Week 1 - MSK pathologies contractile tissues Flashcards
What is tendinopathy?
pain and dysfunction associated with any tendon caused by disease or disorder
Name some common areas affected by tendinopathy in the lower limb
glutes
patella
Achilles
tib post
hamstrings
peroneals
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)
Name some risk factors of tendinopathy
overload/underload
changes in load/training
age
previous injury
increased BMI
Diabetes
Medication
Genetic factors
What is tendinopathy generally triggered by?
overload of a tendon
Name the stages of tendinopathy (cellular level)
altered tendon cell population
disorganisation of collagen
ground substance changes
nuerovascularization
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
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
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
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
What does stress shielded mean?
What would be a normal load for a healthy tendon becomes too much
What are the 3 stages of tendinopathy?
reactive tendinopathy
tendon dysrepair
degenerative tendinopathy
Name some factors that could increase the wear on a tendon
training load
error
previous injury
muscle weakness
biomechanics
Name some factors that can cause repair of a tendon to be reduced
tendon structure
increased BMI
Diabetes
Medication
Age
Gender
Genetics
What are the general signs and symptoms of a tendinopathy?
pain when using that tendon or contractile unit
weakness
decreased function
swelling
How do we manage a tendinopathy?
education
exercise
load modified/management
Stretches
Shockwave
Manual therapy
What is the most prevalent lower limb tendinopathy?
Gluteal tendinopathy
In what populations is gluteal tendinopathy found in?
more commonly in females than males
occurs mostly in mid-life
Which tendons are involved in gluteal tendinopathy?
Gluteus Medius and Minimums
What causes gluteal tendinopathy?
combination of excessive compression and high load
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
