In combined tendon and nerve injuries, the preferred sequence of repair is:

Nerves should be repaired before tendons

Tendons should be repaired before nerves

Tendons should not be repaired simultaneously with nerves

Ulnar collateral ligament injury

Finkelstein's test is done for diagnosis of:

Trigger finger (stenosing tenosynovitis)

A 40-year-old man was repairing his wooden shed on Sunday morning. By afternoon, he felt that the hammer was becoming heavier and heavier. He felt pain in the lateral side of the elbow and also found that squeezing water out of sponge hurt his elbow. Which of the muscles are most likely involved-

Extensor carpi radialis longus and brevis

Which of the following statement(s) is/are true?

Dinner fork deformity is characteristic of Colles' fracture

Normally the radial styloid is 1/2 lower than the ulnar

Oedema & tenderness over the anatomical snuffbox is the characteristic features of Fracture of the scaphoid

Identify the true statement regarding the clinical examination given in the image:

Wrist is held in forced flexion for 60 sec eliciting pain

Wrist is held in forced extension for 60 sec

Wrist is held in forced flexion for 45 sec eliciting pain

Wrist is held in forced extension for 45 sec

Tendinopathies for INI-CET: High-Yield Orthopaedics Lessons

Tendinopathy Basics - Tangoing Tendons

Definition: Overuse injury: pain, ↓ function.
- Tendinosis: Chronic, degenerative; collagen disarray, minimal inflammation.
- Tendinitis: Primarily inflammatory (less common).
Common Sites: Achilles, patellar, rotator cuff (supraspinatus), epicondyles.
Risk Factors:
- Intrinsic: Age, genetics, biomechanics (e.g., malalignment), systemic diseases (diabetes).
- Extrinsic: Repetitive overload, training errors, improper equipment/technique.

Cook and Purdam's Tendinopathy Continuum Model

Cook & Purdam's Continuum Model:

Stage 1: Reactive Tendinopathy
- Acute response to overload; non-inflammatory cell activity & matrix changes.
- Tendon thickening; generally reversible.
Stage 2: Tendon Disrepair (Failed Healing)
- Attempted healing; ↑ cellularity, proteoglycans, collagen disarray.
⭐ Neovascularization and neural ingrowth are key histopathological features in chronic tendinopathy, often visualized on power Doppler USG.
Stage 3: Degenerative Tendinopathy
- Cell death, matrix disorganization, extensive neovascularization.
- Often irreversible changes; ↑ rupture risk.

Clinical Assessment - Spotting Sore Spots

Symptoms: Activity-related pain, morning stiffness.
Signs: Localized tenderness, palpable nodule/thickening, crepitus.

Key Provocative Tests:

Test	For	Positive Sign
Jobe's Test	Supraspinatus tendinopathy	Pain/weakness on resisted shoulder abduction
Finkelstein's	De Quervain's tenosynovitis	Pain over radial styloid with thumb flexion & ulnar deviation
Cozen's/Mill's	Lateral epicondylitis (Tennis Elbow)	Pain at lat. epicondyle (resisted wrist ext./passive flexion)
Phalen's/Tinel's	CTS (differentiate wrist pain)	Paresthesia in median nerve distribution

Imaging:

USG: Initial. Shows tendon thickening, hypoechogenicity, fibrillar disruption, neovascularization.
MRI: Pre-op, failed conservative. Shows signal changes, partial/full tears.

⭐ Pain on resisted active movement of the affected musculotendinous unit, or on passive stretching, is a characteristic clinical finding.

Management Strategies - Taming the Tendon

Conservative First:
- Load management & activity modification: Essential.
- PRICE 📌 (Protection, Rest, Ice, Compression, Elevation) for acute phases.
- Physiotherapy: Key! Eccentric exercises (e.g., Alfredson - Achilles; Stanish - patellar).
- Stretching, progressive strengthening.
Adjunctive Therapies (If Needed):
- Pharmacological: NSAIDs for short-term pain relief.
- Injections ⚠️: Corticosteroids (judicious use: short-term relief, rupture risk). Platelet-Rich Plasma (PRP), Prolotherapy, High-volume image-guided injections (HVI) (evidence varies).
- Other: Extracorporeal Shockwave Therapy (ESWT), Nitric oxide patches.
Surgical Intervention:
- Failure of >6 months comprehensive conservative therapy.
- Persistent significant functional impairment.

⭐ Eccentric exercise programs are the cornerstone of evidence-based physiotherapy for many chronic tendinopathies, particularly Achilles and patellar tendinopathy.

Common Culprits - Tendon Trouble Tour

Common Tendinopathy Sites and Prevalence

Tendinopathy	Location / Key Feature	Key Test(s)	Mgt Pearl / Complication
Rotator Cuff (Supra.)	Shoulder; Painful arc	Jobe's, Neer's, Hawkin's	Impingement common
Lateral Epicondylitis	Lat. elbow; Wrist ext. pain	Cozen's, Mill's	"Tennis Elbow"
Achilles Tendinopathy	Heel; Mid/Insertional pain	Thompson's (rupture)	Alfredson protocol; Rupture risk
Patellar Tendinopathy	Inf. patella; Jumping pain	Pain on palpation	Decline squats; "Jumper's Knee"

High‑Yield Points - ⚡ Biggest Takeaways

Tendinopathy encompasses tendinitis (inflammation) and tendinosis (degeneration).

Overuse and repetitive microtrauma are primary etiological factors.

Key symptom: activity-related pain and localized tenderness.

Eccentric exercises are the cornerstone of non-operative treatment.

Lateral epicondylitis (Tennis elbow): ECRB most affected; pain on resisted wrist extension.

Rotator cuff tendinopathy: Supraspinatus most common; painful arc (60-120°).

De Quervain's tenosynovitis: Positive Finkelstein's test (APL & EPB tendons).

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Tendinopathies