Show Menu
Cheatography
  1. Home >
  2. Education >

Tendinopathy Cheat Sheet (DRAFT) by

General description and treatment of tendinopathies

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Tendon Pathology

Visoel­astic tissue
Loading tendon slowly makes more it more compliant, loading tendon fast engages all fascicles
Iso-vo­lum­etric
Loading and changing shape of tendon does not change volume as tendons are dense
Cross-­linking
Slow loading breaks more links than fast loading, therefore tendon stiffer with fast loading
Tendon stiffness
Greater compliance or greater stiffness both increase injury risk, muscle should be stronger than tendon is stiff

Prognosis

True tendin­opathy can take months to years to heal

Types of Load on Tendon

Energy storage and release loads
Store and release energy, making movements faster and more metabo­lically efficient
Compre­ssive loads
Compre­ssive against bone or bursa, altering range may ease symptoms
Friction
Rubbing against the perite­ndon, may also be affected by an acute blow
Shear
Depending on the muscles involved
 

Tendon Continuum (Jill Cook)

Subjective Markers

Warm up effect
Localized pain with 1-2 fingers
Often increase in activity
Increased pain after a period of rest and is worse the next morning when first getting out of bed
"­Sev­ere­" or "­sha­rp" during the early stages and sometimes as a "dull ache" once it has been present for some weeks
Isometrics act as an analgesic

Objective Assessment

Observ­ation
Muscle atrophy, swelling, asymmetry
Palpation
Tender to palpate, but we should try not to palpate too much
AROM/PROM
May be limited due to pain
Strength
May be decreased due to muscle atrophy or pain
Functional Tests
Tests that load the tendon to reproduce pain, and other loading tests that load altern­ative structures
 

Rehabi­lit­ation

Patient education = load modifi­cation
Isometric, isotonic and HSR loading in comp to target tissue structure change and muscle strength
Slow stretc­h-s­hor­tening cycle out of comp to load as spring
Fast stretc­h-s­hor­tening cycle out of comp to load as spring
Sports specific exercises out of comp

Management

Do not rest the tendons. Could cause more damage.
Address the strength deficit. Heavy load 2-3 times per week. Compare with normative values not the contra­lateral limb.
Tendons respond to heavy load, 70% 1RM. For approx. 5 mins then again in 6 hours.
Type of muscle contra­ction does not affect collagen synthesis, other evidence points to eccentrics
Allow enough time following high load for tissue recovery (every 2nd day)

Adjuncts to exercise

Cortic­ost­eroid injection
Shockwave therapy
Platelet rich plasma
Surgical management