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58 Cards in this Set
- Front
- Back
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Individual muscle fibers are surrounded by ______ and these are congregated into _______ which are surrounded by ______ & then _______
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Individual muscle fibers surrounded by ENDOMYSIUM, these are congregated into FASSICLES, which are surrounded be PERIMYSIUM and then EPIMYSIUM
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Tendons connect _____ to _____.
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Muscle and bone
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Describe the structure of a tendon.
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Dense, organized connective tissue (Type I collagen)
-arranged in parallel bundles |
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What is the response of a tendon to injury?
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Fibrocytes proliferate and produce collagen that is not arranged in parallel bundles so strength isn't as efficient- series of collagenolysis & repair
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What are the 2 types of tendons?
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1) Vascular
2) Avascular |
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What tendons are vascular? What are 2 examples?
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Muscle or other soft tissue
-e.g. triceps, deep gluteal tendon |
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What tendons are avascular? what are 2 examples?
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Tendon sheath
e.g. digital flexor, biceps tendon |
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What type of tendon has poorer healing?
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Avascular tendons,also when sheath is damaged it heals as a unit forming an adhesion
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What is the function of a tendon?
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Connects muscle to bone
Transmits force to move bone |
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***What is tendinitis?
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Damage or inflammation in tendon itself
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***What is tendinosynovitis?
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Damage within tendon & synovial structure surrounding it
-tendons that go over a joint or take a change in direction (so are in tendon sheath) |
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What is a diagnostic tool used to diagnose tendinosynovitis?
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Ultrasound, will see torn tendon fibers and thickened proliferative synovium
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**What is the definition of tenosynovitis?
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Inflammation in tendon sheath but tendon itself is spared
-tendon fibers are fine -happens in jumping horses in rear legs |
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*What are the 3 phases of tendon healing?
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1) Inflammatory
2) Repair 3) Remodeling |
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**The inflammatory phase of tendon healing occurs between ____-____ days.
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0-4 days
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**The repair phase of tendon healing occurs between ___-____ days.
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4-30 days
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**The remodeling phase of tendon healing occurs between ____--_____ days.
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20-365 days
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What happens during the inflammatory phase of tendon healing?
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-leaky vessels
-leukocytes move in -neutrophils first -then monocytes (become macs) clean debris |
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What occurs during the repair phase of tendon healing?
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-Undifferentiated mesenchymal cells differentiate into fibroblasts
-secrete ground substance & collagen ***Vascular ingrowth |
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What happens during the remodeling phase of tendon healing?
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-Continuous collagen production & collagenolysis
-fibers become oriented parallel (response to stress) |
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Tendon healing depends on what 4 things?
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1) Cause****
2) Location of injury 3) Gap vs. no gap 4) Mobilization vs immobilization |
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What is the most common bowed tendon in horses? What causes this?
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SDF tendon in mid-cannon region
-might be an example of repetitive strain |
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What are 2 types of trauma that can happen to tendons?
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1) Avulsion
-More difficult to heal! 2) Laceration |
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How does **repetitive strain damage tendons?
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Results in thick, weakened, fibrotic tendons if not properly treated
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What are 2 reasons to perform a tenotomy?
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Reduce tension
Provide access to an area |
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What are 2 requirements for successful surgery on tendons?
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Gentle tissue handling
Suture apposition without gap |
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Sometimes steroids are injected into tendons because people think if put an antiinflammatory in it will enhance healing, what's the issue with this?
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Slows down fibroblast and fibrocyte activity--> Decreased strength, decreased healing, necrosis
-effects can last up to 1 year |
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Compare the healing capabilities amongst the different locations of tendon damage: avulsion, myotendinous junction, mid-tendon.
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Avulsion is the hardest to heal!
Myotendinous junction: heals best bc of blood supply |
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What are the advantages of a tendon that heals with no gaps?
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Takes less time and heals w/ less scar tissue (or w/o)
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For tendon healing to progress without a detrimental scar a gap of no more than __-____ mm can be present in small animals.
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1-3 mm
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How do you eliminate a gap when performing tendon repair?
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-Pulley sutures
-Taking tendon from other areas -Special sutures that act as a scaffold |
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When repairing a tendon and trying to eliminate a gap, how do you want the leg positioned?
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In extension to minimize the gap, then need to keep it that way bc no suture is strong enough
-also immobilize leg |
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Is a tendon gap more tolerated in horses or large animal species?
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Not more tolerated in horses, but its a more common situation where you have to leave significant gaps
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What TYPE of suture do you want to use for tendon repair? What are some examples?
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-inelastic suture
-monofilament -nonabsorbable (usually) -Nylon, polypropylene |
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What SIZE of suture do you want to use for tendon repair in small animals? Large animals?
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SA: 2-0 or larger
LA: No 2 or greater |
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What are 3 suture patterns that are appropriate for tendon repair?
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1) 3-loop-pulley
2) Locking loop 3) Krackow (SA) **Look at patterns, question: draw one method of repair |
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What is the strongest, most physiologic suture pattern used for tendon repair?
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3-loop-pulley= "da bomb"
-most physiologic w/ regards to being less damaging to the tendon and has less potential for healing problems |
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Describe a 3-loop-pulley.
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Near-far, middle-middle, far-near
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When is the locking-loop pattern preferred for tendon repair?
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Better for sheathed tendon, flat tendons
-Not as strong as 3-loop pulley -2 locked loop pattern -Use a lot in LA |
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When do we like to use the Krackow suture pattern for tendon repair? what is the pattern?
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For flat tendons
-ford interlocking at each end |
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Why is it so crucial to immobilize a limb when performing a tendon repair?
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The joint (or limb) must be immobilized or the stress placed on the repaired tendon during weight- bearing will be too great resulting in failure of repair
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What are some ways to immobilize the limb after tendon repair?
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Heavy bandage
Cast Bandage cast Joint fixation w/ implants |
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****How do you want to immobilize and injured flexor tendon? Extensor tendon?
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-Injured flexor tendons: immobilize in flexion
-Injured extensor tendons: immobilize in extension |
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How long should a limb be immobilized after tendon repair?
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Controlled tension across teh wound will orient healig fibers
so immobilize 3-6* weeks -limited activity at 6 wks, unlimited activity after 6mo-1 yr |
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What is the tensile strength of a tendon 6-weeks post-op?
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Tendon has 56% the tensile strength of a normal tendon
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What is the tensile strength of a tendon 1 year post op?
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Tendon has 79% of the tensile strength of a normal tendon
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What is a desmotomy?
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Cutting a ligament
e.g. check desmotomy means doing check ligament desmotomy |
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What is the definition of a ligament?
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Band of pure collagenous tissue that unites two or more bones
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What type of fibers make up a ligament?
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Long parallel or spiral collagenous fibers w/ some yellow elastic fibers
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What is the function of ligaments?
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Preserve integrity of joints
-may be intracapsular or extracapsular |
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What usually causes damage to ligaments?
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Typically trauma
-may result from degenerative changes (CCL) |
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What usually causes damage to ligaments?
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Typically trauma
-may result from degenerative changes (CCL) |
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What dictates the effects of ligament loss?
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location/function of ligament
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What dictates the effects of ligament loss?
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location/function of ligament
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What do you call inflammation of a ligament?
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Desmitis
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What do you call inflammation of a ligament?
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Desmitis
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Describe the characteristics of ligament healing.
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Slow, poor, minimal strength
- "replace" ligaments w/ other tissue/ prosthesis |
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Describe the characteristics of ligament healing.
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Slow, poor, minimal strength
- "replace" ligaments w/ other tissue/ prosthesis |
