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MSK 1 > 10/28 - Patellar Tendinopathy > Flashcards

10/28 - Patellar Tendinopathy Flashcards

1
Q

what structure is a hallmark for tendinopathy

A

lose highly striated, tightly packed, organized structure
- becomes highly degenerated

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2
Q

what are 6 signs of a failed healing response

A
  1. hypercellularity
  2. microtearing (w/i tissue)
  3. loss of tightly bundled collagen
  4. inc proteoglycan content
  5. neovascularization
  6. absent / minimal inflammation
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3
Q

what are 4 intrinsic factors that contribute to tendinopathy

A

age
body composition
ROM
strength (possibly)

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4
Q

how is age an intrinsic factor for tendinopathy

A

prevalence inc w age
predisposition rather than cause
- inc stiffness & limited tolerance to load
—-> dec proteoglycans
—-> inc cross-links

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5
Q

how is body composition an intrinsic factor for tendinopathy

A

inc waist circumference linked to patellar tendinopathy (and also achilles)

tendinopathy inc w inc adipose tissue

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6
Q

how is ROM an intrinsic factor for tendinopathy

A

dec amt of DF
- inc amt & rate of loading

leading to both patellar and achilles tendinopathy

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7
Q

how is strength an intrinsic factor for tendinopathy

A

literature mixed as to if there is a positive or negative association of tendinopathy with weakness

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8
Q

what are 5 extrinsic factors for patellar tendinopathy

A
  1. corticosteroids
  2. training errors
    - distance, intensity, technique
  3. training surface
    - uneven, incline, rigid
  4. environment
    - cold, wet climate
  5. footwear / equipment
    - esp if direct pressure
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9
Q

what sports have a higher incidence of patellar tendinopathy and why

A

volleyball - inc GRF in take-off
basketball
running

jumping and landing sports, higher incidence d/t GRF

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10
Q

what are anatomical factors that contribute to the epidemiology of patellar tendinopathy (2)

A

dec quad and hamstring flexibility
patellar maltracking

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11
Q

what is the enthesis

A

part of tendon that attaches to bone

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12
Q

what are 3 locations of patellar tendinopathy pathology

A
  1. enthesis site
  2. inferior pole of patella (post)
  3. infrapatellar fat pad highly innervated
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13
Q

what is a technique utilized with other pathologies that might not be useful in patellar tendinopathy

A

palpation - depends on patient

may be able to differentiate things within tendon or the fat pad if come off laterally

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14
Q

during the exam what are hx questions we want to ask (3)

A

prior hx of patellar tendinopathy
prior hx of tendinopathy in other locations and where
pain w loading (jumping, stairs)

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15
Q

what are 4 things to assess in the exam

A
  1. strength - gluts, quads
  2. ms length
    - limited quad and hamstring
    - (+) thomas, ely, SLR, 90-90
  3. ROM - dec DF
  4. palpation
    - inferior pole of patella
    - enthesis
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16
Q

what is an outcome measure for determining patellar tendinopathy

A

VISA-P

17
Q

what are 5 differential dx for patellar tendinopathy and why are these probable

A
  1. PFPS
  2. osgood-schlatter’s dz
  3. bursitis
  4. ant meniscal tear
  5. Hoffa’s dz

all present w ant knee pain
prox weakness or distal ROM/weakness can contribute to knee pain/dysfunction

18
Q

what imaging is appropriate for patellar tendinopathy and why

A

radiographs
- r/o osgood schlatter

CT - not often used bc radiation exposure

MRI** best sensitivity/specificity
- expensive and inc scan time

US - inc utilization
- highly operator dependent

19
Q

what imaging is the most commonly used to patellar tendinopathy and how is it utilized

A

US

assess for hypoechoic region
- disruption of collagen arrangement

20
Q

what is a risk factor for developing sx patellar tendinopathy and what is the significance of US in screening for this

A

asymptomatic hypoechoic regions of patellar tendon

doppler is able to pick up the neovascularity

21
Q

what are 4 interventions for patellar tendinopathy

A
  1. relative rest / reduce tendon load
  2. flexibility - quads, hammies
  3. cross friction massage
  4. eccentric exercise
22
Q

what does relative rest mean

A

immobilization is contraindicated

trying to just reduce tendon load

23
Q

why is cross friction massage utilized

A

break up degenerative tissue to incite normal inflammatory process and inc fibroblastic activity -> create healing environment w normal collagen alignment

24
Q

why is eccentric loading the primary exercise we want

A

helps to realign and restructure the collagen
- should be uncomfortable to disrupt the scar tissue
- we are using loading to remodel the tissue

25
Q

what anatomical changes were seen as a result of eccentric activity

A

inc type 1 collagen
inc tendon stiffness
dec neovascularity -> thus dec pain

26
Q

what is the main eccentric activity that should be introduced as soon as possible bc it is just chefs kiss

A

decline squat
- whether both legs or unilateral

27
Q

why do we love decline squats in this population

A

inc patellar tendon force
inc patellar tendon strain and quad EMG

28
Q

what did research show ab the duration of eccentric and tissue loading exercises

A

likely doesn’t matter the duration as long as tissue is loaded

29
Q

what is PRP, what does the evidence say and how has this been utilized to treat patellar tendinopathy

A

taking platelet rich plasma (PRP) adn spinning in centrifuge and then injecting back into same site to stim healing

mixed literature - depends on body part and patient

combo w PT is important

30
Q

what are the 2 main predisposing factors to consider

A

flexibility
training errors

31
Q

what is the typical duration of most protocols

A

10-12wks

32
Q

what should interventions address and be biased toward

A

address faulty biomechanics w bias toward eccentric strengthening

MSK 1 (31 decks)

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