Week 1 - MSK pathologies contractile tissues Flashcards by Jenna Mowatt

What is tendinopathy?

pain and dysfunction associated with any tendon caused by disease or disorder

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Name some common areas affected by tendinopathy in the lower limb

glutes
patella
Achilles
tib post
hamstrings
peroneals

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Name some common areas affected by tendinopathy in the upper limb

rotator cuff
long head of biceps
lateral epicondylagia
medial epicondylagia
De Quervains (APL and EPB)

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Name some risk factors of tendinopathy

overload/underload
changes in load/training
age
previous injury
increased BMI
Diabetes
Medication
Genetic factors

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What is tendinopathy generally triggered by?

overload of a tendon

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Name the stages of tendinopathy (cellular level)

altered tendon cell population
disorganisation of collagen
ground substance changes
nuerovascularization

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What happens in the first stage of a tendinopathy (cellular level)?

increased number of tenocytes
increased tenocyte metabolism
increased immature tenocytes (which don’t produce collagen)
Increased rate of apoptosis
immunoreactive cells

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What happens What happens in the second stage of a tendinopathy (cellular level)?

reduced type 1 fibres
increased type 3 fibres
higher concentration of immature collagen bundles

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What happens in the third stage of a tendinopathy (cellular level)?

increased proteoglycans
leads to increased water content -> causes increased cross section of tendon, breaks down cross fibres between collagen making tendon weaker
chemical alterations -> increased substance P, glutamate and lactate

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What happens in the final stage of a tendinopathy (cellular level)?

influx of blood vessels and nerves ingrowing into the tendon which makes it more sensitive

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What does stress shielded mean?

What would be a normal load for a healthy tendon becomes too much

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What are the 3 stages of tendinopathy?

reactive tendinopathy
tendon dysrepair
degenerative tendinopathy

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Name some factors that could increase the wear on a tendon

training load
error
previous injury
muscle weakness
biomechanics

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Name some factors that can cause repair of a tendon to be reduced

tendon structure
increased BMI
Diabetes
Medication
Age
Gender
Genetics

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What are the general signs and symptoms of a tendinopathy?

pain when using that tendon or contractile unit
weakness
decreased function
swelling

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How do we manage a tendinopathy?

education
exercise
load modified/management
Stretches
Shockwave
Manual therapy

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What is the most prevalent lower limb tendinopathy?

Gluteal tendinopathy

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In what populations is gluteal tendinopathy found in?

more commonly in females than males
occurs mostly in mid-life

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Which tendons are involved in gluteal tendinopathy?

Gluteus Medius and Minimums

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What causes gluteal tendinopathy?

combination of excessive compression and high load

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What are the clinical signs and symptoms of gluteal tendinopathy?

lateral hip pain/tenderness around greater trochanter
pain on walking/standing on one leg/getting up from sitting/side lying

What can we do to manage gluteal tendinopathy?

education
load management
avoid compressive exercises in early stages
shockwave therapy
corticosteroid injection
surgical intervention

In what sports is there a high prevalence of patella tendinopathy?

jumping sports

Name some risk factors of patella tendinopathy

weight
BMI
Leg length difference
arch height of foot
quads flexibility/strength
hamstring flexibility
Vertical jump performance

What are the clinical signs and symptoms of patella tendinopathy?

anterior knee pain decreased function

How can we manage patella tendinopathy?

Education load management exercise taping corticosteroids shockwave surgical intervention

In what populations is achilles tendinopathy most prevalent?

Elite runners 1/3 of cases are non athletes

What causes Achilles tendinopathy?

overload/underload Biomechanical factors -> overpronation of foot, footwear, training surfaces

What are the clinical signs and symptoms of achilles tendinopathy?

pain and swelling in and around the tendon pain often at its worst at the start and end of a training session tender, nodular swelling usually present

How do we manage achilles tendinopathy?

education load management exercise taping surgery shockwave injections

Describe the prevalence of plantar fasciopathy

1 in 10 people will suffer from it in their lifetime peak incidence between ages 45-65 no difference between men and women increased risk with increased BMI

What are the clinical signs and symptoms of plantar fasciopathy?

pain at the proximal insertion of the plantar fascia, particularly with big toe extension and ankle dorsiflexion Often painful first thing in the morning and after activities/at the end of the day

How can we manage plantar fasciopathy?

education load management exercise -stretching/strengthening orthotics steroid injection shockwave surgery

Name some causes of rotator cuff related shoulder pain

sub-acromial pain syndrome rotator cuff tendinopathy rotator cuff tears

What are the clinical signs and symptoms of rotator cuff related shoulder pain?

pain and impairment of shoulder movement and function, usually during shoulder elevation and lateral rotation painful to lie on affected side

How can we manage rotator cuff related shoulder pain?

education exercise symptom modification steroid injection surgery

What is another name for tennis elbow?

lateral epicondylagia

What is the prevalence of tenis elbow?

most common in 40s/50s male=female

What are some risk factors of tennis elbow?

smoking obesity

Which tendons are affected from Tennis elbow?

ECRB is the most commonly affected supinator, ECRL, ED, EDM, ECU

What can cause tennis elbow?

excessive/ repetitive use can cause it - musicians, computer users, manual workers, racquet sports

What is another name for golfers elbow?

medial epicondylagia

What does golfers elbow affect?

the common origin of the flexors and pronators

What are the clinical signs and symptoms of medial epicondylalgia?

pain on the medial aspect of the elbow - pain on palpation aggravated by resisted/repetitive wrist flexion on pronation, valgus stress, stretching aggravated by throwing/gripping reduced grip strength can involve ulnar nerve

How can we manage golfers elbow?

education load management]exercise brace/taping NSAID corticosteroid injection shockwave surgery

In what type of people is De Quervains most common in?

women new mothers 40-50 years

What causes De Quervains?

inflammation of the synovial sheaths of EPB, APL swelling of the sheaths, leading to eventual thickening of the sheath adhesions may develop between the tendon and the sheath which restricts normal tendon movement enclosed tendons can become constricted may occur spontaneously or can be initiated by overuse of the thumb

What are the clinical signs and symptoms of De Quervains?

pain on the radial side of the wrist that can be referred to the thumb aggravated by resisted thumb extension/abduction, or by stretching the affected tendon pain on palpation of affected tendons

How can we manage De Quervains?

Education Load management Exercise Splinting NSAID corticosteroid injection shockwave surgery

How do we manage sprains/tears?

POLICE/PRICE mobilisation - as soon as possible proprioception endurance training surgery

Name some common muscles for tears

pec Major LHB Rotator cuff Quads/Hams Achilles tendon