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DPT MSK Fall 22' - Spring 23' > achilles tendinopathy - final exam > Flashcards

achilles tendinopathy - final exam Flashcards

1
Q

What is the most frequently reported overuse injury?

A

achilles tendinopathy

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2
Q

who is Achilles tendinopathy most common in?

A

recreational/competitive activities
training > competition
30-50 year olds
10-20% of runners

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3
Q

risk factors and etiology of achilles tendinopathy:
- reduced ____ ROM that limits PE of Achilles
- limited ______ flexibility
- ______ weakness
- _____ gender and ______ age
- abnormal _______
- what about weight?
- 3 things to consider:

A
  • DF
  • calf
  • calf
  • male and older
  • tendon structure
  • obesity
  • training errors, environmental factors, improper shoes
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4
Q

risk factors of achilles tendinopathy : L4-S1 regional interdependence
– excessive _______ with tendinopathy origins due to Achilles attaching more ______ of calcaneus
– ____ neuromuscular deficits
– _______ deficits

A

EV/pronation; medial
hip
balance

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5
Q

pathomechanics of achilles tendinopathy:
- repetitive _______ with compression from limited _____ and/or excessive _______
- lack of PE with limited DF so ______

A

lengthening
DF
EV
overworked

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6
Q

achilles tendinopathy can occur from collagen fibril ______/________ and fibroblast _____ from:
- altered fluid movement leads to _____
- increased nitric acid with _______

A

thinning/disorganization
death
- overheating
- persistent inflammation

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7
Q

with achilles tendinopathy, you get a thickened but weaker tendon from:

A

increase of non-collagen matrix
fat deposition

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8
Q

achilles tendinopathy can result from ineffective ______ and impaired _______

A

force transfer
motor control

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9
Q

symptoms of achilles tendinopathy

A

gradual onset that limits WB activity
localized P! and stiffness
- particularly after inactivity
- lessens with mild bout of activity
- increase with moderate to severe activity

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10
Q

signs of achilles tendinopathy:
- observation:
- ROM:
- resisted:
- accessory motion

A
  • achilles thickening. possible impaired LE control
  • possible P! and limitation with DF
  • possible P! with PF; may be weak. possibly hip and knee weakness of antigravity muscles
  • possible talar hypomobility for DF
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11
Q

Achilles tendinopathy special tests:

palpate tender area; ask pt to DF/PF ankle
(+) = ?

A

arc sign
(+) = tender area moves with DF and PF

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12
Q

achilles tendinopathy special tests:

palpate tender area; ask pt to DF ankle
(+) ?

A

royal london
(+) = tender area less tender in DF

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13
Q

what are two other more functional tests for achilles tendinopathy?

A

single leg heel raise for endurance (if more P! on incline –> plantaris and insertional injury)
single leg hop
both (+) = less reps vs uninvolved side

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14
Q

muscle length test for achilles tendinopathy?

A

shortened gastrocs

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15
Q

where is TTP for achilles tendinopathy?

A

2-6 cm proximal to insertion

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16
Q

achilles pain would be more _____ indicating plantaris involved

A

medial

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17
Q

what are some differential dx at posterior ankle?

A

achilles/fascial tears
calcaneal bursitis
plantaris tendinopathy
posterior ankle impingement

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18
Q

what should you educate your patient on for PT Rx for achilles tendinopathy?

A

rest NOT indicated
optimal stress is best within appropriate P! levels
weight management
shoe wear
timeline (8-12 weeks)
prognosis (80% progress)

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19
Q

effectiveness of modalities for achilles tendinopathy?
- LASER
- Ionto
- shockwave therapy

A
  • contradictory evidence
  • dexamethasone helpful for P! and function
  • more P! relief w ADLs when added to 4 weeks of exercise. no structural changes
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20
Q

PT Rx effectiveness for achilles tendinopathy: Bracing and taping
- neoprene sleeves:
- night splint:
- kinesiotape:

A
  • anecdotal
  • not beneficial and no support
  • anecdotal and conflicting
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21
Q

arch taping for achilles tendinopathy may help predict ______
shock absorbing orthotic _______ rate of injury
heel lift support ?

A

orthotic benefit
decreased
mixed support

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22
Q

PT Rx effectiveness for achilles tendinopathy:
- dry needling:
- STM:
- gentle stretching:
- JMs:

A
  • helpful for pain when added to exercise
  • anecdotal. helpful for motion w exercise
  • weak support. may be contraindicated due to higher tension/compression on tendon
  • for mobility and function
23
Q

primary purposes MET for achilles tendinopathy

A

tendon proliferation and stabilization

24
Q

PT Rx MET muscle actions for achilles tendinopathy:
- ______ only
- _________ and ______ concentrics/eccentrics

A

eccentrics
heavy and slow

25
Q

what exercises would you prescribe for someone with achilles tendinopathy?

A

PF w knee flexed
PF w knee ext
heel raises legs straight and bent

26
Q

how do you progress resistance and activity for achilles tendinopathy?

A

add weight in hand or with loaded backpack
leg press or heel raise machine
sitting or standing heel raises

27
Q

timeline for achilles tendinopathy Rx:

A

at least 2x/week, recommend every other day
6-12 weeks
may need more recovery time between heavy loading in a non-athletic/older patient
once symptoms return to normal P!, repeat exercises

28
Q

recurrence rate for achilles tendinopathy:

A

27%

29
Q

prognosis for achilles tendinopathy:
- mostly normalized ____ and _____
- improved:
- _____ weeks to recovery
- _____% recovered with ______ months of progressive loading at a 5 year follow up

A

tendon structure and thickness
mechanical properties as well as cortical function
12
80%; 3-6 months

30
Q

with eccentric exercises,
______% success for mid portion tendinopathy in athletes
______% sedentary individuals
_____% insertional tendinopathy

A

82-100%
60%
< 32%

31
Q

mild pain may remain in ____% with achilles tendinopathy

A

20-45%

32
Q

MD Rx achilles tendinopathy:
- mid portion:
- insertional:

A
  • insufficient evidence for cortisone
  • guided cortisone effective for P! and function. recommended for non athletic pop.
33
Q

calcaneal apophysitis or Sever’s Disease most common in:

A

9-12 year old boys

34
Q

etiology of severs disease:

A

growth with high activity

35
Q

pathomechanics of severs disease:

A

leg bone growth exceeds PF lengthening
increased tendon tension
growth plate is weak spot
mostly inflammation
complications: avulsion or premature closure

36
Q

risk factors of severs disease

A

long or year round sports
poor fitting shoes that lack cushion
training errors
shortened PFs
foot dysfunction; pes planus/cavus

37
Q

risk factors of severs disease

A

long or year round sports
poor fitting shoes that lack cushion
training errors
shortened PFs
foot dysfunction; pes planus/cavus

38
Q

symptoms of severs disease

A

gradual onset of heel P! with overuse
bilateral (60%) because equally walking on feet

39
Q

ROM for Severs disease:

A

limited DF leading to greater tensile forces on growth plate

40
Q

special tests for severs disease:

A

squeeze test on heel
severs sign: P! with heel raise
m length: shortened gastroc

41
Q

where would be TTP w severs disease

A

cap of calcaneus

42
Q

PT Rx for severs disease:

A

patient education
policed
U shaped foam upside down on achilles w ankle sleeve
restore DF ROM/accessory motion

43
Q

what stretching would you do for severs disease?

A

hamstring stretching due to fascial connections w gastroc
be careful with prolonged calf stretches

44
Q

PT Rx severs disease: orthotics
- arch support for _____
- ______ > arch supports
– gel heel cups with a lift work __

A
  • excessive pronation
  • heel lifts
    – best
45
Q

MET Rx for severs disease

A

any impaired LQ control
caution with muscle/tendon attached to growth plate to avoid greater overuse

46
Q

prognosis for severs disease:
- ___ resolved at 1 month; ___ at 3 months
- can be a ____ and/or ____ problem
- growth plate closes around _____

A
  • 75%; 95%
  • recurrent/persistent
  • 14 years
47
Q

achilles rupture prevalence:

A

men ages 20-50

48
Q

where would the achilles typically rupture

A

3-4 cm proximal to calcaneal insertion

49
Q

how would an achilles rupture typically happen

A

during a sudden eccentric activity

50
Q

Signs of achilles rupture:
- ROM/resisted:
- special tests:

A
  • limited if any PF/ weak PF
    1. Matle’s: prone, knee 90 deg flx, (+) = foot neutral or DF
      1. tendon gap palpation
      2. thompson: in supine squeeze calf
51
Q

PT Rx for achilles rupture:

A

POLICED
like achilles tendinopathy

52
Q

early functional rehab and WB for achilles rupture:
- Week 0-2
- week 3-6
- week 7

A
  • ROM: none
    orthosis: fixed @ 30 deg PF
  • ROM: up to 30 deg DF; free PF
    orthosis: 30 PF to 0 DF
  • normal
53
Q

prognosis for achilles rupture:

A

many professional athletes don’t return to prior levels

DPT MSK Fall 22' - Spring 23' (29 decks)

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