Tendon Injuries

Question 1

Tendon
* … tissue
* Connects…
* Transfer force from …
* Excellent … properties

Tendon Structure

Tendon Enthesis
*…
* F…

Answer 1

Tendon
* Collagen tissue
* Connects muscle to bone
* Transfer force from muscles into skeletal system
* Excellent tensile properties

Tendon Structure
firbil, fibre, primary muscle fibre, secondary, tertiary, tendon

Tendon Enthesis
* Junction between a tendon and a bone
* Fibrocartilage

Question 2

Myotendinous Junction (MTJ)
* Connection between …
* Susceptible for …

Tendon Stress-Strain Curve
* Relationship between stress and deformation of tendons is the … as for ..

Answer 2

Myotendinous Junction (MTJ)
* Connection between tendon and muscle
* Susceptible for injury

Tendon Stress-Strain Curve
* Relationship between stress and deformation of tendons is the same as for ligaments

Question 2

Adaptation to Training

Tendons adapt to training by increasing …

Compared to muscles, it takes …

Strength starts to improve after … of consistent training

Structural changes >…

Increases in CS area take … months of high- load, consistent training

Requires longer recovery times than … → Optimal tendon loading every… days

Answer 2

Adaptation to Training

Tendons adapt to training by increasing cross-sectional (CS) area

Compared to muscles, it takes longer time to gain tendon strength

Strength starts to improve after 4-8 weeks of consistent training

Structural changes >12 weeks

Increases in CS area take 6-12 months of high- load, consistent training

Requires longer recovery times than muscles → Optimal tendon loading every 2- 3 days

Question 3

Overuse tendon injuries
* …
* …

Acute tendon injuries
* …
* …

Answer 3

Overuse tendon injuries
* Enthesopathy
* Tendinopathy

Acute tendon injuries
* Direct trauma
* Rupture - very rare

Question 4

Enthesopathy
* … affecting the …
Cause/mechanism
* O…
* T…
* Characterized by …, …, or calcification of the …
* … and …

Diagnosis
* History
* Inspection & Palpation
* Imaging (rarely used): US, MRI

Treatment
* Rest…
* Pain control: Ice, NSAIDS
* Orthoses
* Physiotherapy: …
* Mild cases (… weeks); moderate to severe cases (… months)

Answer 4

Enthesopathy
* Injury or disorder affecting the enthesis
Cause/mechanism
* Overuse (most common); repetitive loading
* Trauma (direct blow)
* Characterized by inflammation, degeneration, or calcification of the attachment point
* Pain and dysfunction

Diagnosis
* History
* Inspection & Palpation
* Imaging (rarely used): US, MRI

Treatment
* Rest from offending activity
* Pain control: Ice, NSAIDS
* Orthoses
* Physiotherapy: progressive strength training
* Mild cases (4-6 weeks); moderate to severe cases (3-6 months)

Question 5

Tendinopathy
Term used for…

• … tensile (or compressive) loading (e.g., …, …, changing direction) → … microtraumas
• Inadequate…

Answer 5

Tendinopathy
Umbrella term used for tendon problems

• Repetitive tensile (or compressive) loading (e.g., sprinting, jumping, changing direction) → repetitive microtraumas
• Inadequate recovery between loadings

Question 6

Cook–Purdam Model

Reactive tendinopathy
* Non…, … changes & … tendon area
* change loading pattern

Tendon disrepair
* … tendon pathology, tendon becomes..

Degenerative tendinopathy - … damage
* … stage

Intrinsic risk factors
* … age
* … sex
* Menopause
* G…
* Systemic conditions
* M…
* Biomechanics/technique
* Previous …

• Extrinsic risk factors
• … load
• … loads
• Periods of …
• … change

Diagnosis * History: Symptoms often progress
when we feel pain, structural changes have already started
* First pain …
* Then pain…
* Finally pain …

• Physical Examination
• Palpation → tenderness
• Imaging: US, MR

Answer 6

Cook–Purdam Model
* Reactive tendinopathy
* Non-inflammatory, structural changes & thickening of stressed tendon area

• Tendon disrepair
• Worsening tendon pathology, tendon structure becomes disorganized
• Degenerative tendinopathy - permanent damage
• Chronic stage

Intrinsic risk factors
* Older age
* Male sex
* Menopause
* Genetics
* Systemic conditions
* Medications
* Biomechanics/technique
* Previous injury

• Extrinsic risk factors
• Training load
• Spikes in loads
• Periods of deconditioning
• Biomechanical change

Diagnosis * History: Symptoms often progress
* First pain after exercise
* Then pain at the start of an activity
* Finally pain both during and after activity, long to recover from

• Physical Examination
• Palpation → tenderness
• Imaging: US, MR

Question 7

2 most common - … Tendinopathy … Tendinopathy

Tendinopathy: Diagnosis
* History: type of pain, training history, injury history
* Physical examination: palpation, pain provocation tests
* Imaging (rarely used): US, MRI

Management
Education of …
… monitoring
… monitoring
… program

Answer 7

Achilles Tendinopathy Patellar Tendinopathy

Tendinopathy: Diagnosis
* History: type of pain, training history, injury history
* Physical examination: palpation, pain provocation tests
* Imaging (rarely used): US, MRI

Management
Education of patients
Load monitoring
Pain monitoring
Exercise based progressive rehabilitation program

Question 8

Rotator Cuff Tendinopathy
composed of four muscles and tendons

• Diagnosis
• History
• Inspection, palpation, ROM, Pain provocation tests
• Imaging
• Treatment
• Progressive exercise therapy 6-12 weeks
• Surgery and rehabilitation 6-7 months

Other Treatments
* Shock wave therapy, laser, and ultrasound
* M…
* I…
* Passive treatments
* Experimental treatments
* S…

Prevention of Tendinopathy?
- progressive loading
- rest time
- exercise
- pain management
- early treatment

Answer 8

Rotator Cuff Tendinopathy
teres minor, subscapularis, supraspinatus, infraspinatus

• Diagnosis
• History
• Inspection, palpation, ROM, Pain provocation tests(pain from 60-120 degrees)
• Imaging
• Treatment
• Progressive exercise therapy 6-12 weeks
• Surgery and rehabilitation 6-7 months

Other Treatments
* Shock wave therapy, laser, and ultrasound
* Medications
* Injectable therapies
* Passive treatments
* Experimental treatments
* Surgery

Question 8

Tendon Rupture
* … rupture of a normal and healthy tendon is …
* Commonly occur in athletes and recreational exercisers aged
… years

Stages
Eccentric …
… area
… or … rupture

Almost always underlying …
High risk of injury: …, …
Usually occur without …

MECHANISM
Strong calf muscle … during simultaneous tendon … (eccentric loading)

Diagnosis
Acute, intense pain
Audible ‘SNAP’
Reduced power in plantar flexion
‘Gap’ in the tendon tissue
Bruise and swelling
Ultrasound/MRI

Treatment and Rehabilitation
… vs. … repair (end-to-end suture)
Cast
Rehabilitation
Return to Sport
61% of NFL players were able to successfully RTS at 12 months following a primary AT rupture.

Answer 8

Tendon Rupture
* Acute rupture of a normal and healthy tendon is rare
* Commonly occur in athletes and recreational exercisers aged
30-50 years

Stages
Eccentric force generation
Mid-tendon area
Partial or Complete rupture

Almost always underlying pathology
High risk of injury: rapid direction changes, jumps
Usually occur without warning

MECHANISM
Strong calf muscle contraction during simultaneous tendon elongation (eccentric loading)

Diagnosis
Acute, intense pain
Audible ‘SNAP’
Reduced power in plantar flexion
‘Gap’ in the tendon tissue
Bruise and swelling
Ultrasound/MRI

Treatment and Rehabilitation
Conservative vs. Surgical repair (end-to-end suture)
Cast
Rehabilitation
Return to Sport

Question 9

Patellar Tendon Rupture: Treatment
* Partial rupture
* Conservative treatment: Cast … weeks, physiotherapy &
… training
* Surgery
* RTS … months

• Complete rupture
• S…
• End-to-end repair or Transsosseous repair
• Tendon … (severe degenerative tissue changes)
• Post-operative rehabilitation
• Running after 6-15 months
  RTS after …

Prevention of Tendon Ruptures?
- education
- protect
- rest
- progressive loading

Answer 9

Patellar Tendon Rupture: Treatment
* Partial rupture
* Conservative treatment: Cast 4 weeks, physiotherapy &
progressive training
* Surgery
* RTS 4-6 months

• Complete rupture
• Surgery
• End-to-end repair or Transsosseous repair
• Tendon reconstruction (severe degenerative tissue changes)
• Post-operative rehabilitation
• Running after 6-15 months
  RTS after 8-18 months

Prevention of Tendon Ruptures ?