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Orthopedics > Lecture 6: Tendinopathy cont. > Flashcards

Lecture 6: Tendinopathy cont. Flashcards

1
Q

Peritendinitis

Paratenonitis

A

– Marked inflammatory changes of the

peritendinous structures surrounding the tendon

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2
Q

Peritendinitis causes and where can it occur

A

– Causes may include injury, overuse or infection
– Can occur anywhere along the length of the
tendon

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3
Q

Long term peritendinitis leads to

A 
– Long term inflammation can lead to intra-
tendinous change (wrist, hands, feet commonly affected)
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4
Q

How did the paratendon relate to how antiinflammatories are not effective for tendinopathy?

A

Paratendon is the one going through inflammation. So if you take antiinflammatories, you feel better because the inflammation of the paratendon goes down. This is dangerous because the person will decide then to run again and the tendon will not have time to heal.

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5
Q

Enthesis organ: Key features (3)

A

1) Tendon inserts into the
bone at an angle after a
boney prominence

2) There is often a bursa
between the tendon and
bone

3) Fibrocartilage is
expressed to absorb the
compression of the
tendon against the bone

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6
Q

Compressive strain drives tissue change from

A

fibrous tissue to fibrocartilage

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7
Q

Enthesis Organ includes

A

Summation of the insertion + the additional

surrounding structures = the enthesis organ

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8
Q

Enthesis Organ functions to (2)

A 
Functions to:
1) Decrease tensile
load at the insertion
2) Confirm mechanical
advantage to the
muscle tendon
unit
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9
Q

Enthesopathy

A

Consists of most tendinopathy and also called insertional tendinopathy!

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10
Q

Nearly all clinical tendinopathy occurs at, or adjacent to

A

the bone-tendon junction i.e. the enthesis

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11
Q

Anatomical site of compression, position of compression: Achilles tendon

A

Superior calcaneus

Dorsiflexion

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12
Q

Anatomical site of compression, position of compression: Tibialis posterior

A

Medial Malleolus

Anatomically permanent pivot

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13
Q

Anatomical site of compression, position of compression: biceps long head

A

bicipital groove

shoulder extension

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14
Q

Anatomical site of compression, position of compression: supraspinatus

A

greater tuberosity

Adduction

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15
Q

Anatomical site of compression, position of compression: hamstring (upper)

A

ischial tuberosity

hip flexion

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16
Q

Anatomical site of compression, position of compression: glute med and min

A

greater trochanter

hip adduction

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17
Q

Anatomical site of compression, position of compression: adductor longus/rectus

A

pubic ramus

hip abduction/extension

18
Q

Anatomical site of compression, position of compression: peroneal tendons

A

lateral malleolus

anatomically permanent pivot

19
Q

Anatomical site of compression, position of compression: quadriceps

A

femoral condyles

deep knee flexion

20
Q

Where does the pain come from?: Surrounding

Structures

A
  • Paratendon (nearby tendon looks like enthesis)
  • Bursae
  • Fat pad
21
Q

Where does the pain come from?: Chemicals in the

Environment

A

• Nociceptive
substances

  • Neuro-transmitters
  • Lactate
22
Q

Where does the pain come from?: Changes of the Tendon

A
  • Neovascularization

* Neural ingrowth

23
Q

What are the clinical features of

tendinopathy (4)

A
  1. Dose dependent / Hx of increased load
  2. Well localized to tendon or enthesis
  3. Increased pain with increased load
  4. Pain at start of activity, decreased pain with warm up, return of pain post activity (common story of tendinopathy)*
24
Q

Lower Limb Tendinopathy History: Glute med

A

Gluteus Medius Pain with sidelying, lateral hip pain. Mostly menopausal women

25
Q

Lower Limb Tendinopathy History: Hip adductor

A

Hip Adductor Pain with landing from lateral hop.

Sprinting/kicking sports, increased change of direction

26
Q

Lower Limb Tendinopathy History: Hamstring

A

Hamstring Pain with sitting (hard surface). Deep buttock pain.

Sprinters and speed walkers

27
Q

Lower Limb Tendinopathy History: Patella

A

Patellar Pain with prolonged sitting, jumping. Jumping athletes (volleyball, basketball)

28
Q

Lower Limb Tendinopathy History: Achilles tendon

A

Achilles Body of tendon, or above insertion. Morning stiffness.
Young sprinters, older distance runners,
court sports

29
Q

Lower Limb Tendinopathy History: Tib posterior

A

Tibialis Posterior Prolonged eversion (speed skating, running on banked curves).
Change in footwear.
Overpronation in older women

30
Q 
Lower Limb Tendinopathy
Physical Exam (4 steps)
A
  1. Observation
    – Early: generally swollen Late: Lumpy/thickened [Achilles]
  2. Functional Tests
    a. Do they have sound biomechanical form?
    b. How much load can the tendon tolerate?*
  3. Strength Tests
  4. Range of Motion
  5. Special Tests
  6. Differential Palpation (last!)*
31
Q

How much load can the tendon tolerate?*

A

Low load concentric → High load concentric →

dynamic (energy storage/release)

32
Q

At each step of tendinopathy exam assess:

A

a) The presence of pain

b) The quality of the movement

33
Q

Reactive pathology: Definition, goals (2), treatment, PAIN=, how long to rest

A

1 st time flare up, acutely overloaded tendon, direct trauma to the tendon, usually in the young person.
GOAL:
1) Decrease sensitivity of tenocytes (via relative decrease in loading)
2) Increase tendon tolerance to load (based on their needs)
Tx: Deload, Maintain, Rebuild
PAIN=IRRITABLE
Rest 24-72 hours

34
Q

Degenerative pathology: definition, goals (1), treatment, PAIN=

A

Repeated bouts of pain/recovery, quick to recover, middle age to older patient with history of intense use of tendon (high school sprinter), focal tendon swelling.

GOAL:
1) Remodel the matrix (via appropriate loading)
Tx: Maintain, Rebuild (because pain is stable)
PAIN= STABLE

35
Q

Treatment

Where do you start?

A

❑Stage of Tendinopathy
❑How much load their tendon can tolerate
❑If there’s a compressive component involved

36
Q

How to increase load*

A

Isometric load → Low load concentric → High load concentric

Eccentric load → dynamic (energy storage/release) → Sports specific

37
Q

How to increase load from light to moderate to highest: Patella

A

Lightest: flat or decline squats
moderate: split squats/lunge
highest load: forward hopping

38
Q

A note on Eccentric Exercise*

A

• PT’s love eccentric exercise for Tendinopathy!!!
– High load exercise
– Could be detrimental if used incorrectly
• Provocative for reactive tendons, compressive component
– Can be effective as part of a program, but not
necessary to do in isolation

39
Q

1 Tendinopathy is a load based problem

resulting in

A

degenerative changes in the tendon.

40
Q

2 Tendons don’t like

A

rest or change (they need time to adapt)

41
Q

3 Slow loading program is best, with

A

one variable change at a time

42
Q

4 Don’t forget the big picture – consider (3) in the kinetic chain

A

muscle strength
motor control
biomechanics

Orthopedics (12 decks)

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