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Pathophysiology SEM2 Year 1 > Contractile Tissue > Flashcards

Contractile Tissue Flashcards

1
Q

What is tendinopathy?

A

Pain & dysfunction associated with any tendon.

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2
Q

What are the common lower limb areas that can be affected by tendinopathy?

A

Glutes, patella, achilles, tib post, hamstrings, peroneals & plantar fasciopathy (not a tendon)

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3
Q

What are the common upper limb areas that can be affected by tendinopathy?

A

Rotator cuff muscles, long head of biceps, lateral and medial epicondylalgia, de quervains (abductor pollicis longus and extensor pollicis brevis tendons)

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4
Q

What are modifiable risks associated with tendinopathy?

A
  • Overload/underload
  • Changes in load/training
  • Increased BMI
  • Diabetes and meds to an extent
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5
Q

What are non-modifiable risks associated with tendinopathy?

A
  • Age
  • Previous injury
  • Genetics
  • Diabetes and meds (statins and steroids) to an extent
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6
Q

What age group is most at risk to tendinopathy?

A
  • Athletic - 40 and over

- Sedentary - 60 and over

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7
Q

What are the 4 stages of tendinopathy?

A

1) Altered tendon cell population
2) Disorganisation of collagen
3) Ground substance changes
4) Neovascularisation

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8
Q

What is altered tendon cell population?

A
  • Increased number of tenocytes
  • Increased tenocyte metabolism
  • Increased number of immature tenocytes (don’t produce collagen)
  • Increased rate of apoptosis
  • Immunoreactive cells
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9
Q

What is disorganisation of collagen?

A
  • Reduced type 1 fibres and increased type 3 fibres
  • Higher concentration of immature collagen bundles
  • Fibres don’t run parallel to each other anymore, become more disorganised
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10
Q

What are ground substance changes?

A

CHANGED CHEMICAL LEVELS IN TENDON

  • Increased proteoglycans (hydrophilic)
  • Leads to increased water content -> increased cross section of tendon -> breaks down cross fibres (tendon fibres are pulled away from each other) -> tendon weaker.
  • Chemical alterations: increased substance P, glutamate and lactate.
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11
Q

What is neovascularisation?

A

Influx of blood vessels and nerves ingrowing into tendon which increases sensitivity.

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12
Q

How does overload (in terms of exercise) lead to tendinopathy?

A

No rest leads to a consistent decreased collagen and protein synthesis which gradually degrades the tendon and decreases the ability to withstand load which leads to the overload cycle.

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13
Q

What are the general clinical signs and symptoms of tendinopathy?

A
  • Pain (when using contractile unit)
  • Weakness
  • Decreased function
  • Swelling
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14
Q

Gluteal Tendinopathy (GTPS)

A
  • Occurs mostly in mid-life
  • Females more than males as they have an increased Q angle and naturally have more hip ADD
  • Gluteus medius and minimus tendons.
  • Combination of excessive compression and high load.
  • Clinical signs and symptoms include: lateral hip pain, tenderness around GT, pain on walking, standing on one leg, getting up from sitting, side lying
  • Managed with education and load management commonly.
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15
Q

Patella Tendinopathy

A
  • High prevalence in jumping sports
  • Risk factors: weight, BMI, leg length difference, arch height of foot, quads flexibility/strength, hamstring flexibility, vertical jump performance.
  • Clinical signs and symptoms include: ant. knee pain, decreased function e.g. when using stairs, going up and down hills, kneeling.
  • Managed with education, load management, exercise, taping commonly.
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16
Q

Achilles Tendinopathy

A
  • Common in elite runners but 1/3 cases are non athletes.
  • Can be insertional or mid-portion of Achilles.
  • Biomechanical factors: overpronation of foot, footwear, training surfaces
  • Clinical signs and symptoms include: pain and swelling, pain worst at start and end of training session, tender, nodular swelling normally prevalent in chronic cases.
  • Managed with education, load management, exercise, taping commonly.
17
Q

Plantar Fasciopathy

A
  • 1/10 will suffer from this in their lifetime
  • Peak incidence from 45-65
  • No difference between men and women.
  • 90% of cases resolve in 12 months with conservative treatment.
  • Increased risk with increased BMI
  • Other risk factors: overpronated feet, reduced gastroc length, severe hallux valgus.
  • Clinical signs and symptoms include: pain at proximal insertion of plantar fascia (hallux extension and ankle DF), painful in morning and after activities/ at end of day/
  • Managed with education, load management and exercise (stretching and strengthening) commonly.
18
Q

Rotator Cuff Related Shoulder Pain

A
  • Pain & impairment, usually during shoulder elevation & LR, painful to lie on affected side.
  • Managed with education, exercise, symptom modification commonly.
19
Q

Lateral Epicondylalgia (Tennis Elbow)

A
  • Most common overuse syndrome of elbow. Involves extensor muscles of forearm.
  • Affects 1-3% of population
  • More common in 40s-50s
  • Smoking and obesity are risk factors
  • ECRB is commonly affected.
  • Clinical signs and symptoms include: pain around lateral epicondyle, aggravated by resisted wrist/finger extension, forearm supination.
  • Managed with education, load management, exercise, brace/taping.
20
Q

Medial Epicondylalgia (Golfers Elbow)

A
  • Affects common origin of flexors and pronators.
  • Age 40-60
  • Affects more females than males
  • Clinical signs and symptoms include: pain on medial side of elbow, tender on palpation, aggravated by resisted/repetitive wrist flexion or pronation, valgus stress, stretching, throwing and gripping, reduced grip strength
  • Managed with education, load management, exercise, brace/taping commonly.
21
Q

De Quervains

A
  • More common in women (new mothers)
  • Age 40s-50s
  • Inflammation of synovial sheaths of EPB and APL. Swelling of sheaths leads to thickening of sheath. Adhesions may develop between tendon and sheath which restricts normal tendon movement. Enclosed tendons can become restricted.
  • Clinical signs and symptoms include: pain on radial side of wrist, aggravated by resisted thumb extension/ABD or by stretching affected tendon (Finkelstein test), pain on palpation.
  • Managed with education, load management, exercise, splinting (offloading) commonly.

Pathophysiology SEM2 Year 1 (3 decks)

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