rupture

Surgical Algorithm

Stage 1 Tendonitis

Non-operative

Walking cast / NSAIDS

- 6/52

UCBL

- 3/12

- worn inside the shoe

- ends under malleoli

- controls the heel (which must be flexible)

- supports the arch

Operative / Synovectomy and debridement

(+/- FDL transfer and calcaneal osteotomy +/- T Achilles lengthening)

Epidemiology

Usually occurs in patients over 60

- due to decreased vascularity & collagen weakness

Younger patient on steroids / growth hormone

Occasionally occurs in young athlete with excessive contracture

Aetiology

Often preceded by quadriceps tendinosis

Epidemiology

Adolescent apophyseal avulsion

- treat non operatively

- unless displaced > 2 cm

Adult

- soft tissue avulsion

Aetiology

Usually associated with sporting activities

- skiing

- water skiing

Violent contraction

- knee extended

- hip flexing

Anatomy

Function

LHB primary function is humeral head depressor

Also accelerate / decelerate arm in overhead sports

Problems

Biceps problems usually occur with other pathology 

- rotator cuff / instability

3 main problems

1.  Degeneration

Complications

1.  Flexor Tendon Rupture

2.  Adhesions

3.  PIPJ contractures

4.  Triggering

5.  Pulley failure

6.  Quadrigia

1.  Flexor Tendon Repair Rupture

Incidence

5%

Management Options

FDS only

Epidemiology

Usually occurs in young people

- often previous history of tendonitis ± steroid injections

Location

Usually at level of inferior pole of patella

- less common at tibial tubercle

- mid-substance ruptures rare

Clinical

Severe pain

Palpable defect

Extensor deficit / unable to SLR

Xray

Patella alta / high riding patella