Tendon And Bone

Question 1

What are the mechanics of tendons

Answer 1

They transfer muscle generated force to the skeleton
They are 75-85% collagen - and have a stiff structure due to fibre alignment

Question 2

What load do tendons like and dislike

Answer 2

Agree with progressive tensile loading with adequate rest
Dislike compression torsion repeated loads without adequate rest

Question 3

What model can explain tendon injuries

Answer 3

Stress / strain curve
Toe region - linear region - failure

Question 4

What is an acute tendon injury and what causes them

Answer 4

A partial tear
Rupture - age, degeneration, medication
Avulsion - age, location, mechanism

Question 5

What is a chronic tendon injury

Answer 5

Tendinopathy

Question 6

What is a tendinopathy and what does it result in

Answer 6

Overuse injury that results in pain, decreased exercise tolerance and reduced function

Question 7

What causes tendinopathy

Answer 7

By LOAD,
Repetitive storage and release
Excessive compression

Question 8

What is the continuum of pathology for tendinopathies

Answer 8

The transition from a normal tendon through to degenerative
Tendon in dysrepair stage has potential to reverse
Reversibility is unlikely in the degenerative stage
Tendon can move up and down continuum by adding or removing load

Question 9

What are the stages of tendinopathy

Answer 9

Reactive - tenocyte activity is unregulated
Disrepair - tenocytes can’t keep up with regeneration of collagen and start to break down - disrepair tendon is when change doesn’t happen quick enough and isn’t offloaded
Degeneration - tenocyte death - causes reduction of collagen

Question 10

What are the typical tendinopathy gradual onset of symptoms

Answer 10

AM stiffness or after prolonged mobility
Pain with palpation
Pain with SSC activities like running, jumping
Deficits in strength and performance

Question 11

What is the normal 24hr symptoms of tendinopathy

Answer 11

P ++ in AM
Eases during day with ADL, movement, light exercise
P ++ in PM

Question 12

What is the treatment approach for tendinopathy

Answer 12

Two pronged approach
You modify risk factors to target the cause
Extrinsic factors can be identified and modified
Intrinsic factors are related to the biomechanics of kinetic chain

Question 13

What are the exercises based on in the two pronged approach of tendinopathy
Give order for rehab

Answer 13

Balance pain and load
Eccentric loading
1. Isometric
2. Strength
3. Functional strength
4. Speed
5. Plyometrics
6. Return to play

Question 14

Why is eccentric loading used in tendinopathy rehab

Answer 14

Stimulate cell activity
Increased protein production and restructure matrix
Increase collagen production and decrease in pain

Question 15

What is the composition of bone

Answer 15

Organic compounds - 90% type 1 collagen
Inorganic compound - calcium and phosphate

Question 16

What are the 3 types of bone cells

Answer 16

Osteoblasts - build, make new bone tissue and help repair
Osteoclasts - clear, break down bones and help form them to correct shape
Osteocytes - mature bone cells

Question 17

What does bones being anistrophic mean

Answer 17

Stress is dependent on direction of strain

Question 18

What are the mechanical properties of bone

Answer 18

Compact and can absorb a great deal of mechanical energy before fracturing
Suffer from fatigue that can cause micro damage and stress fractures

Question 19

What are the two types of bone and which one is stronger

Answer 19

Trabecular - spongy bone -
Cortical - compact bone - external parts of long bone

Question 20

What are the signs and symptoms of fractures
MOI ?

Answer 20

Patient reports an audible crack/pop
MOI - traumatic, direction of force,
NWB - gait change of avoidance to use
++ pain

Question 21

What will indicate a fracture when assessing a patient

Answer 21

Obs - visual abnormality
Lots of pain on palpation and compression
Muscle atrophy

Question 22

What law is used in bone healing

Answer 22

Wolffs law
Balance between absorption and bone formation

Question 23

What are the 2 levels in the mechanical properties of bone healing

Answer 23

Lvl 1 = constant repair of micro damage
Lvl 2 = fracture and breaks
- need blood flow to site so blood clot formed
- rapid formation of callus provides temporary strength and support

Question 24

What is the pathophysiology of bone healing
What are the 3 stages

Answer 24

Inflammatory - hours to days
Reperative - days to weeks
Remodelling - months to years

Question 25

What principles are used for bone healing management

Answer 25

Reduction - manipulate bone into correct anatomical position
Immobilisation - hold bone in correct reduced position
Rehabilitation

Question 26

Who created the continuum for tendinopathy of a tendon

Answer 26

Cook and purdam