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93 Cards in this Set
- Front
- Back
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What is the diffence between a tendon transfre versus a tendon transpositon?
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In a tndon transfre procedure the etndon is detached st its insertion and rlocatded to an ew attachment, whreas a taranspositon involves rerouting the ocurs of a tend without detachment
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Describe a tendon's blood supply
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thre mian sourcs are responsible for providing nourisment to the tnedo
1.muscular branches at he myutendinous junction 2. vessels at the tendo-osseous juncito (periosteum and boen) 3. blod vessels rinnign ni th mesotoen or paraten (tendons als receive ntutrition form lymphatic and synovial fluid) |
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Of the sources of blood supply to a tendion, which supplies hte majorityu of the blood?
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papatenon and mesotenon
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Waht ar the stages in tendon hearlng fro a surgically repaijred tendona?
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Inflammatory (exudative) pahse seen initally in 48-72 hours
fibrfoblastic (formative) phase at begining approximately at day 5 in which collage in is laid down in random fashion remodeling (organizaiton) pahse form 15 to 28 days in whic hcollagen is laed parallel to the tendon |
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Which muscls of hte lower leg are predomantly swing pashe muslces?
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tibalis anterior , extnesor hallucis longus, exnteso digitorum longs,and peroneus teritus
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Aftre primary repair of a tendon, when should hte patin being isometic execisse
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3 weeks
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What is the watrershed area of a tndono
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area of lwo vscualrity of thetnendok, hwich cna be a common ara of ruture
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Ho does the anatomical arrangement of blood supply to thenedon cntribute to weakned ares?
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Of the sources dexcribed, the umculodtendinous nadn tendo-oseous vessels supply theproxima and distal 1/3 of the tendon. Teh apratenon or mesoten supply th mdidle 1/3 . between these reigosn are areas of decreased vascualrity resulting in weakned protion of htenddon
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Which of the tendons that cross the ankle joint lack a synovia tndion sheath?
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achiles tendon and plantaris
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Of thenendos that hav a nynovia tendo sheath in the foot and ankle, whic hsheat extend th most distal
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extnesor hallucis longus synovia tnedion sheath
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Name and dexrib ehte supproting tissue of atneidon that has dircet course form it s orignto insetion
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paratenon - loose elastic areolar tissue that move with the ndon during contracitn
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Describe the cora so fteindon with asynovia tnedon sheat
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antendon that is ubject ot pressure such as on ecoursing benth reinacula or oneo that change directio nro rounds a corner throu a fibro=opssous tunnel
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Which tnds of the foot and ankel shar a comon synovia tendon sheat?
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1. peroneus logn and peroneus brevis
2. extensor digiotum longus and peroneus terius |
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What kindo f defomit must be rpeent for a tendon transfer to effective?
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flexible diefomity in whic hter is as dynoamic muscular imalance.
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What is the naome of themost basic molecue of ateondn
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tropocollagen
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DEscribe the transition fo cedlls a the insertion of tendon in to bone
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collagen fibers to fibrocartilage, which becom calcified and organized into bone.
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Waht ares tarnsigtion fibers ath eh insetion fo tendon in to bone know as ?
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perforatin fibers of sharpy or Sharpey' fiber
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What stuctue of thetendon has been shown to be thwm os t proleferative stuctu in the tendon reapir process?
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epitenon
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Describ ethe sternth of a healing tendon durign the first week status post premary repair.
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The sterngth of healing tendon at this time is no greater than the stuure (usually until 10-14 days)
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What is a tendon callus? when does it form?
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The tendon callus (also know as fibroblastic s;iont) fomrs duign the firstr week of tendon healing. It is a bridge of serous and graulaito tissue (from the inflammatory cell exudates ) tha forms within the perisheath tissue or gap zone
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What acts as a fulcrum for the peroneus longus tendon?
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cuboid
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Can a msucle / tendon be "retraidn " if transferred out of phase?
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yes - ost-op rehab e is imperative
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What tneodn transfer procedure woudl b eindicated for a rgidly plantarflexed first metatarsal?
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none - deformity must be flexible for tendon transfer ot be indicated unless rigid deformity is feixe dprior to tendo procedure
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Whe nperformin maual muscl etesting, at what posiotn must the muscle be placed?
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at its end range of motion
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If a patient can move only agaisnt gravity alone withou resistance, what grade of strenght woudl this be?
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three, fair
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Does a tendon transfer or lenghemng procedure effect the strenght of the tendo involved? explain
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yes p usually it si equal to a los f 1 grade of muscle strneg on manual muscle eamination.
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what if any is the ffect of prolonge dimmbiliztion ithjthe tnedon repair process
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retarded tensile strenght of union as well as increse chance of adhesion.
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What tendon transfer procedure is indicated for spasticity of the tricps surae?
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Murphy - procedure -annterir oadvancment of hte achille stendon.
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What tneodn tranfer coudl be useful n the correction of a hallux varus deformity?
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abductor hallucis tansferred from the medial to lateral sideo fhte hallux (adjucntcvie procedure)
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A patient presents iet ha r=ducible hammertoe deformity of the hallux. what endon procedure cold be idnicatecd?
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jones tendon transfer
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What other procedure would be perfomred wit hte above tnedon transfer and why?
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IPJ fusion - this perfomred ot prevnet hammering ath theIPJ afet trnasfer
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Waht structues msut be preserved at all costs for atndeon to heal proper;ly?
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peritndinous structurees (paraten, mesoten)
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Folowng tnendon reapir, wen shoudl the paitnet be allowed ot have agradual returnto activity?
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4 weeks
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Why is early movemnt essential afte4r atnedo ntarsnfe is performed?
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t prevent long lasting adhesion formation
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Whre is the watershed are fo the achilles tednon?
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2-6 cm proximal to the calcaneal insetion
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What is the graces period for primary repair of a tendon laceration?
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6-8 hours
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Describe the innervation of tendons.
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three type sof nerve endings innervate tendos. Paciniform whic receives touch, golgi tendon orags whci percieve stretch, and free nerve dndings, whic htanmit pain sensation.
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After performin the HIbbs proceure , what (if anything) is done wit hthe distal stumps of the transferrred tendons and why?
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distal stumps ot hte longus tendos are sutrue din thtoe corresponding brevis tendosto allow for activ edorsiflexion fo the toes.
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Desscribe the innervati of thendos.
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Trhee etypes of nerve endings nnervate tendons. Pacindiform whic recevies touch, golgi tindon rognas hwic perceve stretch, and free nerve ndings which tansmit pain sensation.
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Describe the rerouting of hte ntendon in the jones supension preocedure.
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Teh EHL is transected at he IPJ of the hallux and reroute through a medial to a ltaqral drill hle in th head of hte firt metarsal and stured back ono itself dorsally. The distal sutmp of the tendon is attached th o the EHb to maintain some extensor funcito nof hte hallux.
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A paitn with aq dropfoot deformity undregoes a tibialsi psoterior tendon tansfer. Decribe ht phasic activey involve pre and post transwfer
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stance phsae preop to swing phase post op
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Throug waht structure msut the tibialsi posterior tendoin be pssed it nhe above procedure.
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interosseous membrane of the leg
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Wrhe is the tendoesis site for the hibbs procedure?
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BAsde fo tghrid metatrsal or lateral cuneiform
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Wher is the watershed reigo fo thetibials poosterio tendon?
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behind the meidal mallolus
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Waht are the foru typs of peterio tibial tendon rubpure?
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Group 1 isw avulsion of the tendon ususaly 1-2 cm proximial to its navicular insetion. Grou 2 is a midsubstance tear around the mdial malleolus, gorup 2 ins isn continuit9 lognitudina tear without complete rupture, and grop 4 is tenosynovitis wothut visible disrution
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What is the graces period for primary repair of a tendon laceration?
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6-8 hours
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Describe the innervation of tendons.
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three type sof nerve endings innervate tendos. Paciniform whic receives touch, golgi tendon orags whci percieve stretch, and free nerve dndings, whic htanmit pain sensation.
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After performin the HIbbs proceure , what (if anything) is done wit hthe distal stumps of the transferrred tendons and why?
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distal stumps ot hte longus tendos are sutrue din thtoe corresponding brevis tendosto allow for activ edorsiflexion fo the toes.
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Desscribe the innervati of thendos.
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Trhee etypes of nerve endings nnervate tendons. Pacindiform whic recevies touch, golgi tindon rognas hwic perceve stretch, and free nerve ndings which tansmit pain sensation.
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Describe the rerouting of hte ntendon in the jones supension preocedure.
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Teh EHL is transected at he IPJ of the hallux and reroute through a medial to a ltaqral drill hle in th head of hte firt metarsal and stured back ono itself dorsally. The distal sutmp of the tendon is attached th o the EHb to maintain some extensor funcito nof hte hallux.
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A paitn with aq dropfoot deformity undregoes a tibialsi psoterior tendon tansfer. Decribe ht phasic activey involve pre and post transwfer
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stance phsae preop to swing phase post op
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Throug waht structure msut the tibialsi posterior tendoin be pssed it nhe above procedure.
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interosseous membrane of the leg
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Wrhe is the tendoesis site for the hibbs procedure?
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BAsde fo tghrid metatrsal or lateral cuneiform
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Wher is the watershed reigo fo thetibials poosterio tendon?
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behind the meidal mallolus
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Waht are the foru typs of peterio tibial tendon rubpure?
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Group 1 isw avulsion of the tendon ususaly 1-2 cm proximial to its navicular insetion. Grou 2 is a midsubstance tear around the mdial malleolus, gorup 2 ins isn continuit9 lognitudina tear without complete rupture, and grop 4 is tenosynovitis wothut visible disrution
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What is the graces period for primary repair of a tendon laceration?
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6-8 hours
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Describe the innervation of tendons.
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three type sof nerve endings innervate tendos. Paciniform whic receives touch, golgi tendon orags whci percieve stretch, and free nerve dndings, whic htanmit pain sensation.
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After performin the HIbbs proceure , what (if anything) is done wit hthe distal stumps of the transferrred tendons and why?
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distal stumps ot hte longus tendos are sutrue din thtoe corresponding brevis tendosto allow for activ edorsiflexion fo the toes.
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Desscribe the innervati of thendos.
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Trhee etypes of nerve endings nnervate tendons. Pacindiform whic recevies touch, golgi tindon rognas hwic perceve stretch, and free nerve ndings which tansmit pain sensation.
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Describe the rerouting of hte ntendon in the jones supension preocedure.
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Teh EHL is transected at he IPJ of the hallux and reroute through a medial to a ltaqral drill hle in th head of hte firt metarsal and stured back ono itself dorsally. The distal sutmp of the tendon is attached th o the EHb to maintain some extensor funcito nof hte hallux.
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A paitn with aq dropfoot deformity undregoes a tibialsi psoterior tendon tansfer. Decribe ht phasic activey involve pre and post transwfer
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stance phsae preop to swing phase post op
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Throug waht structure msut the tibialsi posterior tendoin be pssed it nhe above procedure.
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interosseous membrane of the leg
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Wrhe is the tendoesis site for the hibbs procedure?
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BAsde fo tghrid metatrsal or lateral cuneiform
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Wher is the watershed reigo fo thetibials poosterio tendon?
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behind the meidal mallolus
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Waht are the foru typs of peterio tibial tendon rubpure?
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Group 1 isw avulsion of the tendon ususaly 1-2 cm proximial to its navicular insetion. Grou 2 is a midsubstance tear around the mdial malleolus, gorup 2 ins isn continuit9 lognitudina tear without complete rupture, and grop 4 is tenosynovitis wothut visible disrution
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Whic tendo lies adjacent ot bone in the fibular groove.
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peroneus brvis.
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When the achilles tendo is rupture, which fibers are mostuauly ruptured first?
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posterior fibers
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Describe the Thompson-Doherty testg
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Used ot test hte integrity of hte achilles tendon . (good for testing total rupture). The patient si prone with his/her foot hangin off the table. The claf is squeezed and the foot is wattched for its reponse. Absence of plantarflexion is a postive test and indcates sever rutpure of the tendon. IF plantarflexion occurs, this is anegative test and indicatesintgegrity of the tendon.
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Would you expect a petient with a total rubpure of the achilles tendon to perfom active plantarflexion? explain
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yes - utilizng hte osteri and lateral muscle gourps.
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What is the strongest part of the msuculoteninous unti?
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tendon
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List some predisposign factors ot rugpure of a tendon.
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corsone injecitonsk, calcification fo tendon, stenosynovits, tendoinits, arhtits, infection, underlying mecdia condition, age, decreased blood supply to tendo, biomcecnical abnormailties, and other dieae preesses of the tendion.
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A patietn presentws with a dorsa medial laceratio fo the foot. describe your clincial exmainatio nto rule out an EHL tendon laceraiton.
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Havea paietn do activ edorsiflexio at he IPJ against resitance. If adysfuincion is presint, IPJ join extensio shou d be lacking. MtJP dorsiflexion woudl still occur beacue of htefruniton EHB
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Waht is the most comon casue of tendon rubpur of the positer tibialis tendon?
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chornic or acute tress ona n already degenrated tendon
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Can an x-ray contribue to the diagnosis of an achilles tendon rubpure? explain
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yes, by examing Kager's triangle whci cna be blunted supreriorly beacus eo retation of the proximal stunmp. Als the appearnce of the traingel may be hcgne as compared to the contarlateral side secondary to swelling and hamatoma.
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What is the arrangement of collagen wiht ia tndon and how does this contibue to the tendon's strenght?
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collange lies in a parallelorientation and g\this give sthetnedon gerat ensile sternght.
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Describe the antaomy of a tendo form is mos tbasic molecuel to the tendon iself
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tropocollage plmeryi into bundle ocalled collagen filament
filaments bundle to form a fibril fibrile bundole ot form a primitive fibe which in tun bundle sto form a fier these fiver bundle ot fom a fscicle. fasiclle are surrounded by aned endotenon these are gathere to form the tndon whic surrounded by the epinotono \ |
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to what dgree doest thw tneodn shteath contribue to tnedon healing
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little if anything
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Are adhesion consdiered a complication of surgery aftre primary tendon rapir? explain
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no adhesion fomation is a normal preces and an itnergarl aprt of he ahealing process. hewerver htey anc abeocm exessiv and imped tendon funtion
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waht are the thwo varialbe taht blix refers to n hsi contgractile forc ecurve?
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tensio versu lenght
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muscle tned to procue theri grates for ce ath what percnta fo theri restin glengh?
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120% of hteri resting lenght
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As muscle shortne , wht ahppensto tnesion the blix congtactile force curve?
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tension decreases
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When surgically apporoximatin the neds of a severe tnedo, whic is thedseire tensoin of hte muscultendou unti
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zero or phyiological tnesion
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at what percentage of a muxle restin glengh is zero teinsio presnt?
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aproximatelyh 60% of theri resting lenght
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How dos the lenght of a lever arm affct force?
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along lever arm will incrae forc - allow form more toque ot be produce
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What i s the nomal ratio of torque prouce by the anter and posteir leg muscle in contrilling foot funcitn
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1:4 (anteior : posteri)
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regarding the aboe ratio hwo is this deicrapjncy offset bomechnically?
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tha nterio lever arm of the rofeoot is ong whic incrases the forc eof hte anterio leg muscls compared ot the shor tlever arm o f thertrcps thogh the psoteri calcaneus
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Waht dos the cross deciotn mss of atndo determine
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strength of force
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Whe nevalusti the ralino ship of jiont axe sth vario sutendons, what dos the oximity fo atendo to ajoint xis determin?
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the poximaty of tendo to jion axis weil dtgermin whcth its for s primaryly stabioling or attory.l The clse ra tendo is to a jonjt axis the more of as tibilzing forc e it wil lhave. the urhgwe qey it is mthe more fo rotatory forc eit wil hav
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If hte tndo synovia shtath is damge or wxide cna itrapir itseorl or generate
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yes p ixison o fhte sheat result in reapir throhg the formation of garunualti ntissue (this tisuse oes nto contriube to no ingterfiw healing of tendon)
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In general what are the ways thatn tendos can be aattache tin a tendo transfer
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ttendo to tnedon, toend ot perostiem and toendon to bon e
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Describe the loaction of a skin inciosn in raltin to atendon when palnning a tendon procere why is it impotnan ot palc ethe insciosn in the is manner
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theinciosn shoudl not be directoy ove rhtendndon. wehdn possible it shoud be mad parale to lac skin line sor elaxe skin tenon line.incion plannin in this maner is mpemativ to minimize the dvelopment of scar tissue whic anc inrefere iwht fee tendon movment
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Descrbie the attachment of the tranfered tejndo fibers ti nht STATT proceudre
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the later fiber so thetibialsi antero are sugture to the peronus teruiou tendon (when presnt) if not presnt the fiber cna be attache to the cuogbie bone laterlly or into the fiber os htpe peroneus brevis tendon
rang eof motin roango mf mito is the key ot hehavilaiton since resotration fo moiton assist all other reabiltiaton parametws |
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What are idnicator sof an athelte \to return to activity
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fulla nd pain free range of miton
normal muscle strengh vs cantralatera side satrfacroy muscualr \endurance correctonof msucle imablances correcton or rectifcatiof o prexistg inbiolmehcni flaw/faluts restoration fo pretctive prociocetpin compeitonof appropriat skinll test per particualr speort evenr |
