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usa term 2 > FMC Test 2 *Tendon Healing & Tendinopathy* > Flashcards

FMC Test 2 *Tendon Healing & Tendinopathy* Flashcards

1
Q

What is the function of a Tendon?

A

Attach muscle to bone
- Transmits force between muscle to bone

Serves as a dynamic stabilizer of joints
- Via muscle-tendon unit

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2
Q

The tendon can be divided into three main sections, what are they?

A
  • Muscle-Tendon Junction
  • Bone-Tendon Junction
  • Tendon Mid Substance
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3
Q

What is the composition of a Tendon?

A

Similar to ligament make up but muscle attachment create a transfer of loads

-They are dense connective tissue
- Specialized fibroblastic cells called tenocytes

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4
Q

The Midsubstance of the Tendons is composed of?
(3 connective tissues)

A

Peratenon
Epitenon
Endotenon

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5
Q

In the Midsubstance of the tendons, what is Peratenon?

A

Loose areolar connective tissue composed of mainly type 1 and type 3 collagen, elastin and synovial cells
- It is a Tendinous sheath that may be filled with synovial fluid (tenosynovium) in tendons subject to friction. (For ex. tendons passing under retinaculums in wrist and ankle)
- The Peratenon is also attached loosely to the Epitenon

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6
Q

In the Midsubstance of the tendons, what is Epitenon?

A

The Epitenon is directly under the Peratenon.
- Its a fine sheath of connective tissue the envelopes the entire tendon

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7
Q

In the Midsubstance of the tendons, what is Endotenon?

A

Endotenon is deep within the tendon, it forms a network of connective tissue around the subfascicle, fascicle, and fiber bundles of tendon tissue
- Organizes, orients, and provides gliding surfaces for the tendon fibers.
- Holds nerve, lymphatics and Blood vessels

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8
Q

What is Myotendinous Junction (Muscle-tendon Junction)?

A
  • Numerous interdigitations between muscle cells and collagen fibers (this allows the terminal actin ligament within the sarcomeres to connect via the cell membrane to tendon collagen fibers)
  • Infoldings increase the surface area to distribute stress, (this ensures the junctions are loaded in shear rather than tension to provide friction to minimize are of stress concentration)
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9
Q

What are muscle cells surrounded by?

A

Muscle cells are surrounded by collagenous tissue so that the entire surface of the muscle fiber can transfer tension across cell membrane to the tendon.

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10
Q

What are tendons responsible for and whats their mechanisms of injury?

A

Tendons are responsible for tensile loads transmitted from muscle to bone for movement

  • If the tensile load is Greater then the tensile strength this can lead to Micro-Failure/Partial Tearing (which is most commonly found by PTs), and/or Macro-failure/Full Rupture (Can be seen in bicep brachii long-head, achilles t., and RTC)
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11
Q

What are the 3 sources of blood supply of Tendon?

A
  • Bone-Tendon Junction
  • Muscle-Tendon Junction
  • Peratenon and intra-tendinous vascular network
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12
Q

Where does the Bone-Tendon Junction supply blood to?

A
  • Typically supplies the lower/distal 1/3 of tendon
    • Because of the fibrocartilage barrier between bone and tendon tissue, it offers NO vascular supply to midsubstance tendon
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13
Q

Where does the Muscle-Tendon Junction supply blood to?

A
  • The proximal 1/3 of tendon
    • Vascularity of the muscle is evident with only a sparse network of vessels at this junction
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14
Q

Where does the Peratenon and intra-tendinous vascular network supply blood to?

A

Supplies midsubstance of the tendon

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15
Q

In terms of Tendon Nutrition, what is the difference between Intrinsic and extrinsic mechanism?

A
  • All tendons have intrinsic blood supply, direct blood flow is supplied by the vessels of the region or by the vincula. (Intrinsic)
  • Tendons surrounded by tendon sheath have POOR blood supply and require additional method so they can receive nutrition, this extrinsic method of receiving nutrients to keep the tendon healthy comes from diffusion which is enhanced by motion. (Extrinsic)
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16
Q

What type of healing do Tendons have?

A

They have Intrinsic and Extrinsic Mechanisms of healing.
- They can heal spontaneously from the formation of tenocytes, fibroblast and vascular inflammatory response mechanisms from adjacent tissue.

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17
Q

What does the degree of healing depend on for tendons?

A
  • Degree of injury
  • Need for surgical repair or not
  • Amount of immobilization after injury
    –Need for controlled stress to develop tensile strength of the tendon
18
Q

Where are tendons innervated?

A
  • Primarily innervated at the musculotendinous junction
    –Little innervation at midsubstance
19
Q

What are the different types of sensory Mechanoreceptors for tendons?

A
  • Pressure and stretch receptors (Ruffini corpuscles) ~slow rate of response
  • Movement receptors {Acceleration/Deceleration movements} (Pacinian Corpuscles) ~rapid response
  • Proprioceptive receptors (Golgi tendon organs) ~gives input on position, active muscle contraction, and passive stretch
  • Free nerve endings (C Fibers
    –Response to pain
20
Q

What is Acute Tendinitis depicted by?

A

Pain, functional loss, and signs of inflammation from repetitive activity before 1-7 days before seeking treatment.

21
Q

How does Tendinosis develop?

A

Develops after a tendon fails to heal

22
Q

Chronic Tendinopathy is depicted by?

A

Is when the tendon lacks inflammatory signs that is commonly seen in the achilles, quad. tendon, and suprasinatus tendon.

23
Q

If a patient has a tendon rupture, what do they usually require?

A

They usually require surgery

24
Q

Other than poor tendon health, other factors can contribute to injury, such as: autoimmune disease, infection, tumors, etc. How can this affect a tendon?

A

They can all lead to poor tendon healing that can lead to micro and macro injuries to tendons.

PT must do a thorough review of symptoms to see if the patient has an underlying condition that is leading to tendon dysfunction.

25
Q

In tendon healing, what is the Acute (Inflammatory) stage?

A

Trauma incites a complex series of chemical events

  • This is the inflammatory phase of healing
  • Causes Hemostasis
26
Q

In tendon healing, what is the Subacute (Proliferative/repair) stage?

A

Gradual removal of cellular waste from the injured site
–Accumulation of fibroblast and myofibroblasts signal the initiation of the proliferative stage
–Neoangiogenesis or capillary budding is a characteristic of this phase
–Starts with Type 3 Collagen then Type 1 Collagen

  • Repair and Healing
27
Q

In tendon healing, what is the Chronic (Remodeling) stage?

A
  • Maturation and remodeling phase
  • Density of tendon collagen is almost exclusively Type 1 Collagen
  • This stage may last greater than or equal to 1 year depending on extent of initial injury
28
Q

What is the Safe Load Bearing Progression for Conservative (For mallet or central slip avulsion) tendon? (Inflammatory phase, repair phase, and remodeling)

A

Inflammatory phase:
- RICE
- Avoid stresses/motion to involved tissue (restriction devices used for 6-8 weeks)

Repair phase:
- Avoid stresses/motion to involved tissue (restriction devices used for 6-8 weeks)

Remodeling:
- Progressive load bearing as long as no joint lag is noted

29
Q

What is the difference between Minor tendon injuries and Major tendon injuries?

A
  • Minor tendon injures (incomplete) have the potential to heal without surgical intervention
  • Major tendon injuries may require surgical repair
    -Suture repair of tendon
    -Helps minimize scar formation by closing the gap
    between tendons
30
Q

How long does it take for a tendon to regain strength?

A
  • The tendon is weakest 7-10 days
  • Regains strength at 21-28 days
  • Near full strength at 6 months
31
Q

Treatment guidelines for tendon (and Ligament) injuries guide us through decisions regarding…

A
  • Protection of the joint structure during healing
  • Early protected motion after injury/repair
  • Progressive therapeutic exercises and functional activities
  • Encourage weight bearing and progressive function as soon as the tissue tolerates
32
Q

What is the Safe Load Bearing Progression for Post-surgical tendons? (Inflammatory phase, repair phase, and remodeling)

A

Inflammatory Phase: Focus on protecting newly repaired tendons and mange edema
- PRICE
- Avoid AROM focus on PROM

Repair Phase:
- Continue PROM; work towards AAROM/AROM (Usually 3 1/2 to 4 weeks)
- Avoid strengthening of involved muscular
–Avoid co-contractions
–until remodeling phase

Remodeling Phase:
- Progress resistance slowly with guidance of surgeon

33
Q

What is Tendinitis associated with?

A

Inflammation

34
Q

What is Tendinosis associated with?

A

Degeneration

35
Q

What is Tendinopathy?

A

Basic def.: Pain in the tendon

Considered to be a degenerative cascade that may occur in tendons
- Encompasses all conditions related to micro-injury of tendon

36
Q

What are the 4 stages associated with Tendinopathy?

A

Stage 1: Associated with inflammation
Stage 2: Poorly developed vasculature and disorganized collagen bundles
Stage 3: Microscopic failure of the tendon
Stage 4: Tissue fibrosis (scarring)

37
Q

What is the Safe Load Bearing Progression for tendons with micro-trauma, Inflammatory Phase?

A

RICE (Relative rest/education)
Limit painful motions
Avoid strengthening of involved musculature
–Assess entire kinetic chain for impairments that
may be related

38
Q

What is the Safe Load Bearing Progression for tendons with Micro-Trauma, Repair Phase?

A

Remain within pain-free range
Isometric progression to eccentric/isotonic strengthening
–Address entire kinetic chain impairments

39
Q

What is the Safe Load Bearing Progression for tendons with Micro-Trauma, Remodeling Phase?

A

Continue education and strategies to avoid re-irritation

40
Q

What is the Safe Load Bearing Progression for Tendinopathy? (7-steps)

A

We can load pathologic tendons without fear

  1. Ensure the tendon is the source of pain
  2. Assess existing muscle and tendon capacity and function
  3. Establish what patient wants to achieve, the capacity and function required
  4. Slowly build from one to another
    -Decrease loads enough to eliminate pain
  5. Unload the tendon where the problem began
  6. Exercises to reduce pain - loaded isometrics
  7. Adress comorbidites

usa term 2 (22 decks)

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