer 45

wrist flexion/pronation | grasping

Question 46

most common causes of dequervain's tenosynovitis?

Answer 46

repetitive use of the wrist and radial styloid process eg gaming, texting

Question 47

how to examine for de quervain's tenosynovitis?

Answer 47

finkelsteins test: grip thumb in palm of hand and ulnar deviate

Question 48

investigations for dequervains?

Answer 48

USS | X ray

Question 49

why is an x ray done in de quervains?

Answer 49

can mimic OA so its to rule it out

Question 50

treatment for dequervains?

Answer 50

``` splint rest physio NSAIDs steroid injection surgical decompression ```

Question 51

cause of an extensor tendon rupture in RA?

Answer 51

autoimmune attack on synovium causes tendon degeration until it ruptures

Question 52

treatment for extensor tendon rupture?

Answer 52

tendon transfer

Question 53

clinical presentation of extensor tendon rupture?

Answer 53

weakness in wrist extension | dropped finger

Question 54

common comorbidities that could cause an EPL rupture?

Answer 54

RA | colles fracture

Question 55

treatment for EPL rupture?

Answer 55

tendon transfer

Question 56

why is the EPL prone to injury?

Answer 56

has a tortuous route

Question 57

what makes up the extensor mechanism of the knee?

Answer 57

quadriceps muscle quadriceps tendon patella patellar tendon

Question 58

features on clinical examination of a tendon rupture in the extensor mechanism of the knee?

Answer 58

palpable gap | no straight leg raise

Question 59

can you inject the lower limb with steroids?

Answer 59

no

Question 60

investigations for kne extensor mechanism tendon rupture?

Answer 60

x ray for effusion/displacement | USS/MRI for tear

Question 61

treatment for tendon rupture in knee extensor mechanism?

Answer 61

surgical | increase in ROM post op

Question 62

what is an apophysis?

Answer 62

growing bone has tendon on side rather than bone

Question 63

pathology behind Osgood schlatters?

Answer 63

traction apophysitis AT TIBIAL TUBERCLE

Question 64

who gets Osgood schlatters?

Answer 64

teenage boys

Question 65

clinical presentation of Osgood schlatters

Answer 65

bony prominent lump at tibial tuberosity or sometimes patella/achilles

Question 66

what does Achilles tendon rupture feel like?

Answer 66

kicked shot

Question 67

examination presentation of Achilles tendon rupture?

Answer 67

palpable gap unable to tip toe positive ismmonds test

Question 68

what is Simmonds tets?

Answer 68

squeeze gastrocnemius over Achilles tendon

Question 69

investigation for Achilles tendon rupture?

Answer 69

USS | MRI

Question 70

treatment for Achilles tendon rupture?

Answer 70

plaster | repair

Question 71

pathology behind tibialis posterior rupture?

Answer 71

tenosynovitis causes progressive elongation of muscle until it ruptures

Question 72

what condition can tibialis posterior dysfunction commonly cause?

Answer 72

flat feet

Question 73

how to test for flat feet?

Answer 73

look at patient from behind, if more than 1 toe visible = flat feet

Question 74

treatment for tib posterior rupture?

Answer 74

NSAIDs cast inject debride