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Flashcards in Tendon Growth and Repair Deck (29)
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1

How is the composite unit of the muscle and tendon arranged?

-Muscle origin from bone
-Muscle belly
-Meuscultendinous junction
-Tendon (+/- sesamoid bone, tendon sheath)
-Tendinous insertion into bone (Sharpey's fibres)

2

Describe the structure of tendon.

-Longitudinal arrangement of cells (mostly tenocytes) and fibres (collagen type 1-tirple helix)
-Fascicles of long narrow spiralling collagen bundles

3

How are tendons composed?.

-Collagen bundles covered by endotenon
-Fascicles covered by paratenon
-Tendon covered by epitenon

4

How are tendons attached to tendon sheaths?

Via vinicula

5

What is a tendon sheath?

-A tendon sheath is a layer of synovial membrane with fluid around a tendon
-It permits gliding lubrication and nutrition

6

What do the tendon sheaths in the distal palm and fingers act as?

They are thickenings which form strong annular pulleys

7

What happens if we lose mobility?

There is a reduction in water content and glycosaminoglycan concentration and strength

8

In what ways can tendons be injured?

-Degeneration
-Inflammation
-Enthesiopathy
-Traction apophysitis
-Avulsion +/-bone fragment *
-Tear - intrasubstance (rupture) *
-Tear - musculotendinous junction
-Laceration/ incision
-Crush / ischaemia / attrition
-Nodules

9

Give an example of a tendon prone to degeneration.

Achilles

10

How does Achilles tendon degeneration present?

-Intrasubstance mucoid degeneration
-May be swollen, painful, tender or may be asymptomatic
-Is a precursor to rupture

11

Give an example of a inflammatory condition of the tendons.

De Quervain's stenosing tenovaginitis

12

What tendons are susceptible to de Quervain's stenosing tenovagnitis?

Tendons of EPB + APL passing through common tendon sheath at radial aspect of wrist

13

How does de Quervain's stenosing tenovaginitis present?

-Swollen, tender, hot, red
-Positive Finklestein's test

14

What is enthesiopathy?

-Inflammation at insertion to bone
-Usually at muscle origin rather than tendon insertion

15

What does enthesiopathy present as in ligaments?

Plantar fasciitis

16

Give an example of traction apophysitis.

Osgood Schlatter's disease

17

How does Osgood Schlatter's disease?

-Insertion of patellar tendon into anterior tibial tuberosity
-Adolescent active boys
-Recurrent load
-Inflammation

18

What can avulsion +/- bone fragments result in?

Mallet finger
-Insertion of extensor tendon into dorsum of base of distal phalanx of finger
-Forced flexion of extended finger

19

Why does avulsion +/- bone fragments occur?

-Failure at insertion
-Load exceeding failure strength while muscle contracting

20

How is avulsion treated?

Conservative
-Limited application
-Retraction tendon

Operative
-Reattachment tendon through bone
-Fixation bone fragment

21

Why does intrasubstance rupture occur?

Load exceeds failure strength

22

What are the possible mechanisms of rupture?

-Pushing off with weight bearing 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 plantar flexed foot (10%) e.g. fall from height

23

How does Achilles tendon rupture appear on examination?

-'Positive' Simmond's squeeze test
-Palpable tender gap

24

Where do tears commonly occur of the musculotendinous junction?

Medial head of gastrocnemius at musculotendinous junction with Achilles tendon though often partial

25

How are tendon ruptures treated?

Conservative
-If ends can be opposed: mobilise and splint/cast
-Where healing will occur : not intraarticular

26

When is surgery considered for tendon ruptures?

-High risk rupture
-High activity
-Ends cannot be opposed

27

Where do lacerations commonly occur?

Finger flexors (FDS and FDP)

28

Who do lacerations commonly occur in?

Males> females

29

How are lacerations treated?

Repair surgically and early