Term
| what is the breakdown of tendon composition |
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Definition
| 20% cellular, 56% water, the rest is mostly collagen with some GAGs |
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Term
| what type of cell makes up tendon matrix |
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Definition
|
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Term
| what is the main component of tendon |
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Definition
|
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Term
| describe the architecture of collagen |
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Definition
| hierarchical. Multiple layers of organization. Grouped kind of like muscle. |
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Term
| what is the collagen orientation when tendon is unloaded |
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Definition
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Term
| what is the collagen orientation when tendon is loaded |
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Definition
| straightened, aligned, parallel, only a few fibers in other directions |
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Term
| what is the job of a tendon |
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Definition
| deliver force from muscle to bone |
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Term
| why do we want collagen fibers in tendon to be aligned |
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Definition
| to deliver the tensile stress/force going through them. |
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Term
| what are microscopic characteristics of chronic tendinosis |
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Definition
| reduced collagen content - replaced by mucoid ground substance. Collagen fibers not in a nice alignment = weak. |
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Term
| what is unique about a tendon's stress-strain curve |
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Definition
| there is a small toe region where it takes up the crimp. Once the crimp is taken up, the tissue becomes stiff as stress and strain increase |
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Term
| at what % strain does tendon fail |
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Definition
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Term
| what do we see on the stress strain curve of tendon prior to macrofailure |
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Definition
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Term
| what are the microfailures |
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Definition
| places where additional strain occurs without additional stress because of shearing between adjacent collagen fibers or adjacent collagen bundles |
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Term
| what are tendon mechanisms for injury (4) |
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Definition
| tensile stress, frictional abrasion, compression, interface injuries |
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Term
| describe tensile stress as tendon MOI |
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Definition
| too much magnitude, frequency, duration can damage tendon tissue |
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Term
| describe frictional abrasion as tendon MOI |
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Definition
| bony or retinacular pulleys: where tendons wrap around bone they will have frictional abrasion, compressive stress, and tensile stress. Example = carpal tendons |
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Term
| where can compression be an MOI for tendon injury |
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Definition
| bony or retinacular pulleys. |
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Term
| where would you see a tendon interface injury |
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Definition
| musculotendinous or bone insertion site junctures |
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Term
| is it easier to heal muscle tendon injury or tendon bone injury |
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Definition
| easier to heal muscle tendon injury |
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Term
| how does tendon's metabolic issues affect healing |
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Definition
| poor or nonexistent blood supply, poor lymph supply, no good access to reparative cells |
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Term
| what happens to tendons with increased use |
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Definition
| increase in size and number of collagen fibers = hypertrophy |
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Term
| what happens to tendons with decreased use |
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Definition
| decrease in size and number of collagen fibers = atrophy |
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|
Term
| how does temperature affect tendon mechanics |
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Definition
| increased temperature increases ultimate strength and strain at failure |
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|
Term
| how does age affect tendons |
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Definition
| no great change in ultimate strength until 7th or 8th decades |
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|
Term
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Definition
| medication shown to increase total collagen content and ultimate strength |
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Term
| when might indocin application be helpful |
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Definition
| supraspinatus tendon: right where it wraps around the humeral head in the subacromial space in an avascular region it can have frictional abrasion, compression, impingement. If you have tendonitis there, indocin could be helpful. |
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Term
| how do steroid injections affect tendons |
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Definition
| steroids weakens collagen structure, doesn't do a single thing to address what is causing the problem, masks the pain so that the person starts doing things they shouldn't be doing that can increase injury, when the pain returns the patient thinks he needs another shot, wastes time and money |
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Term
| are there potential adverse effects of prolonged oral prednisone for RA or other systemic inflammatory conditions on tendons? |
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Definition
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|
Term
| what are guidelines for steroid injections |
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Definition
| inject around and not into tendon, decrease activity for several weeks after injection, never repeat again |
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|
Term
| what are side effects of steroid injection |
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Definition
| skin atrophy, fat pad atrophy, tendon rupture |
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Term
| what is the effect of fluoroquinolones on tendon |
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Definition
| causes disruption of collagen structure, leads to tendon rupture. Especially bad in older adults, women, people taking prednisone, people with renal disease |
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|
Term
| what are tendon pulley injuries |
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Definition
| injuries of tendons at bony or retinacular pulley mechanisms where tendons wrap around. |
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|
Term
| what 3 forces cause tendon pulley injuries |
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Definition
| frictional abrasion, compressive stress, tensile stress |
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Term
| what to do if you think tensile stress is causing tendon pulley injuries |
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Definition
| 1. keep the muscle quiet. Keep it from tugging with too much magnitude, frequency, duration; 2. heat the muscle and stretch it; 3. check the other side of the joint to see if the involved muscle unit is compensating for something |
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Term
| how is there compressive stress in the tendon pulley? |
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Definition
| the tendon is attached at one end to the bone. It wraps around another bone and is pulled in another direction by a muscle. It forms an angle and is pulled in different directions, causing compressive stress at the pulley. This stress is the resultant of the two different pulling forces |
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Term
| what are 3 ways that the compressive stress at the pulley could be increased? |
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Definition
| the more you contract, the greater the 2 pulling forces, and the greater the resultant force that goes between the 2 pulling forces and pulls the tendon into the pulley. The more acute the angle, the greater the resultant force. The more the tendon wraps around/touches the pulley, the more compressive stress there is. |
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Term
| describe what happens to tendons in the carpal tunnel when you extend your wrist |
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Definition
| you increase tendon force by activating the muscle, and you also make the angle more acute by extending your wrist. Double whammy for increased compressive forces. |
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|
Term
| what position should a wrist be kept in if it has carpal tunnel syndrome |
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Definition
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|
Term
| do you want a lot of radial or ulnar deviation if the person has carpal tunnel syndrome |
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Definition
|
|
Term
| at what position is the size of the tunnel at its largest |
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Definition
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|
Term
| is vibration good or bad for carpal tunnel |
|
Definition
| bad. Wear heavily padded gloves |
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|
Term
| how to treat someone with supraspinatus tendinitis |
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Definition
| rest in abduction and flexion using armrest or pillow. Don't sleep on the ipsilateral side (adduction increases acuity of the angle) |
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|
Term
| what is another problem of pulleys? |
|
Definition
| wringing out blood supply |
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Term
| what position reduces blood supply to supraspinatus tendon |
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Definition
| extension and adduction reduces blood supply in supraspinatus tendon because it stretches the tendon across the humeral head AND because it decreases the angle. |
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Term
| what location of the long head of the biceps is its worst blood supply |
|
Definition
| where it wraps around the humeral head |
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|
Term
| how does concentric muscle action affect a pulley? |
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Definition
| the muscle is shortened, so the direction of movement goes toward the muscle. Friction is in the opposite direction. Increases force and friction between pulley and tendon |
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|
Term
| with concentric contraction, which side of the tendon is Tmax |
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Definition
| the side next to the muscle. This is where the force is pulling from. |
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|
Term
| what is the formula for frictional abrasion |
|
Definition
| Log10Tmax - Log10 Tmin = 0.4343μα |
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|
Term
| what does the formula for frictional abrasion mean |
|
Definition
| the larger the muscle tendon forces,t he greater the friction |
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|
Term
| what is alpha in the frictional abrasion equation? |
|
Definition
| arc in contact: how much the tendon wraps around |
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|
Term
| how does the arc in contact affect frictional abrasion |
|
Definition
| the greater the arc in contact, the greater the frictional abrasion AND compressive stress AND tensile stress |
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|
Term
| what is the affect of a tight tissue opposite the concentric muscle contraction |
|
Definition
| Tmax has to be even greater, which will increase frictional abrasion |
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|
Term
| when a muscle is eccentrically contracting, which side of the tendon is Tmax |
|
Definition
| the side connected to the bone. |
|
|
Term
| why do you not want the tibialis posterior to wrap around the medial malleolus too much? |
|
Definition
| when you go into pronation, you'll passively stress the muscle tendon unit so that the tensile stress will increase, the angle between the two tendon forces will be more acute, and the combination of things will result in a lot of compressive stress. |
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|
Term
| what to do for someone who pronates a lot |
|
Definition
|
|
Term
| what benefits do you see by controlling pronation |
|
Definition
| decreases resultant tendon force, decreases compression, decreases frictional abrasion |
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|
Term
| what interventions to do for tendon problems/ |
|
Definition
| address tendon pulley issues, identify other MOI such as intensity, frequency, duration and remove patient from MOI. Try other equipment |
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|
Term
|
Definition
| within the first week, when there's still inflammation there |
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|
Term
| what to do to treat acute tendinitis |
|
Definition
| rest, NSAIDs, ice, gradual return to activity after solving MOI problem, heel lift or modification |
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|
Term
|
Definition
| pathologic condition within tendon tissue |
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|
Term
|
Definition
| acute inflammatory process within tendon. Most people we see do not have tendinitis. |
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|
Term
|
Definition
| tendinopathy lasting longer than one week. Chronic degeneration of tendon tissue with reduced collagen fiber content and increased volume of mucoid ground substance, disrupted collagen orientation, absence of inflammatory cells. |
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|
Term
| will anti-inflammatory drugs help someone with tendinosis |
|
Definition
| probably not. In fact, it will mask the pain and real pathology |
|
|
Term
| what is chronic tendinosis |
|
Definition
|
|
Term
| how to examine a patient with chronic tendinosis |
|
Definition
| 1. see where they are TTP: start with area outside the discomfort, mark the discomfort area with a pen and measure its size. |
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|
Term
| how to treat someone with chronic tendinosis |
|
Definition
| 1. heat up the tissue to make it stronger and more extensible. 2. apply vigorous transverse friction massage to release adhesions. 3. brief bout of heavy controlled loading for muscle tendon juncture or midsubstance tendinosis. 4. stretch. 5. ice if needed. 6. rest. 7. return to activity if minimally TTP |
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|
Term
| is this aggressive approach good for bone insertion tendinopathy? |
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Definition
|
|
Term
| describe the brief bouts of heavy loading for midsubstance and muscle-tendon juncture tendinosis |
|
Definition
| 3 sets of 12-15 reps to fatigue muscle |
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|
Term
| how to treat tendon-bone insertion tendinosis |
|
Definition
| rest, NSAIDs, very cautious return to loading |
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|
Term
| is it better to do eccentric or concentric loading of tendon with tendinopathy |
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Definition
| unclear. BUT before you send the patient out into the real world, you need to advance them to being able to do eccentric loading: hypertrophy the muscle tendon and bone insertion site to prepare them for the unpredictable |
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|
Term
| when lifting an object at the wrist by extending against gravity, is there more tensile stress in the common extensor tendon in concentric lifting or eccentric lowering and why? |
|
Definition
| more tensile stress in concentric lifting because the angle is getting smaller and the moment in the muscle group has to be greater than the resisting weight force. There is more force transmitted through the tendon during concentric phase |
|
|
Term
| why might eccentric lowering still be harder? |
|
Definition
| we have more problems controlling eccentric movement than concentric movement |
|
|
Term
| what is the evidence on iontophoresis with dexamethazone |
|
Definition
| short term (1 month)benefits for lateral epicondylitis and plantar fasciitis. 12 month benefits for Achilles tendinosis |
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|
Term
| what is the evidence on iontophoresis with acetic acid |
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Definition
|
|
Term
| what must you remember about modalities |
|
Definition
| you still have to address the MOI |
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|
Term
| what are some additional treatments for calcific tendinitis |
|
Definition
| disodium EDTA = chelator that pulls calcium out of calcium deposit; acetic acid dissolves calcium deposit; extracorporeal shock wave |
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|
Term
| how do protein growth factors promote tendon healing |
|
Definition
| insulin growth factor stimulates tenocytes to produce more collagen and produce stronger healing tendon.Similar results for other proteins |
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|
Term
| is surgical or non-surgical treatment better for Achilles tendon ruptures and why |
|
Definition
| surgical might be better: fewer re-ruptures, earlier returns to activity, more return to full activity, usual surgical risks |
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