Rotator Cuff tendinopathy

Question 1

What is a tendinopathy?

Answer 1

• Painful condition in and around tendons
• overuse
• imbalance between protective and regenerative changes from overuse
• tendon degeneration / weakness

Question 2

Describe an unhealthy tendon

Answer 2

• Cells degenerate
• ground substance increases (live substance around connective tissue)
• collagen disarray
• fat deposits calcify
• blood vessels invade

Question 3

What is REACTIVE tendinopathy

Answer 3

• non inflammatory
• temporary localised thickening of tendon in response to acute overload / trauma
• tendon can revert to normal structure if overload is reduced or sufficient time between loading

Question 4

what is tendon DYSREPAIR

Answer 4

• Chronic overload
• tendon matrix breakdown
• increase collagen production and separation
• matrix disorganisation
• ingrowth of vessels and nervs
• swelling
• tendon degeneration
• tendon weakness

Question 5

what is degenerative tendinopathy

Answer 5

• large areas of disordered matrix
• largely irreversible matrix breakdown
• absence of tenocytes and collagen
• neovascular inflammation
• structural failure

Question 6

Clinical features of rotator cuff tendinopathy

Answer 6

• pain with overhead activity
• activities less than 90 degrees usually pain free
• maybe a history of instability

Question 7

what examination would take place

Answer 7

• tenderness of supraspinatus proximally at insertion
• painful arc 70-120 degrees
• decrease internal rotation
• pain at all extremes of passive flexion

Question 8

What are the clinical features of reactive tendinopathy / dysrepair

Answer 8

• acute overload
• painful
• swelling

Question 9

management of reactive tendinopathy/dysrepair

Answer 9

• decrease load and maybe frequency
• avoid aggravating activity
• pain management
• ICE

Question 10

clinical features of late tendon disrepair/degeneration

Answer 10

• chronic overload
• pain increases
• focal areas of swelling

Question 11

management of tendon disrepair / degeneration

Answer 11

• eccentric exercise
• soft tissue treatment
• shock wave therapy

Question 12

treatment for tendon disrepair/degeneration

Answer 12

• glenohumeral stability
• muscle weakness (EXTERNAL ROTATION weaker then internal rotation)
• soft tissue tightness
• tightness and muscle thickening of rotator cuff muscles
• impaired scapulohumeral rhythm
• training errors