Tendon Problems

Question 1

What defines tendinopathy?

Answer 1

Disease of a tendon, tendon related pain

Question 2

What defines tendonitis?

Answer 2

Inflammation of a tendon

Question 3

What defines tendinosis?

Answer 3

Chronic tendon injury with damage to a tendon extracellular matrix

Question 4

What defines tenosynovitis?

Answer 4

Inflammation of a tendon sheath

Question 5

What defines enthesopathy?

Answer 5

Inflammation of the tendon origin or insertion into bone

Question 6

What is the predominant cell in a tendon? What is their function?

Answer 6

Fibroblast: production and maintenance of collagen and and other proteins

Question 7

What is the function of collagen within a tendon?

Answer 7

Confers flexibility and strength

Question 8

90% of a tendon is made up of what type of collagen?

Answer 8

Type 1

Question 9

What is the heirarchial structure of a tendon?

Answer 9

Fibrils divide into sub fibrils which divide into microfibrils

Question 10

What are the 3 blood supplies to tendons?

Answer 10

Perimysium, periosteal insertion, paratenon

Question 11

What is a paratenon?

Answer 11

The tissue occupying the space between a tendon and its sheath

Question 12

Which sex is more likely to be affected by tendon problems?

Answer 12

Males

Question 13

What are some drugs which may predispose to tendon problems?

Answer 13

Steroids, fluoroquinolones (e.g. ciprofloxacin)

Question 14

What causes tendinosis?

Answer 14

Histological degeneration of collagen and extracellular matrix

Question 15

Degeneration of collagen which causes tendinosis occurs as a result of what?

Answer 15

Matrix metalloproteinases which increase with age and repetitive strain

Question 16

Where is tendinosis most likely to occur?

Answer 16

Areas of poor blood supply

Question 17

Is tendinosis always painful?

Answer 17

No, it can be present and not painful

Question 18

What are some general conservative managements for for tendinosis?

Answer 18

Rest, physio, eccentric strengthening, analgesia, anti-inflammatories, injections of local anaesthetic and cortisone

Question 19

LA and cortisone injections are especially useful for what conditions?

Answer 19

Rotator cuff, tennis elbow

Question 20

What are some different surgical managements which can be used for tendinopathies?

Answer 20

Debridement, decompression, synovectomy, tendon transfer

Question 21

What is the purpose of a synovectomy?

Answer 21

Helps to prevent rupture

Question 22

A tendon is often taken from where to be used for tendon transfers? Why?

Answer 22

An extensor tendon of the index fingers since there are two

Question 23

Why are steroid injections controversial for tendinosis?

Answer 23

Steroids are toxic to tenocytes

Question 24

Rotator cuff problems cause a dull, achy pain down the arm. This is referred pain from where?

Answer 24

Axillary nerve

Question 25

What difficulties can patients with rotator cuff problems have?

Answer 25

Difficulty sleeping on the affected side, reaching overhead and lifting

Question 26

Most cases of rotator cuff problems will settle without surgery in how long?

Answer 26

1-2 years

Question 27

What is the gold standard test for imaging of the rotator cuff? What else can be used?

Answer 27

Gold standard is US, MRI can be used to provide more detailed images

Question 28

Which end of the biceps muscle is affected in biceps tendinopathy? Which head is more likely to be affected?

Answer 28

Can be either end, more likely to be the long head

Question 29

Where does most inflammation occur in biceps tendinopathy?

Answer 29

As the long head passes through the bicipital groove anterior to the proximal humerus

Question 30

Inflammation in biceps tendinopathy is usually a result of what?

Answer 30

Friction

Question 31

What can cause biceps tendinopathy?

Answer 31

Overuse, instability, impingement or trauma

Question 32

Where will there typically be pain in biceps tendinopathy? What will make it worse?

Answer 32

Anterior to the shoulder- made worse by flexion of the shoulder and pronation of the forearm

Question 33

What may patients with biceps tendinopathy describe on shoulder movement?

Answer 33

Clicking or snapping sensations

Question 34

What does snapping in biceps tendinopathy imply?

Answer 34

The distal end of the biceps is affected

Question 35

What may be visible on examination of biceps tendinopathy?

Answer 35

Popeye sign and extensive bruising

Question 36

What causes a Popeye deformity in biceps tendinopathy?

Answer 36

The tendon spontaneously ruptures which results in relief of symptoms and a bunched up biceps

Question 37

What is the mainstay of treatment for biceps tendinopathy?

Answer 37

Rest and physiotherapy

Question 38

What surgery may relieve symptoms of biceps tendinopathy? What is the risk?

Answer 38

Surgical division of the tendon: risk of neuromuscular complications, especially when involving the distal end

Question 39

What is the chance of lateral epicondylitis being bilateral?

Answer 39

10-20%

Question 40

What is lateral epicondylitis characterised by?

Answer 40

Pain and tenderness over the lateral epicondyle at the attachment of the forearm extensors

Question 41

When will pain from lateral epicondylitis be worse?

Answer 41

Resisted extension of the middle finger and wrist

Question 42

What does pathology of lateral epicondylitis show?

Answer 42

Micro-tears in the common extensor origin, most likely the origin of ECRB

Question 43

Which out of lateral and medial epicondylitis is inflammatory?

Answer 43

Medial

Question 44

How is epicondylitis (medial or lateral) diagnosed?

Answer 44

Mainly clinical diagnosis, US and MRI can be used

Question 45

Why do lateral and medial epicondylitis occur?

Answer 45

Repetitive strain injury or degenerative enthesopathy

Question 46

Who is more likely to get lateral epicondylitis?

Answer 46

Tennis players, and those who regularly perform resisted extension at the wrist

Question 47

What is the management of lateral epicondylitis?

Answer 47

Self-limiting: rest (avoid the activity which makes it worse), physiological, steroid injections, NSAIDs, brace

Question 48

What is the surgical treatment for lateral epicondylitis? How successful is it?

Answer 48

Division and or excision of some fibres of the common extensor origin. Has variable results.

Question 49

Which is more common, medial or lateral epicondylitis?

Answer 49

Lateral

Question 50

What is medial epicondylitis?

Answer 50

Inflammation of the origin of the flexor forearm muscles

Question 51

Where will there be pain in medial epicondylitis?

Answer 51

Medial elbow, especially over the flexor origins

Question 52

How is medial epicondylitis treated?

Answer 52

Self-limiting: physiology, rest, NSAIDs

Question 53

Why should steroid injections not be used in medial epicondylitis?

Answer 53

Too near the ulnar nerve

Question 54

Some cases of medial epicondylitis may have what associated neurological problems?

Answer 54

Ulnar neuropathy and muscle weakness

Question 55

If there are any neurological symptoms in medial or lateral epicondylitis, what test should be done?

Answer 55

Nerve conduction studies

Question 56

What condition causes extensor tendon rupture?

Answer 56

RA

Question 57

What is an extensor tendon rupture?

Answer 57

An autoimmune attack on the synovium which results in tendon degeneration and rupture

Question 58

What clinical signs will occur in an extensor tendon rupture?

Answer 58

Weakness in wrist extension or a dropped finger

Question 59

In RA extensor tendon rupture, the tendon cannot be repaired. What treatment is used?

Answer 59

Tendon transfer

Question 60

If an RA extensor tendon rupture is caught early, what can prevent it?

Answer 60

Synovectomy

Question 61

What conditions can cause an extensor pollicis longus rupture?

Answer 61

RA or a Colles fracture

Question 62

What occurs with an extensor pollicis longus rupture? What is the treatment?

Answer 62

Substantial loss of function, needs a tendon transfer