Tendinitis Flashcards
Inflammation of a tendon
● Tendons are made of regularly arranged, dense collagen fibrils
● They attach muscle to bone and are part of the musculotendinous unit
● Tendons appear in two shapes: cord-like structures and broad, sheet-like called aponeuroses
● A tendon that moves in a straight line is surrounded by a paratendon-blood vessels are coiled in the loose alveolar tissue which stretches along with the tendon
● A tendon that runs across a bony prominence is surrounded by a tendon sheath-this double-layered tubular structure is filled with synovial fluid
Tendons
● The dense CT of tendons has a limited blood supply originating from muscles and bones
● Tendons are subject to great tensile stress
● When a load is placed on a tendon, the
waves of its collagen fibres straighten out
● The collagen fibres then temporarily deform
● Over time, a tendon can experience micro tearing, partial tearing or complete rupture, usually at the point of most reduced blood supply
Causes of Tendinitis
● Chronic overload of the tendon, leading to microtearing and an inflammatory response in the tendon
Contributing Factors
● Muscle imbalances, lack of flexibility, improper equipment and training
errors
Types of Tendon Overuse Injuries
Tendon overuse injuries have all been termed “tendinitis”
● Tendinitis
● Paratendinitis
● tendinosis
Paratendinitis
● Inflammation of the paratendon or the tendon sheath where these structures are associated with a tendon, either of which may be irritated by the tendon as it rubs over a bony prominence
● Associated with tendon injuries
● Also called tenosynovitis or tenovaginitis
● Tenosynovitis is irritation of the inner surface of the tendon sheath by the roughened surface of the tendon
● Tendovaginitis is irritation and thickening of the sheath itself
Tendinosis
● Degenerative changes occurring with chronic overuse tendon injuries, such
as “tennis elbow”
● Aging and avascularity may be contributing factors to tissue degeneration
● There are no signs of inflammation in the tendon itself, but biopsies have shown angiofibroblastic degenerative changes occurring (invasion of organized vascular tissue and a disorganization of collagen tissue in the tendon)
Grades of Tendinitis
● Grade 1-pain after activity only
● Grade 2-pain at the beginning of activity
which disappears during activity then returns after activity
● Grade 3-pain at the beginning of activity,
during activity and after activity. Pain
may restrict activity
● Grade 4-pain with ADL’s and pain
continues to get worse
Common Tendinitis Locations and Causes
● Supraspinatus tendon
● Infraspinatus tendon
● Subscapularis tendon
● Biceps long head tendon
● Common extensor tendon
● Common flexor tendon
● Abductor pollicis longus and Extensor pollicis brevis tendons
● Patellar tendon
● Popliteus tendon
● Tibialis posterior tendon
● Achilles tendon
Supraspinatus Tendon
To palpate:
● The client is seated with their arm held
behind the back and the elbow in
flexion
● The humerus is maximally internally
rotated and maximally extended,
bringing the humeral attachment of
supraspinatus out from under the
acromion
● The tendon is palpated immediately
inferior to the AC joint
● The therapist palpates through deltoid
in the indentation between the
anterior and middle fibres
Infraspinatus Tendon
To palpate: (infraspinatus and teres minor)
● The client is seated or prone with the
humerus flexed to 90 degrees,
adducted 10 degrees and externally
rotated 20 degrees
● This position brings the tendon out
from under the acromion
● The tendon is palpated immediately
inferior to the AC joint and the lateral
portion of the spine of the scapula
● The therapist palpates the tendon
through the posterior fibres of the
deltoid muscle
Subscapularis Tendon
To palpate:
● The client is seated with the humerus at
their side and the elbow flexed to 90
degrees
● The tendon is palpated inferior to the
clavicle, lateral to the coracoid process
(medial to anterior deltoid)
● The tendon is palpated deep in the
deltopectoral triangle, between the
tendons of the long and short heads of
biceps
Rotator Cuff Tendons
● Supraspinatus, infraspinatus, teres minor
and subscapularis are prone to tendonitis
with sports such as swimming, tennis, golf
or any throwing sport
● Occupations or activities that stress the
shoulder muscles with the arms in an
overhead position, such as drywall
installation or assembly line work
● Pain is usually experienced when the arm
is in more than 90 degrees of abduction
Biceps Long Head Tendon
To palpate:
● The client is seated with the humerus
internally rotated 20 degrees or to a
“hands on lap” position
● The tendon is palpated inferior to the
clavicle, lateral to the coracoid process in
the same areas as the subscapularis
tendon
● Swimming and throwing sports where the
arm is adducted, compressing the tendon
can cause bicep tendinitis
Common Extensor Tendon
To palpate:
● The client is seated with the elbow in
slight flexion
● The tendon is located distal to the lateral
epicondyle
● It may extend over top of the radial head
which can be located by the client
pronating and supinating the hand while
the therapist palpates for the moving
head
● Repetitive forceful extension, supination
and radial deviation are the movements
lost likely to provoke extensor tendinosis
● Wheelchair athletes and meat cutters are
also susceptible
Common Flexor Tendon
To palpate:
● The client is seated with the elbow in
flexion and the wrist supinated
● The tendon is located distal to the medial
epicondyle
● Repetitive activity such as hammering or
using a screwdriver may cause injury to
the CFT
● Sports involving wrist flexion and
pronation such as golfing and overhead
serving in tennis are other causes
Abductor Pollicis Longus & Extensor
Pollicis Brevis Tendons
To palpate:
● The sheaths of these two muscles is
palpated at the radial side of the wrist
● Activities requiring repetitive thumb use,
repetitive radial and ulnar deviation and
forceful gripping cause De Quervain’s
tenosynovitis
Patellar Tendon
To palpate:
● Palpated immediately inferior to the
patella
● Pain is localized to the tendon
● Activities include running or jumping such
as track and field are causes
Popliteus Tendon
To palpate:
● Palpated just inferior to the lateral
femoral condyle, directly posterior to the
lateral collateral ligament and biceps
femoris tendon
● It is palpated through the lateral
gastrocnemius muscle
● Activities such as downhill running or
downhill walking combined with foot
pronation cause this tendinitis
● Can be confused with ITB friction
syndrome
Tibialis Posterior Tendon
To palpate:
● The foot is placed in plantarflexion
● The tendon in its sheath is palpated just
posterior and inferior to the medial
malleolus
● Pain runs along the medial border of the
tibia and along the course of the tendon
● Activities such as running, using step
machines or doing step aerobics
combined with excessive pronation can
cause this tendinitis
Achilles Tendon
To palpate:
● The tendon lies between the
gastrocnemius-soleus complex and the
calcaneus
● Pain is felt along the tendon
● Activities such as running combined with
pronation, poor footwear or tight
gastrocnemius-soleus muscles cause this
condition
Impingement Syndrome
● Inflammation, pain and edema in the tissues within the coracoacromial arch and
between the acromioclavicular and glenohumeral joints
● Painful compression of the tendons, especially supraspinatus, may occur when the humerus is abducted against the acromion
● The biceps tendon and the subacromial bursa may be affected as well
○ Stage 1-edema and hemorrhage of the subacromial bursa
○ Stage 2-tendinitis and fibrosis are present. Both stages are reversible with conservative
care such as rest, stretching and progressive strengthening
○ Stage 3-incomplete tears or complete tendinous rupture occurs. There may be
associated bony changes in the acromion and the AC joint. Surgery is usually indicated
Rotator Cuff Tears
● Overuse, impingement and normal aging can lead to painful tearing of the rotator cuff tendons
● Tears may be partial or full thickness with
supraspinatus the most frequently injured
● Medically, tears are treated by open rotator cuff repair surgery in which the rotator cuff is exposed
Calcific Tendinitis
● A late-occurring stage of rotator cuff tendinitis, usually developing in the supraspinatus tendon
● Supraspinatus functions to hold the head of the humerus in place and this constant
pressure of the head of the humerus seems to “wring out” the blood supply to the
poorly supplied tendon
● The tendon’s fibrocytes change to chondrocytes, collagen disintegrates and calcific deposits accumulate in the cells
● Over time, these deposits are set free into the intercellular spaces
● The deposits can be soft, toothpaste-like material or hard and chalky
Trigger Finger
● Through overuse, flexor tendons of any finger may develop a thickened, nodular swelling
● This swelling is unable to move through the tendon sheath and gets caught
● The finger is stuck in flexion until it is passively extended by an external forces
● Rest, NSAIDs and stretching are the usual treatments
Palpation
Acute:
● Point tenderness occurs over the tendon
● Heat and swelling may be palpated at the tendon
● HT and TPs are present in the affected muscle and its antagonists
- Chronic:
● Pain occurs over or near the tendon
● Swelling adhesions are present. The tendon may feel granular or hard at the adhesion site
● HT and TPs occur as in the acute stage
● Crepitus may be palpated on movement of the tendon in its sheath
● A snapping sensation may be felt due to tight tendons that snap over bony prominences or bursae
