W1 - MSK Contractile Tissue Flashcards
What is a tendonopathy
Pain or dysfunction associated with any tendon
What are the common areas affected by a tendonopathy in the lower limb
Glutes
Patella
Achilles
Posterior tibia
Hamstrings
Peroneals
What are the most common areas affected by tendinopathy in the upper limb?
Rotator cuffs
Long head of biceps
Lateral and medial epicondylalgia
De Quervains (abductor pollicis longus & extensor pollicis brevis)
What are the two types of risk factors?
Modifiable= patients can reduce their risk
Non-modifiable = patients cannot reduce their risk (genetic factors)
What are some of the common risk factors for a tendinopathy?
Overload and underload
Changes in load and training
Age
Previous injury
Increased BMI
Diabetes
Medication
Genetic factors
What age is more likely to develop per tendinopathy?
Athletic population over 40 years old or the sedimentary population over the age of 60
What is the structure of a normal tendon from outer to inner?
Tendon
Inter fascicular matrix
Fascicle (contain tenocytes)
Fibre (crimp waveform)
Fibril (think healthy ones & thin immature ones)
Tropocollagen (structure)
What are the 2 types of load
Tensile load
Compressive load
What is a tensile load
When the force occurs in a LONGITUDINAL direction to the collagen fibres
What is a compressive load
When the force occurs PERPENDICULAR to the college fibres
What is the first stage of the development of a tendonopathy
Altered tendon cell population
What happens in the altered te don cell population
Increased number of tenocytes & tenocytes metabolism
This means that there are more immature tenocytes that cannot produce collagen
This increases the rate of apoptosis (cell death due to no college for regeneration)
Immunoreactive cells
What is the second stage of the development of tendinopathy?
Disorganisation of collagen
What happens when the disorganisation of collagen stage?
Reduced type one fibres
Increased type three fibres
A higher concentration of immature collagen bundles
What is the third stage of the development of a tendinopathy?
Ground substances changes
What happens in the ground substance changes stage?
Increased proteoglycans
This leads to an increase in water tension causing an increased cross-section of the tendon which breaks down collagen fibres making the tendon weaker
Chemical alterations cause an increase in substance P , glutamate and lactate
What is the fourth stage of the development of tendinopathy?
Neovascilarization
What happens in the neovascularization stage
Blood vessels and nerves grown into the tendon making it more sensitive
What factors can increase wear on a tendon
Training load or errors
Previous injuries
Muscle weakness
Biomechanics
What factors can affect the repair of tendinopathy?
Tendon structure
Increased BMI
Diabetes
Medication
Age
Gender
Genetics
What are the four general signs and symptoms of a tendinopathy?
Pain
Weakness
Decreased function
Swelling
Why would a physiotherapist manage tendinopathy by starting with isometric loading instead of eccentric loading?
Isometric loading has analgesic affects in some studies so it helps to reduce pain
Therefore, if a patient has a very irritable tenant using Isometric loading will help to reduce their pain
What is shockwave therapy?
Electrotherapy that promotes tissue healing
What is manual therapy?
Helps to manage your patients pain
What is a gluteal tendinopathy also known as?
Greater tronchanteric pain syndrome (GTPS)
Greater trochnteric bursitis
What are the common facts of a gluteal tendinopathy?
- Most common type of tendinopathy
- Occurs mostly in midlife and females are more at risk than males (especially long distance runners)
- Occurs between the ages of 50 to 79
- Gluteus medius and minimus tendons are involved
- Caused by a combination of excessive compression and high load
Why are women at a higher risk than men of developing a gluteal tendinopathy?
Women have an increased Q angle of their pelvis which means they naturally sit in more of a hip adducted position which compresses the tendon against the greater trochanter by the ITBY
What are the clinical signs and symptoms of a gluteal tendinopathy?
Lateral hip pain and tenderness around the greater trochanter (will be painful to palpate)
What are some aggravating factors of a gluteal tendinopathy?
Pain on walking
Standing on one leg
Getting up from sitting (being in a 90° angle of hip flexion for a prolonged period of time causes compression on the tendon)
Lying sideways (causes hip adduction which compressions the tendon)
What is the physiotherapy management of a agree to attend an empathy?
Education
Load management
Avoid compressive exercise exercises in early stages
Shockwave therapy
Corticosteroid injections
Surgery
What are the key factors of a patella tendinopathy?
Common and jumping sports
Risk factors include weight , BMI, leg length the difference, flexibility, and strength of hamstrings and quad muscles
Chronic overload theory is the most commonly used
Clinical signs and symptoms of a patella tendinopathy
Anterior knee pain near the patella attendant and any insertion points around the patella and tibia
Decreased function ( going up or down the stairs, kneeling, ect)
What physiotherapy management is used for a patella tendinopathy?
Education
Load management
Exercise (eccentric loading is more effective than concentric)
Taping (short-term reduction in symptoms)
Corticosteroids
Shockwave
Surgery
What are the common factors of an Achilles tendinopathy?
Common in elite runners and other athletes
Can occur at the insertion point or mid portion of the Achilles tendon
Caused by: overload or underload or mechanical factors, such as overpronation of the foot, footwear, training surfaces
Clinical signs and symptoms of an Achilles tendinopathy
Pain and swelling around the area
Pain is worse at the starting end of a training session
In severe cases attend a nodules swelling will be present
Physiotherapy management for an Achilles tendinopathy
Education
Load management
Exercise
Taping
Surgery
Shockwave therapy
Injections
Clinical signs and symptoms of a rotator cuff related shoulder pain
Pain and impairment of the shoulder movement and function during shoulder flexion and lateral rotation
Painful to lie on the affected area
Physiotherapy management for rotator cuff related injury
Education
Exercise
Symptom modification
Steroid injections
Surgery
What are the common facts of a lateral epicondylalgia (tennis elbow)
More common than 40s and 50s
Smoking and obesity or risk factor
ECRB is the most commonly affected
Caused by excessive and repetitive use
Clinical signs and symptoms of tennis elbow
Pain on the lateral epicondyle of the elbow (radiating in line with the extensors)
Various pain can be reported (intermittent, continuous and can vary in severity)
Aggravated by resisted wrist and finger extension and forearm supination
Stretching the tendon can also produce symptoms such as gripping
Physiotherapy management for tennis elbow and medial epicondylalgia
Education
Load management
Exercise
Brace/taping
NSAIDs
Corticosteroid injections
Shockwave therapy
Surgery
Two facts about medial epicondylalgia (golfers elbow)
Less common than tennis elbow
Common in age is 40 to 60
Common in females
Involves per terries and FCR
Clinical signs and symptoms of golfers elbow
Pain on the medial side of the elbow
Aggravated by resisted repetitive wrist flexion or pronation, vagus stress & stretching, throwing or gripping
Reduced grip strength
Can involve the ulnar nerve (20%)
