Tendinopathy Flashcards
What is a tendon?
A dense regular connect tissue that attaches muscle to bone
Why is a tendon injury a ‘tendinopathy’, not tendonitis?
There are no inflammatory markers present in tendon injuries
What are the signs and symptoms of a tendinopathy?
- Localised pain
- Morning pain & stifness
- Pain on load / activity
- Pain on provocative tests
- History = usually gradually worsening pain
What are the three stages of the tendinopathy continuum?
- Reactive tendinopathy
- Dysrepair
- Degenerative Tendinopathy
What are some of the intrinsic risk factors for tendinopathy?
- Age
- Genetics
- Anatomy / Biomechanics
- Leg-length discrepancies
- Mal-alignments
- Bony impingement
- Muscle weakness
- Joint laxity
- Gender?
- Body weight
- Nutrition
- Systemic disease
What are some of the extrinsic risk factors for tendinopathy?
- Occupation
- Sport
- Physical load
- Excessive force
- Repetitive loading
- Abnormal training errors
- Decreased eccentric strength
- Poor technique
- High intensity
- Fatigue
- Shoes / Equipment
- Environmental conditions
- Temperature
- Running surface
Describe the reactive tendinopathy stage
Reactive tendinopathy is a reaction to an acute overload causing adaptive thickening of a portion of tendon.
The increase overall volume of the tendon = reduces stress on the area
Collagen fibre integrity is largely maintained = reversibility of this stage
What can cause reactive tendinopathy?
- Acute overload, usually a burst of unaccustomed physical activity
- Direct blow, such as falling onto patella tendon
Who may be at risk of reactive tendionopathy?
- V. Common in young athletes - especially if they have dramatically increased their load
- Detrained athletes returning from illness or injury
- Sedentary person who has moderately increased their load
How can we diagnose reactive tendinopathy?
- Subjective history
- Very painful
- Mild effusion on ultrasound & MRI (from increased water bound in the matrix)
What is tendon dysrepair?
Tendon dysrepair is the failed healing response following persistent overload.
Resulting in:
- Greater matrix breakdown and disorganisation
- Neovessels and nerve in-growth develops in tendon
- Increased production of Type 3 collagen (Weaker)
Structural change is more permanent & less reversible
What is degenerative tendinopathy? What is the prognosis and who is likely to suffer from it?
Large changes in the matrix:
- Type 1 collagen reduces & is replaced by type 3 & debris (weaker to tensile stress)
- Poor prognosis for structural reversal = rupture is possible with tendon stress
- Structural reversal is unlikely - but tendon should still adapt to functional loading
- Surgery is considered
- Clinically more common in older patients or young athletes with substantial load
Describe the relationship between prognosis & pain through the continuum
The relationship between prognosis and pain is paradoxial.
Acute reactive tendon
- Significantly painful
- Structural integrity intact
- Good Prognosis
Degenerative Tendon
- Significant pain absent
- Structurally Weakened
- Poorer Prognosis
What are some of the treatments for tendinopathy?
- Specific exercise programmes (eccentric, isometric, heavy slow resistance)
- Thermal modalities
- Injection therapies
- Pain killers & NSAIDs
- Electrotherapy
- Epicondylar clasp / strapping
- Acupuncture
- Surgery
As a physio, how would you manage a reactive tendinopathy / early tendon dyrepair vs. Late tendon dysrepair/degeneration?
Early - Load management, reduction in frequency intensity of tendon load
Late - Exercise with eccentric component, shockwave therapy, ultrasound, frictions
