W1 - MSK Contractile Tissue

Question 1

What is a tendonopathy

Answer 1

Pain or dysfunction associated with any tendon

Question 2

What are the common areas affected by a tendonopathy in the lower limb

Answer 2

Glutes
Patella
Achilles
Posterior tibia
Hamstrings
Peroneals

Question 3

What are the most common areas affected by tendinopathy in the upper limb?

Answer 3

Rotator cuffs
Long head of biceps
Lateral and medial epicondylalgia
De Quervains (abductor pollicis longus & extensor pollicis brevis)

Question 4

What are the two types of risk factors?

Answer 4

Modifiable= patients can reduce their risk
Non-modifiable = patients cannot reduce their risk (genetic factors)

Question 5

What are some of the common risk factors for a tendinopathy?

Answer 5

Overload and underload
Changes in load and training
Age
Previous injury
Increased BMI
Diabetes
Medication
Genetic factors

Question 6

What age is more likely to develop per tendinopathy?

Answer 6

Athletic population over 40 years old or the sedimentary population over the age of 60

Question 7

What is the structure of a normal tendon from outer to inner?

Answer 7

Tendon
Inter fascicular matrix
Fascicle (contain tenocytes)
Fibre (crimp waveform)
Fibril (think healthy ones & thin immature ones)
Tropocollagen (structure)

Question 8

What are the 2 types of load

Answer 8

Tensile load
Compressive load

Question 9

What is a tensile load

Answer 9

When the force occurs in a LONGITUDINAL direction to the collagen fibres

Question 10

What is a compressive load

Answer 10

When the force occurs PERPENDICULAR to the college fibres

Question 11

What is the first stage of the development of a tendonopathy

Answer 11

Altered tendon cell population

Question 12

What happens in the altered te don cell population

Answer 12

Increased number of tenocytes & tenocytes metabolism

This means that there are more immature tenocytes that cannot produce collagen

This increases the rate of apoptosis (cell death due to no college for regeneration)

Immunoreactive cells

Question 13

What is the second stage of the development of tendinopathy?

Answer 13

Disorganisation of collagen

Question 14

What happens when the disorganisation of collagen stage?

Answer 14

Reduced type one fibres
Increased type three fibres
A higher concentration of immature collagen bundles

Question 15

What is the third stage of the development of a tendinopathy?

Answer 15

Ground substances changes

Question 16

What happens in the ground substance changes stage?

Answer 16

Increased proteoglycans

This leads to an increase in water tension causing an increased cross-section of the tendon which breaks down collagen fibres making the tendon weaker

Chemical alterations cause an increase in substance P , glutamate and lactate

Question 17

What is the fourth stage of the development of tendinopathy?

Answer 17

Neovascilarization

Question 18

What happens in the neovascularization stage

Answer 18

Blood vessels and nerves grown into the tendon making it more sensitive

Question 19

What factors can increase wear on a tendon

Answer 19

Training load or errors
Previous injuries
Muscle weakness
Biomechanics

Question 20

What factors can affect the repair of tendinopathy?

Answer 20

Tendon structure
Increased BMI
Diabetes
Medication
Age
Gender
Genetics

Question 21

What are the four general signs and symptoms of a tendinopathy?

Answer 21

Pain
Weakness
Decreased function
Swelling

Question 22

Why would a physiotherapist manage tendinopathy by starting with isometric loading instead of eccentric loading?

Answer 22

Isometric loading has analgesic affects in some studies so it helps to reduce pain

Therefore, if a patient has a very irritable tenant using Isometric loading will help to reduce their pain

Question 23

What is shockwave therapy?

Answer 23

Electrotherapy that promotes tissue healing

Question 24

What is manual therapy?

Answer 24

Helps to manage your patients pain

Question 25

What is a gluteal tendinopathy also known as?

Answer 25

Greater tronchanteric pain syndrome (GTPS) Greater trochnteric bursitis

Question 26

What are the common facts of a gluteal tendinopathy?

Answer 26

- Most common type of tendinopathy - Occurs mostly in midlife and females are more at risk than males (especially long distance runners) - Occurs between the ages of 50 to 79 - Gluteus medius and minimus tendons are involved - Caused by a combination of excessive compression and high load

Question 27

Why are women at a higher risk than men of developing a gluteal tendinopathy?

Answer 27

Women have an increased Q angle of their pelvis which means they naturally sit in more of a hip adducted position which compresses the tendon against the greater trochanter by the ITBY

Question 28

What are the clinical signs and symptoms of a gluteal tendinopathy?

Answer 28

Lateral hip pain and tenderness around the greater trochanter (will be painful to palpate)

Question 29

What are some aggravating factors of a gluteal tendinopathy?

Answer 29

Pain on walking Standing on one leg Getting up from sitting (being in a 90° angle of hip flexion for a prolonged period of time causes compression on the tendon) Lying sideways (causes hip adduction which compressions the tendon)

Question 30

What is the physiotherapy management of a agree to attend an empathy?

Answer 30

Education Load management Avoid compressive exercise exercises in early stages Shockwave therapy Corticosteroid injections Surgery

Question 31

What are the key factors of a patella tendinopathy?

Answer 31

Common and jumping sports Risk factors include weight , BMI, leg length the difference, flexibility, and strength of hamstrings and quad muscles Chronic overload theory is the most commonly used

Question 32

Clinical signs and symptoms of a patella tendinopathy

Answer 32

Anterior knee pain near the patella attendant and any insertion points around the patella and tibia Decreased function ( going up or down the stairs, kneeling, ect)

Question 33

What physiotherapy management is used for a patella tendinopathy?

Answer 33

Education Load management Exercise (eccentric loading is more effective than concentric) Taping (short-term reduction in symptoms) Corticosteroids Shockwave Surgery

Question 34

What are the common factors of an Achilles tendinopathy?

Answer 34

Common in elite runners and other athletes Can occur at the insertion point or mid portion of the Achilles tendon Caused by: overload or underload or mechanical factors, such as overpronation of the foot, footwear, training surfaces

Question 35

Clinical signs and symptoms of an Achilles tendinopathy

Answer 35

Pain and swelling around the area Pain is worse at the starting end of a training session In severe cases attend a nodules swelling will be present

Question 36

Physiotherapy management for an Achilles tendinopathy

Answer 36

Education Load management Exercise Taping Surgery Shockwave therapy Injections

Question 37

Clinical signs and symptoms of a rotator cuff related shoulder pain

Answer 37

Pain and impairment of the shoulder movement and function during shoulder flexion and lateral rotation Painful to lie on the affected area

Question 38

Physiotherapy management for rotator cuff related injury

Answer 38

Education Exercise Symptom modification Steroid injections Surgery

Question 39

What are the common facts of a lateral epicondylalgia (tennis elbow)

Answer 39

More common than 40s and 50s Smoking and obesity or risk factor ECRB is the most commonly affected Caused by excessive and repetitive use

Question 40

Clinical signs and symptoms of tennis elbow

Answer 40

Pain on the lateral epicondyle of the elbow (radiating in line with the extensors) Various pain can be reported (intermittent, continuous and can vary in severity) Aggravated by resisted wrist and finger extension and forearm supination Stretching the tendon can also produce symptoms such as gripping

Question 41

Physiotherapy management for tennis elbow and medial epicondylalgia

Answer 41

Education Load management Exercise Brace/taping NSAIDs Corticosteroid injections Shockwave therapy Surgery

Question 42

Two facts about medial epicondylalgia (golfers elbow)

Answer 42

Less common than tennis elbow Common in age is 40 to 60 Common in females Involves per terries and FCR

Question 43

Clinical signs and symptoms of golfers elbow

Answer 43

Pain on the medial side of the elbow Aggravated by resisted repetitive wrist flexion or pronation, vagus stress & stretching, throwing or gripping Reduced grip strength Can involve the ulnar nerve (20%)