Tendinitis

Question 1

Definition of tendinitis

Answer 1

Inflammation of a tendon

Question 2

What is a tendon

Answer 2

-Dense collagen fiber that connect muscle to bone
-Part of the musculotendinous unit

Question 3

2 types of tendons

Answer 3

-Paratendon
-Sheath

Question 4

A paratendon surrounds

Answer 4

-A tendon that moves in a straight line
-Cord like

Question 5

Tendon sheath surrounds

Answer 5

-Tendons that run across a bony prominence- filled with synovial fluid (bursa)
-Sheet like (aponeuroses)

Question 6

Blood supply to paratendon

Answer 6

Blood vessels coiled in aveolar tissue-> vascularized

Question 7

Blood supply to tendon sheath

Answer 7

-Blood supply compromised when tendon is exposed to compression, friction, torsion-> avascular
-Limited blood supply from mm to bone

Question 8

Strength of tendon sheath

Answer 8

Have great tensil strength

Question 9

What happens when placing load on tendon sheath

Answer 9

It will straighten out, collagen fibers will deform->accounts for 4% of tendon lengthening

Question 10

What happens if a tendon sheath lengthens past 4%

Answer 10

Tendon will return to normal length

Question 11

What happens if a tendon sheath lengths past 8%

Answer 11

Collagen links begin to fail-> causing microtearing, partial tearing, even complete rupture

Question 12

Cause of tendinitis

Answer 12

Chronic overload of tendon

Question 13

Contributing factors of tendinitis

Answer 13

-Muscle imbalance
-Poor Biomechanics
-Lack of flexibility
-Chronic degenerative changes in tendon
-Poor blood supply to tendon

Question 14

Tendinitis due to

Answer 14

Microtearing of tendon fasicles do to overloading of tendon-> result in inflammation

Question 15

Grade 1 tendinitis

Answer 15

Pain after activity only

Question 16

Grade 2 tendinitis

Answer 16

Px beginning + after activity

Question 17

Grade 3 tendinitis

Answer 17

Pain throughout activity + after, pain may restrict activity

Question 18

Grade 4 tendinitis

Answer 18

With daily activity + tends to get worse

Question 19

What is paratendinitis

Answer 19

Inflammation of Paratendon or tendon sheath

Question 20

What is tendenosis

Answer 20

-Degenerative changes occurring with chronic overuse tendon injuries (tennis elbow) No inflammation in tendon itself

Question 21

Contributing factors of tendenosis

Answer 21

Aging/avascularity may be contributing factors

Question 22

Medical treatment for tendinitis acute stage

Answer 22

-Rest
-Ice
-NSAIDS
-Stretching
-Strengthening
-Return gradually to activity
-In arms use support strap
-Surgery- necessary with total rupture especially in shoulder

Question 23

Other tendon pathologies

Answer 23

-Shoulder tendons
-Rotator cuff pathologies

Question 24

Impingement syndrom

Answer 24

-Inflammation, pain, edema within coracoacromial arch ( between acromioclavicular + glenohumeral joints)
-Pain in tendon when humerus is abducted against acromion
-Downward curving or hooked

Question 25

Rotator cuff tears due to

Answer 25

-Overuse -Impingement syndrome -Aging

Question 26

What muscle is usually affected in Rotator cuff tears

Answer 26

Usually supraspinatus affected

Question 27

What is Calcific tendinitis

Answer 27

Late- occurring stage of Rotator cuff tendinitis

Question 28

Cause of calcific tendonitis

Answer 28

Extreme pressure on Rotator in internal rotation at 90% abduction

Question 29

What happens to collagen in calcific tendonitis

Answer 29

-As collagen disintegrates, calcific deposits accumulate in cells -Deposits are eventually re-absorbed causing pain and swelling

Question 30

Cause of trigger finger

Answer 30

-Overuse of flexor tendon of any finger, may develope nodular swelling, unable to move through tendon sheath + gets caught, finger stuck in flexion

Question 31

Symptom picture tendinitis acute stage

Answer 31

-Gradual onset, tenderness local to tendon one/two days after activity- increase to pain during activity -Inflammation, heat along tendon/sheath -Crepitus can develop -Decrease ROM

Question 32

Symptom picture tendinitis chronic stage

Answer 32

-Pain during + after activity -Chronic- inflammation, fibrosis, adhesions -Crepitus may be present -Decrease ROM + strength -Flare ups->acute -Rupture can occure with tendon degeneration

Question 33

Common tendinitis locations

Answer 33

Supraspinatus tendon Infraspinatus tendon Subscapularis tendon Biceps long head tendon Common flexor tendon Abductor pollicis longus tendon Extensor pollicis brevis tendon Patellar tendon Popliteus tendon Tibialis posterior tendon Achilles tendon

Question 34

Contraindications

Answer 34

No friction with Anti-Inflammatory