Lecture 8

Question 1

What are tendons made of?

Answer 1

Collagen tissue

Question 2

What do tendons do?

Answer 2

Connect muscle to bone, transfer force from muscles into skeletal system, also have excellent tensile properties

Question 3

What is a tendon enthesis?

Answer 3

Junction between a tendon and a bone, made of fibrocartilage

Question 4

What is a myotendinous junction?

Answer 4

Connection between muscle and tendon, susceptible for injury

Question 5

What is the tendon stress-strain curve for tendons?

Answer 5

Same as for ligaments

Question 6

How do tendons adapt to training?

Answer 6

By increasing cross-sectional area

Question 7

How long does it take for tendon strength to improve?

Answer 7

4-8 weeks

Question 8

When do tendon structural changes occur?

Answer 8

Over 12 weeks

Question 9

How long does it take to increase CS area of tendons?

Answer 9

6-12 months

Question 10

What is optimal tendon loading?

Answer 10

Every 2-3 days

Question 11

What are the 2 types of overuse tendon injuries?

Answer 11

Enthesopathy and tendinopathy

Question 12

What are the 2 types of acute tendon injuries?

Answer 12

Direct trauma and rupture

Question 13

What is an enthesopathy?

Answer 13

Injury or disorder affecting the enthesis of the tendon

Question 14

What are the characteristics of an enthesopathy?

Answer 14

Inflammation, degeneration, or calcification of the attachment point
Also pain and dysfunction

Question 14

What causes an enthesopathy?

Answer 14

Over use (most common), or trauma

Question 15

What is the D&T for enthesopathy?

Answer 15

History, physical (palpation), imagine (rarely used): US, MRI
Rest, pain control, orthoses, physiotherapy

Question 16

What is the return to sport for an enthesopathy?

Answer 16

Mild: 4-6 weeks
Moderate/severe: 3-6 months

Question 17

What is a tendinopathy?

Answer 17

An umbrella term used for tendon problems

Question 18

What are the mechanisms for tendinopathy?

Answer 18

Repetitive tensile, and loading: causes repetitive microtraumas
Also inadequate recovery between loadings

Question 19

What is reactive tendinopathy?

Answer 19

Non-inflammatory, structural changes and thickening of stressed tendon area

Question 20

What is tendon disrepair?

Answer 20

Worsening tendon pathology, tendon structure becomes disorganized

Question 21

What is degenerative tendinopathy?

Answer 21

Chronic stage

Question 22

What are 8 intrinsic risk factors for tendon injury?

Answer 22

Older age, male sex, menopause, genetics, systemic conditions, medications, biomechanics/technique, previous injury

Question 23

What are 4 extrinsic risk factors for tendon injuries?

Answer 23

Training load, spikes in loads, periods of deconditioning, biomechanical change

Question 24

What are the diagnostic steps for tendinopathy?

Answer 24

History, physical examination (tenderness?), imaging (US, MRI)

Question 25

What are the parts of a physical examination for tendinopathy?

Answer 25

Palpation, pain provocation tests

Question 26

What are the 4 main points for tendon injury managment?

Answer 26

Education of patients, load monitoring, pain monitoring, exercise based progressive rehab program

Question 27

What is stage 1 of an exercise based rehab program for lower limb tendinopathy?

Answer 27

Isometric exercises

Question 28

What is stage 2 of an exercise based rehab program for lower limb tendinopathy?

Answer 28

Isotonic and heavy slow resistance exercises

Question 29

What is stage 3 of an exercise based rehab program for lower limb tendinopathy?

Answer 29

Increase in speed and energy storage exercises

Question 30

What is stage 4 of an exercise based rehab program for lower limb tendinopathy?

Answer 30

Energy storage and release and sport specific exercises

Question 31

What is the diagnosis progress for rotator cuff tendinopathy?

Answer 31

History, inspection, palpation, ROM, pain provocation tests, imaging

Question 32

What is the treatment for rotator cuff tendinopathy?

Answer 32

Progressive exercise therapy 6-12 weeks, surgery and rehab 6-7 months

Question 33

What is the #1 treatment for shoulder cuff recovery?

Answer 33

Training

Question 34

By what % does the OSTRC shoulder program decrease injury rate?

Answer 34

28%

Question 35

What is the age range for acute tendon rupture?

Answer 35

30-50 yrs

Question 36

What are the 3 steps that lead to tendon rupture?

Answer 36

Eccentric force generation, mid-tendon area, partial or complete rupture

Question 39

How do achilles tendon ruptures happen?

Answer 39

Underlying pathology, rapid direction changes, jumps, usually occurs without warning

Question 40

What is the mechanism of achilles rupture?

Answer 40

Strong calf muscle contraction during eccentric loading

Question 41

What are the 6 characteristics of achilles ruptures?

Answer 41

Acute, intense pain, audible snap, reduced power in plantar flexion, gap in tendon tissue, bruise and swelling, ultrasound/MRi

Question 42

What is the treatment and rehab for achilles injuries?

Answer 42

Conservative vs. surgical repair, cast, rehab, return to sport

Question 43

What % of NFL players were able to RTS after 12 months following a AT rupture?

Answer 43

61%

Question 44

What is the partial rupture treatment for the patella?

Answer 44

Conservative treatment (cast 4 weeks, physio & progressive training), surgery, RTS 4-6 months

Question 45

What is the complete rupture treatment for the patella?

Answer 45

Surgery (end-to-end repair or transosseous repair, or tendon reconstructions), post-operative rehab

Question 46

What is the recovery for a complete patellar rupture?

Answer 46

Running after 6-15 months, RTS after 8-18 months