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Tendon Injuries and Disorders |
What Are the Causes of Tendinitis and Ruptured Tendons?
Knee tendon injuries range from tendinitis (inflammation of a tendon) to a ruptured (torn) tendon. If a person overuses a tendon during certain activities such as dancing, cycling, or running, the tendon stretches like a worn-out rubber band and becomes inflamed. Movements such as trying to break a fall may cause excessive contraction of the quadriceps muscles and tear the quadriceps tendon above the patella or the patellar tendon below the patella. This type of injury is most likely to happen in older people whose tendons tend to be weaker. Tendinitis of the patellar tendon is sometimes called jumper's knee. This is because in sports requiring jumping, such as basketball, the muscle contraction and force of hitting the ground after a jump strain the tendon. The tendon may become inflamed or tear after repeated stress.
What Are the Symptoms of Tendon Injuries? How Are Injuries Diagnosed?
People with tendinitis often have tenderness at the point where the patellar tendon meets the bone. They also may feel pain during faster movements, such as running, hurried walking, or jumping. A complete rupture of the quadriceps or patellar tendon is not only painful but also makes it difficult for a person to bend, extend, or lift the leg against gravity. If there is not much swelling, the doctor will be able to feel a defect in the tendon near the tear during a physical examination. An x ray will show that the patella is lower in position than normal in a quadriceps tendon tear and higher than normal in a patellar tendon tear. The doctor may use an MRI to confirm a partial or total tear.
How Are Knee Tendon Injuries Treated?
Initially, the doctor may ask a patient with tendinitis to rest, elevate, and apply ice to the knee and to take medicines such as aspirin or ibuprofen to relieve pain and decrease inflammation and swelling. If the quadriceps or patellar tendon is completely ruptured, a surgeon will reattach the ends. After surgery, the patient will wear a cast for 3 to 6 weeks and use crutches. If the tear is only partial, the doctor might apply a cast without performing surgery.
A partial or complete tear of a tendon requires an exercise program as part of rehabilitation that is similar to but less vigorous than that prescribed for ligament injuries. The goals of exercise are to restore the ability to bend and straighten the knee and to strengthen the leg to prevent a repeat knee injury. A rehabilitation program may last 6 months, although the patient can return to many activities before then.
What Are the Causes of Osgood-Schlatter Disease?
Osgood-Schlatter disease is caused by repetitive stress or tension on a part of the growth area of the upper tibia (the apophysis). It is characterized by inflammation of the patellar tendon and surrounding soft tissues at the point where the tendon attaches to the tibia. The disease may also be associated with an avulsion injury, in which the tendon is stretched so much that it tears away from the tibia and takes a fragment of bone with it. The disease most commonly affects active young people, particularly boys between the ages of 10 and 15, who play games or sports that include frequent running and jumping.
What Are the Symptoms of Osgood-Schlatter Disease? How Is It Diagnosed?
People with this disease experience pain just below the knee joint that usually worsens with activity and is relieved by rest. A bony bump that is particularly painful when pressed may appear on the upper edge of the tibia (below the knee cap). Usually, motion of the knee is not affected. Pain may last a few months and may recur until a child's growth is completed.
Osgood Schlatter disease is most often diagnosed by the symptoms. An x ray may be normal, or show an avulsion injury, or, more typically, show that the apophysis is in fragments.
How Is Osgood-Schlatter Disease Treated?
Usually, the disease disappears without treatment. Applying ice to the knee when pain first begins helps relieve inflammation and is sometimes used along with stretching and strengthening exercises. The doctor may advise the patient to limit participation in vigorous sports. Children who wish to continue participating in moderate or less stressful sports may need to wear knee pads for protection and apply ice to the knee after activity. If a great deal of pain is felt during sports activities, participation may be limited until any remaining discomfort is tolerable.
What Causes Iliotibial Band Syndrome?
This is an overuse inflammatory condition due to friction (rubbing) of a band of a tendon over the outer bone (lateral condyle) of the knee. Although iliotibial band syndrome may be caused by direct injury to the knee, it is most often caused by the stress of long-term overuse, such as sometimes occurs in sports training.
What Are the Symptoms of Iliotibial Band Syndrome and How Is It Diagnosed?
A person with this syndrome feels an ache or burning sensation at the side of the knee during activity. Pain may be localized at the side of the knee or radiate up the side of the thigh. A person may also feel a snap when the knee is bent and then straightened. Swelling is usually absent and knee motion is normal. The diagnosis of this disorder is usually based on the patient's symptoms, such as pain at the lateral condyle, and exclusion of other conditions with similar symptoms.
How Is Iliotibial Band Syndrome Treated?
Usually, iliotibial band syndrome disappears if the person reduces activity and performs stretching exercises followed by muscle-strengthening exercises. In rare cases when the syndrome doesn't disappear, surgery may be necessary to split the tendon so it is not stretched too tightly over the bone.
What Is Osteochondritis Dissecans?
Osteochondritis dissecans results from a loss of the blood supply to an area of bone underneath a joint surface and usually involves the knee. The affected bone and its covering of cartilage gradually loosen and cause pain. A person with this disruption of the joint may eventually develop osteoarthritis. This disorder usually arises spontaneously in an active adolescent or a young adult. It may be due to a slight blockage of a small artery or to an unrecognized injury or tiny fracture that damages the overlying cartilage.
The bone undergoes avascular necrosis (degeneration from lack of a blood supply). 2 The involvement of several joints or the appearance of osteochondritis dissecans in several family members may indicate that the disorder is inherited.
What Are the Symptoms of Osteochondritis Dissecans? How Is It Diagnosed?
If spontaneous healing doesn't occur, cartilage eventually separates from the diseased bone and a fragment breaks loose into the knee joint, causing locking of the joint, weakness, and sharp pain. An x ray, MRI, or arthroscopy can determine the condition of the cartilage and be used to diagnose osteochondritis dissecans.
How Is Osteochondritis Dissecans Treated?
If cartilage fragments have not broken loose, a surgeon may fix them in place with pins or screws that are sunk into the cartilage to stimulate a new blood supply. If fragments are loose, the surgeon may scrape down the cavity to reach fresh bone and add a bone graft and fix the fragments in position. Fragments that cannot be mended are removed, and the cavity is drilled or scraped to stimulate new growth of cartilage. Research is currently being done to assess the use of cartilage cell transplants and other tissues to treat this disorder.
Plica (pronounced PLI-KAH) syndrome occurs when plicae (bands of remnant synovial tissue) are irritated by overuse or injury. Synovial plicae are remnants of tissue pouches found in the early stages of fetal development. As the fetus develops, these pouches normally combine to form one large synovial cavity. If this process is incomplete, plicae remain as four folds or bands of synovial tissue within the knee. Injury, chronic overuse, or inflammatory conditions are associated with development of this syndrome.
What Are the Symptoms of Plica Syndrome? How Is It Diagnosed?
People with this syndrome are likely to experience pain and swelling, a clicking sensation, and locking and weakness of the knee. Because the symptoms are similar to symptoms of some other knee problems, plica syndrome is often misdiagnosed. Diagnosis usually depends on the exclusion of other conditions that cause similar symptoms.
How Is Plica Syndrome Treated?
The goal of treatment is to reduce inflammation of the synovium and thickening of the plicae. The doctor usually prescribes medicine such as ibuprofen to reduce inflammation. The patient is also advised to reduce activity, apply ice and compression wraps (elastic bandage) to the knee, and do strengthening exercises. If this treatment program fails to relieve symptoms within 3 months, the doctor may recommend arthroscopic or open surgery to remove the plicae. A cortisone injection into the region of the plica folds helps about half of the patients treated. The doctor can also use arthroscopy to confirm the diagnosis and treat the problem.
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