Tendinopathy

Question 1

Tendon structure

Answer 1

Fibril
v
Fibre
v
Fascicle
v
Tendon

• Tendon Crimp = bunched part of tendon that extends on stretch (uncrimping)
• Fascicles = surrounded by endotendon (interfascicular matrix) which is a rich source of cells that can then move into tissue

Question 2

Define tendinopathy (vs itis/osis)

Answer 2

> Tendinopathy - active process of degeneration that involves inflammatory pathways (ie problem with tendon)
Tendinitis - inflammation of tendon
Tendinosis - degeneration of tendon

Question 3

Cellular Process

Answer 3

(similar to that of OA)
> Tendon cell is over/ understimulated
> becomes primed (overly switched on)
> overreacts to stress
> produces wrong chemicals
> stimulating autoimmune response
> if not resolved this can lead to chronic inflammatory response

Question 4

Structural process - Tendon cell population

Answer 4

> Increased no. of tenocytes (up to 6x)
Increased tenocyte metabolism
Increased no. of immature tenocytes (don’t produce correct collagen)
Increased rate of apoptosis (programmed cell death)
Increased no. of immunoactive cells

Question 5

Structural Process - Disorganisation of collagen

Answer 5

> Reduced type 1 collagen (organised - rope)
Increased type 3 collagen (stringy)
Disorganised area (appears mushy)

Question 6

Stuctural process - ground substance changes

Answer 6

> Proteoglycan (PG) and Glucosaminoglycan (GAG) content alters (natural lubricants)
Increased H2O content - PG + GAG = hydrophillic - draws water in (breaks cross bonds - weakens tendon)
Increased levels of substance P, glutamate and lactate (sensitises neural tissue)

Question 7

Structural process - neovascularisation

Answer 7

> Blood vessels + nerves grow into anterior and mid surface of tendon (therefore we have increased number of nerve endings where there shouldn’t be and also sensitisation of those nerve endings)

Question 8

Risk Factors

Answer 8

> Modifiable

• Tendon Load (exercise trigger collagen degradation followed by synthesis which can take between 24 and 72 hours)
• Muscle power
• Obesity (increases cytokine levels - increased inflammation throughout body)
• Cholesterol

> Un- modifiable

• Diabetes (sugar forms in tissue + collagen = less flexible)
• Genetic factors
• Early menopause
• Rheumatological disease
• Recent Sciatica
• Recent injury

Question 9

Generally affects

Answer 9

> Older athletes (late 20’s)
Active @ 40 yrs
Inactive @ 60 yrs
Rapid changes in loading

Question 10

Common tendinopathies

Answer 10

> UL 
- Rotator Cuff (particularly supraspinatus)
- Lateral epicondylalgia (tennis elbow)
- Medial epicondylalgia (golfers elbow)
> LL 
- gluteal tendinopathy 
- Patella tendinopathy
- achilles (mainly insertional/ mid tendon)
\+ tib post
\+ peroneal