Sports Medicine Book

Traumatic Injury

http://www.fpnotebook.com/

Tendon Injury

Aka: Tendon Injury, Tendon Strain, Tendinopathy, Tendonitis, Tendinosus
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  1. Anatomy: Normal Tendon
    1. Collagen fibers
      1. Collagen fibrils organized into budles of fibers
        1. Each bundle organized into larger bundles
      2. Interwoven with other tendon components
        1. Proteoglycans
        2. Elastin
        3. Lipids
    2. Tendon sheath (epitenon)
      1. Contains nerves and vessels supplying tendon
    3. Osteotendinous Junction (Tendon attachment to bone)
      1. Muscle force is transmitted to this site
      2. Site of most Tendon Injury
      3. Tendons are most hypovascular at this site
        1. Osteotendinous junction most prone to Hypoxia
        2. Appears to be important in Tendinopathy development
  2. Classification of Tendinopathy
    1. Tendonitis (Misnomer; use Tendinosus or Tendinopathy)
      1. Acute inflammatory Tendinopathy
      2. True Tendonitis at presentation is uncommon
        1. Sudden onset, resolves completely in days to weeks
        2. Most tendon injuries at presentation are chronic
    2. Tendinosus
      1. Describes most chronic tendon overuse injuries
      2. Chronic course over 3-6 months
        1. Incomplete resolution in up to 20%
      3. Associated with chronic degenerative changes
        1. Collagen degenerates into disordered structure
        2. Proteoglycan ground substance increases
        3. Neovascularization
      4. Key related points
        1. NSAIDs do not help and in fact delay healing (non-inflammatory condition)
        2. Absolute rest delays healing (tendons heal best when under some level of tension)
  3. Specific Tendinopathies
    1. Rotator Cuff Tendinopathy
    2. Elbow Tendinopathy
      1. Lateral Epicondylosis (Tennis Elbow)
      2. Medial Epicondylosis (Golfer's Elbow)
    3. Patellar Tendinopathy
    4. Achilles Tendinopathy
  4. Symptoms
    1. Gradual onset of localized pain at tendon insertion
    2. Associated with new or increased activity
    3. Initially, limited to sharp pain during activity
    4. Later, dull pain may persist even at rest
  5. Management
    1. RICE-M
    2. Local Cold Therapy
    3. Orthotics (e.g. Tennis Elbow counterforce strap)
    4. Stretching and Strengthening Exercises
      1. Start after acute pain has resolved
      2. Eccentric Exercises are preferred
    5. Medications to consider at initial onset (acute phase)
      1. Brief NSAID course
      2. Local Corticosteroid Injection
        1. May be more effective than NSAIDs in acute pain
        2. Do not change longterm course of Tendinopathy
        3. Risk of delayed healing, tendon rupture
    6. Physical Therapy modalities
      1. Local Ultrasound
      2. Iontophoresis and Phonophoresis
      3. Extracorporeal Shock Wave Therapy (ESWT)
  6. References
    1. Khan (2003) Clin Sports Med 22:711-25
    2. Wilson (2005) Am Fam Physician 72(5):811-8

Tendinitis (C0039503)

Definition (MEDLINEPLUS)

Tendons are the tough cords of tissue that attach muscles to bones. They help your muscles move your bones. Tendinitis means inflammation of a tendon. It causes pain and tenderness near a joint. It usually occurs in the shoulders, elbows, knees, hips, heels or wrists. Depending on where it happens, it may have a special name, such as tennis elbow.

Injuries and overuse are common causes of tendinitis. Cross-training, stretching and decreasing your intensity when you exercise might help prevent tendinitis. Certain diseases, such as rheumatoid arthritis, also can cause it. You can usually treat tendinitis with rest, ice and medicine to relieve pain and decrease swelling. Other treatments include ultrasound, physical therapy, steroid injections and surgery.

Definition (MSH) Inflammation of TENDONS. It is characterized by the degeneration of tendons accompanied by an inflammatory repair response, fibroblastic proliferation, and formation of granulation tissue. Tendinitis is not a clinical diagnosis and can be confirmed only by histopathological findings.
Concepts Disease or Syndrome (T047)
MSH D052256
ICD10 M77.9
SnomedCT 312785002, 267996008, 34840004, 156665008, 202893001, 268091003
French TENDINITE, Tendinite, Ténosite
English TENDINITIS, TENDONITIS, Tendinitis, NOS, Tendonitis, NOS, Tendinitis NOS, tendonitis (diagnosis), tendonitis, Tendinitis NOS (disorder), tendonities, tendoniti, tendinities, Inflammatory disorder of tendon, Tendinitis (disorder), tendinitis, disease (or disorder); tendon, inflammatory, inflammation; tendon, tendon; disorder, inflammatory, tendon; inflammation, Tendonitis NOS, Tendinitides, Tendinitis, Tendonitides, Tendonitis
Portuguese TENDINITE, Tendinite
Spanish TENDINITIS, Tendinitis NOS, Tendonitis NOS, Tendinitis, tendinitis (trastorno), tendinitis, SAI (trastorno), tendinitis, SAI, tendinitis, tendonitis
German TENDINITIS, Tendinitis, Tendonitis, Sehnenentzündung
Japanese 腱炎, ｹﾝｴﾝ
Czech tendinitida, Tendinitida
Italian Tendinite
Hungarian Tendinitis
Dutch aandoening; pees, inflammatoir, ontsteking; pees, pees; aandoening, inflammatoir, pees; ontsteking, tendinitis
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Tendinopathy (C1568272)

Definition (MSH) Clinical syndrome describing overuse tendon injuries characterized by a combination of PAIN, diffuse or localized swelling, and impaired performance. Distinguishing tendinosis from tendinitis is clinically difficult and can be made only after histopathological examination.
Concepts Disease or Syndrome (T047)
MSH D052256
English Tendinopathy, Tendinopathy [Disease/Finding], Tendinopathies
Swedish Tendinopati
Czech tendinopatie
Finnish Tendinopatia
Russian TENDINOPATIIA, TENDINOZ, TENDINIT, ТЕНДИНИТ, ТЕНДИНОЗ, ТЕНДИНОПАТИЯ
Polish Zapalenie ścięgna, Choroby ścięgna
Japanese 腱炎, 腱障害
Portuguese Tendinopatia
German Tendopathie
Italian Tendinopatia
French Tendinopathie
Spanish Entesiopatia, Entesiopatía, Tendinopatia, Tendinopatía
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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