UE Tendinopathies

Question 1

What category do tendinopathies fall under?

Answer 1

• Cumulative trauma (CTI)
• Repetitive strain injuries (RSI)
• Commonly related to work injuries
• Can occur in anyone
• Can affect tendons and nerves. The first stage of healing is inflammation and therefore inflammation can affect the nerves

Question 2

What are causes of tendinopathy?

Answer 2

• Trauma induced tendinopathy
• Poor blood flow
• Poor posture and mechanics
• Poor proximal stability and core strength decreases ability to maintain a good safe posture leading to added stress on tendons

Question 3

What are the different types of tendon pain?

Answer 3

• “itis” or inflammation
• “osis” or scar tissue
• “algia” or nerve irritation
• A combination of all the above

Question 4

What is the definition of tendinitis?

Answer 4

• Is an inflammatory process. Inflammatory cells are found in tissue

Question 5

What is the definition of tendinosis?

Answer 5

• Degenerative process with fibrosis, decreased circulation. Fibrosis is found in tissue

Question 6

What is tendonalgia?

Answer 6

• “Pain” neurogenic in nature. Free nerve endings are irritated and signaling “pain” to the brain. Neurotransmitters and inflammatory markers are present

Question 7

What is tenosynovitis?

Answer 7

• The synovial sheath the tendon runs through is also inflamed. Ex: tendons in fingers have to go through pulleys

Question 8

Why should a therapist not take a doctors prescription at face value?

Answer 8

• Because doctors automatically call things tendonitis even if inflammation is not present

Question 9

What is tendinopathy secondary to a repetitive strain injury?

Answer 9

• Repetitive use especially against resistance
• Repetitive sheering of tissue across a bone
• Extreme postures for prolonged period of time. Pulls on the origin and insertion sites
• Carrying resistance when muscles are stretched

Question 10

What is lateral epicondylitis?

Answer 10

• Aka Tennis Elbow
• Starts as inflammation of the tendon fibers that attach the forearm extensor muscles to the lateral epicondyle
• Routine use of the arm causing shearing of the ECRB over the radial head especially with the elbow extended or an injury to this area may stress or damage the muscle attachment
• During healing the tendons often get stuck in fibroplasia (body lays down collagen within the first three weeks). The tissue has a failure to thrive. Calcification, rupture, and additional fibrosis can follow

Question 11

Why is lateral epicondylitis a challenging diagnosis?

Answer 11

• It is usually caught after the inflammatory stage
• It is difficult to alleviate symptoms if the condition is chronic
• Treatment is different for acute vs chronic conditions
• Still don’t quite understand the diagnosis

Question 12

How many different ailments can cause lateral elbow pain and what are examples?

Answer 12

• Cervical Radiculopathy (C5/C6)
• Proximal Neurovascular entrapment of lateral antebrachial cutaneous nerve
• Arthritis
• Tumors
• Radial tunnel/PIN entrapment can cooccur with lateral epicondylitis
• Distal biceps insertion at radial tuberosity - may feel like lateral epicondylitis or be both
• Triceps insertion at olecranon
• Shoulder tendonitis
• Carpal Tunnel Syndrome
• Trigger points - the supinator is a common area
• Loose Bodies (bone fragments)

Question 13

Where is the common extensor origin for the ECRB, EDC, ECRL, and ECU

Answer 13

• Lateral epicondylitis
• ECRB is always involved because it extends the wrist
• EDC is involved in finger extension
• ECRB and EDC almost become one

Question 14

What is the origin and insertion of the ECRB?

Answer 14

• Origin: lateral epicondyle
• Insertion: dorsal surface, base of the long metacarpal.
• Most often cited as being the primary structure involved in lateral epicondylitis
• Has poor blood supply at origin because the common extensor origin is shallow
• Does not travel as far as ECRL

Question 15

• How can posture and positioning of the wrist affect the extensor digitorum communis?

Answer 15

• Origin: lateral epicondyle
• Insertion: base of the long metacarpal with the ECRB
• Poor posture and body mechanics while performing activities such as typing and playing the piano can cause problems because there is excessive strain placed on the EDC
• The fingers should float below the wrist and the head should not protrude forward

Question 16

True/False: lateral epicondylitis is a inflammatory condition

Answer 16

• False
• Histology research shows that:
• • there is an immuno-reactive neurogenic component to lateral epicondylitis
• • there can be microscopic tears of ECRB and EDC
• • there can be calcification of the muscles
• • there can be excessive granulation - over healing by laying down excessive scar tissue
• • there is an alteration in neuropeptides (they are the ones that signal that injury has occurred)
• • there are avascular areas
• • there can be adhesions
• • there can be mucoid degeneration
• • glutamate is released which is toxic to nerve tissue and results in free nerve endings which results in pain

Question 17

What are Dr. Robert Nirschl’s stages of lateral epicondylitis?

*do not need to memorize

Answer 17

• Stage I: peritendinous inflammation
• Stage II: angioblastic degeneration - angioblastic fibroplasia - pain is not due to inflammation to the sensory nerve
• Stage III: further degeneration which can result in rupturing of the tissues
• Stage IV: fibrosis and calcification