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MSK Exam 3 > Tendons and Healing > Flashcards

Tendons and Healing Flashcards

1
Q

Describe dense regular connective tissue.

A
  • Type 1 collagen (resists tension: dense connective tissue)
  • Low elastin
  • Fibrocytes
  • Parallel fibers for more unidirectional loads
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2
Q

Tendons resist what?

A

Tension and releases energy with muscle action

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3
Q

More stiffness (beneficial for tendon) will give you what kind of transmission or potential energy?

A

Better force transmission for storing of potential energy

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4
Q

What is the structure of a tendon (connects muscle to bone)?

A

Smallest:
- Collagen Fibril
- Collagen Fiber
- Primary Fiber Bundle (sub-fascicle)
- Secondary Fiber Bundle (fascicle)
- Tertiary Fiber Bundle
- Tendon
Largest:

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5
Q

Is the mid portion of a tendon hypo or hyper vascular and hypo or hyper neural?

A
  • Hypovascular
  • Hyponeural
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6
Q

Is the insertion of a tendon hypo or hyper vascular and hypo or hyper neural?

A
  • Hypervascular
  • Hyperneural
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7
Q

What is the prevalence of a tendinopathy?

A
  • 30% of general musculoskeletal injuries
  • 30-50% of sport injuries
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8
Q

Is tendinitis common or uncommon?

A

Uncommon

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9
Q

What is tendinitis?

A

Inflammation of a tendon without structural changes due to overuse

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10
Q

What are signs and symptoms of tendinitis?

A
  • Typically acute and classic presentation
  • TTP (tender to palpation)
  • Pain and limitation with lengthening
  • Pain with resisted testing and MMT, particularly in a lengthened position - may be weak
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11
Q

What kind of tendinopathy is the most common?

A

Tendinosis

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12
Q

What is tendinosis?

A

Degenerative changes with some inflammation

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13
Q

What is tendinosis due to?

A
  • Repetitive stress and tendinitis
  • Impingement pathomechanics
  • Neural/ vascular insufficiency
  • Exercise induced hyperthermia
  • Older age
  • Hormonal fluctuations
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14
Q

If a tendinosis is acutely irritated what signs and symptoms present? (big picture… it presents like what other tendinopathy)

A

Tendinitis Signs and Symptoms

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15
Q

What are specific tendinosis symptoms?

A
  • Persistent (> 4-6 weeks) often with previously failed PT
  • Decreasing tendon tolerances
  • Often mislabeled as tendinitis and treated as such
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16
Q

What are specific tendinosis signs?

A
  • Observation: enlarged tendon may be visible
  • Acts like tendinitis if acutely inflamed
  • Otherwise … ROM and resistance testing and MMT likely WNL
  • No convincing association between strength deficits and tendinopathy
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17
Q

What are you going to see with palpation and tendinosis?

A
  • TTP with decreased pain thresholds
  • Increased in-growth of vessels and nerves
  • Elevated pain neurotransmitters
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18
Q

What are the special tests specific to for tendinosis?

A

(+) special tests specific to tendon, etiologies, and pathomechanics

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19
Q

What amount of inflammation is there with tendinosis?

A

Little to no inflammation

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20
Q

What kind of fiber changes do you see on imaging with tendinosis?

A
  • Degeneration and disorganization that also may be present prior to symptoms
  • Weakened and greater likelihood of overload
  • Increased non-collagen matrix
  • Fatty infiltration
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21
Q

What do corticospinal (voluntary movement) influences do to tendinosis?

A
  • Increased inhibition
  • Increased excitability (aberrant/ excessive firing)
  • Bilateral influences as well
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22
Q

Are acute tendon tears common or rare?

A

Rare

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23
Q

Where do you see higher and oblique forces?

A

During fast eccentric loading

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24
Q

When do you typically get and acute tendon tear?

A
  • With higher and oblique forces during fast eccentric loading
  • Prior degeneration or tendinosis
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25
Q

Why are acute tendon tears more likely with age and disuse?

A
  • Elastin and vascularity decrease
  • Atrophy and drying
  • Shorter smaller tendon is less pliable and durable
26
Q

When do most tendinitis heal?

A
  • Primarily resolution of inflammation
  • At most in 4-6 weeks (sometimes 2 weeks: inflammation phase)
27
Q

When do most tendinosis and smaller tears heal?

A
  • Primarily proliferating tendon (repair phase)
  • Tensile strength initially improves at 3-5 weeks
  • Even greater tensile strength when dense fibrous tissue fills in at 8 to 12 weeks
  • Gradual and partial tears can improve with PT
28
Q

Traumatic and full tear tendinosis likely require what?

A
  • Surgery
  • 10-12 months to normal strength postoperatively
29
Q

What kind of patient education should you be doing with patients with tendinitis and tendinosis?

A
  • Load management: optimal loading
  • POLICED
30
Q

NSAIDS should be used for _____ _____ pain relief in acute presentations.

A

Short term … because they dont address the problem

31
Q

NSAIDS delay healing if the injury is where?

A

At the insertion

32
Q

NSAIDS have poor response and no support in what kind of tendinitis and tendinosis presentations?

A

Persistent presentations … because they have little to no inflammation at this point

33
Q

Bracing (neoprene sleeves on the involved muscles) and taping (prn/ straps) decrease what?

A

The resistance arm

34
Q

Do modalities have any impact on tendinitis and tendinosis?

A

Modalities - iontophoresis, ultrasound, phonophoresis, and low-level laser treatment lack sufficient evidence at this time

35
Q

What should you tell you patient with a tendinosis in regards to their soreness with ADLs and exercise?

A

It is okay to have mild symptoms during or up to 24 hours after exercise, but no more and no longer

36
Q

What does manual therapy help with in regards to tendinosis?

A

Manual therapy helps to restore accessory motion as needed

37
Q

What should be the primary and ultimate goal for tendinosis MET?

A
  • Tendon proliferation
  • Possible spinal stabilization if regional interdependence
38
Q

When should you implement parameters for tendinosis?

A

After any acuity settles and for all structural changes in tendon, including tears

39
Q

Should your parameters have heavy or light loads with tendinosis?

A

Heavy

40
Q

What kind of actions should you do with tendinosis parameters?

A
  • Slow eccentrics
  • Possibly 3 second muscle actions (concentric, isometric, and eccentric)
41
Q

Parameters pertaining to actions and ranges for tendinosis are what… (he uses an example with the biceps … shortened position is elbow flexed and shoulder flexed)

A
  • Isometric loading without compression from lengthening - isometrics in a shortened position
  • Isotonic loading without compression from lengthening - isotonic from neutral into shortened position
  • Isotonic loading with compression from lengthening - isotonic from a lengthened position
  • (Isometric loading in weight bearing), I.e., UE weight shifting, planks, push ups, etc
  • Plyometric loading, I.e. ball bounces, tosses, throwing, etc.
42
Q

What kind of position prevents compression?

A

Shortened

43
Q

How many sets, reps, and exercises should you give your patient with a tendinosis?

A
  • 2-3 sets of 10-15 reps to fatigue
  • 2-3 exercises with involved tendons
44
Q

What kind of activity response should you see with a tendinosis?

A
  • Mild to moderate increase in pain possibly up to a 5/10
  • Timeframe of pain should ease back to baseline levels before repeating exercises 24-48 hours
  • Soreness Rule: Mild symptoms during or up to 24 hours after exercise as long as it is no more or no longer
  • Most likely can repeat exercises every other day; may increase to daily in higher level patients
45
Q

How long should your MET program be for a tendinosis?

A

8-12 weeks

46
Q

What kind of tendinosis populations should have precautions with heavy loads to fatiguing points?

A
  • Deconditioned populations
  • Peri-pubescent population until growth plates are fused
47
Q

What are the most important areas to watch for growth plate fusions?

A
  • Humeral head epiphysis at the shoulder
  • Last growth plates to fuse are the ASIS, ischial tube, and the base of the 5th metatarsal
48
Q

What muscle attaches to the ASIS?

A

Sartorious

49
Q

What muscles attaches to the Ischial tuberosity?

A
  • Big picture: Hamstrings!
  • Inferior Gemellus
  • Quadratus Femoris
  • Adductor Magnus
  • Biceps Femoris
  • Semitendinosus
  • Semimembranosus
50
Q

What muscles attaches to the base of the 5th metatarsal?

A

Fibularis Brevis

51
Q

What is a predisposition patients with tendinosis have? (in regards to healing)

A

Patients have a predisposition or prevalence for “failed healing response”

52
Q

Pts with both a tendinosis and obesity are prone to what complication?

A

Obesity: excessive fat absorbs inflammatory cells away from the tendon

53
Q

Pts with both a tendinosis and diabetes are prone to what complication?

A

Diabetes: excessive glucose impairs collagen production and remodeling

54
Q

Low grade and persistent inflammation is associated with what (in regards to tendinosis).

A
  • Associated with systemic disease(s) and/ or SAD diet
  • Limits proliferation and remodeling
55
Q

Do MD Rx have long term or functional benefits?

A

No

56
Q

What kind of benefits do cortisone injections have?

A

Short term benefits

57
Q

What kind of benefit do glycerin trinitrate patches have?

A

Effective by increasing circulation

58
Q

What do sclerosing injections do?

A

Stiffen tendons for pain relief

59
Q

Is surgical debridement the first or last option when it comes to MD Rx?

A
  • Last option
  • Expensive
  • Modest Success
  • This is basically scrapping the tendon to get tendon proliferation
60
Q

What are future options in regards to MD Rx when it comes to tendinosis?

A
  • Growth factors
  • Stem cells

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