Tendinopathy Flashcards
What is tendinopathy?
Disease or disorder of a tendon
What is inflammation of a tendon?
Tendinitis
What is the non inflammatory degeneration of a tendon (over time)?
Tendinosis
What is the inflammation of a the outermost layer of the tendon?
Paratenonitis
What is the inflammation of the synovial sheath?
Tenosynovitis
What is the etiology?
- Chronic degeneration due to trauma, repetitive usage, age
- Rheumatoid arthritis, lupus, or chronic renal failure
- Poor biomechanics
- Muscle imbalances
- Insufficient rest after activity
- Degeneration is thought to be more common than inflammation
Where is it frequently seen?
- Common flexor tendon (golfer’s elbow / medial epicondylitis)
- Common extensor tendon (tennis elbow / lateral epicondylitis)
- Quadriceps (patellar)
- Achilles / Calcaneal / Triceps Surae
- Wrist & Ankles (tendon sheath)
- 2nd-5th digits (flexor tendons)
- 1st digit (abductor & extensor pollicis tendon sheath - De Quervain’s Tenosynovitis)
- Rotator Cuff
- Biceps Brachii (Long Head)
What are the general signs & symptoms?
- In all stages of tendinosis, stiffness & pain are present, especially with resisted movements and stretching - Stretching the damage tendon
- Often the client can clearly identify the location of tendinopathy
- Pain is frequently described as “severe” or “sharp” in early stages, “dull ache” after tendinopathy has been present for a longer period
Tenosynovitis has an added feature of?
Resistance & crepitus as the affected tendon moves through its sheath
Tendinitis presents with classic signs of ______ and & is categorized by ______
- Inflammation
- Grade
What is the sign & symptom of Grade 1 tendinitis?
- Pain after activity only
- Playing tennis but hurts after playing
What is the sign & symptom of grade 2 tendinitis?
- Pain at beginning of activity, disappears during activity, then returns after the activity
- Pain at beginning of playing tennis, disappears during, goes home & it hurts
What are the signs & symptoms of grade 3 tendinitis?
Pain at beginning, during and after activity : pain may restrict activity
What are the signs & symptoms of grade 4 tendinitis?
Pain with ADLs
What are contraindications & precautions?
- No frictions with anti inflammatory or blood thinners
- Avoid joint movements that produces pain or will overstretch that injured tissue
- If repeated cross fiber strokes produces inflammation, end with cool or cold local hydrotherapy
Assessment
- AROM usually painless (tendon damage, not muscle)
- PROM pain in the range that STRETCHES the affected tendon
- RROM pain in the range that TESTS THE AFFECTED MUSCLE, pain increases with the force of contraction, and possible weakness
- Strength testing possible weakness and pain, especially if testing the muscle in a lengthened position
- Length testing of the affected muscle is likely painful
- Potential impact on ADLs
- Positive tendinopathy tests (de Quarvain’s)
What assessments to do in acute?
- Antalgic gait or posture
- Signs of inflammation may be visible
- Palpation reveals point tenderness of the affected tendon, as well as hypertonicity & TPs (local & antagonists)
What assessment to do in chronic?
- Postural assessment to determine source of muscle imbalances
- Palpation reveals pain at or near the tendon, adhesions, stiffness, HT, TPs, and possibly crepitus
What are goals in acute?
- Control inflammation (if present)
- Reduce pain via (strip, frictions)
- Prevent excess adhesion formation
- Maintain strength, function & mobility
- ASAP, gradual return to movement within pain tolerance to avoid excess scar tissue formation
- Encourage local circulation
What are goals in chronic?
- Decrease muscle imbalance
- Restore mobility
- Normalize muscle tone
- Gradually restore muscular length & strength
- Reduce TPs & adhesions
What are techniques?
- Compressions increase circulation
- Stripping, kneading reduce HT
- Pickups, open c’s
- Stretching reduce adh form
- AROM
What are homecares?
- RICE
- Breathing
- Contrast / hot to increase local circulation
- Stretching (slow and pain free)
- up to pain
- AROM - Strengthening (eccentric contractions)
- low level : isometric / isotonic
