Patellar Tendonitis --> Osgood Schlaughter

Surgical Treatment Achilles Tendonitis

Excision of abnromal tendinous and paratendinous tissue longitudinal tenotomy DONT WORK WELL

T1 MRI emphasizes ________ T2 MRI supresses ______

FAT

Diagnostic Studies Patellar tendonitis

MRI Diagnostic Ultrasound clinician can look at tendon directly and assess whether or not there has been injury or strain not needed can be diagnosed in clinical exam

Diagnostic Studies Achilles Tendonitis

MRI normal and abnormal structures tendon fiber alignment

Treatment OSD

NSAIDS rest ice resolve once growth plate closes

Treatment Non Op Achilles Tendonitis

NSAIDS Physical Therapy

PT achilles Tendonitis

PT ACUTE PHASE CAN HELP Open chain progress to closed chain Cryotherapy heating and stretching

WHAT DO YOU NOT GIVE PEOPLE WITH TENDONITIS OF ANYTHING

STEROIDS NO STEROIDS make tendons softer and weaker GREATER CHANCE FOR RUPTURE

Difference between Tendonitis and Tendonosis

Tendonitis - acute inflammation Tendonosis - chronic breakdown of tendon CT tendon becomes weaker can result in rupture rupture repair doesnt work well

In Achilles Tendonitis the collagen transforms from type _______ to type _____

Type 1 Type III

The distal and proximal achilles tendon are well vascularized and the middle has an area of hypovascularity ALSO KNOWN AS (true in most tendons)

WATERSHED AREA

Patellar tendonitis can occur in....

adults with a previous osgood schlatter fibrous nonunion ossicle loose

Plica

anterior posterior plane --> cruciate medial lateral plane become patellofemoral ligaments lateral or medial 50% of people have fold in tssue with trauma plica can impinge causing ant/med knee pain crosses the joint can mimic meniscal injury

Patellar Tendonitis causes

attributed to external factors such as rapid acceleration loading that puts the patellar tendon at greater risk to be injured repeated use in activity that emphisizes running kicking and jumping repeated eccentric loading

Patellar Tendonitis Pathophys

causes worsens inflammation causing focal deteriorations and microtraumas of the patellar tendon leading to signs and symptoms associated with this condition

Pathophysiology of Achilles Tendonitis and Tendonopathy

combination of intrinsic and extrinsic factors vascularity nutrition shoe wear muscle imbalances and body weight combined with subthreshold microtraumas to the tissue lead to degeneration of tendon

Clinical Presentation/ Exam findings Patellar Tendonitis

common in populations that run jump in large quantities pain progessively worsening in participation of sport localized anterior knee pain at the INFERIOR POLE/SUPERIOR POLE of the patella or tibial tuberosity observed swelling apprehensive upon palpation active extension of knee and ascending and descending stairs difficult quad hamstring tightness

Osgood Schlatter Definition

disturbance in the development of the tibial tuberosity typically in young children or adolescents which is caused by repeaed and rapidly applied tensile forces by the quadriceps muscles at the tendinous insertion of the patella tendon on tibia traction apophysitis at the level of the tibial tuberosity occurs due to the preossification phase or the ossified phase of secondary ossification center common cause of knee pain in growing adloescents during growth spurts

in Osgood Schlatters is commonly seen

during growth spurts and when the bones and cartilage grow much faster than the muscles and tendons cartilage of tib tuberosity can resist forces but not as strong resistance as bone if individual with OSD continues to participate in sports symptoms worsen and more microavulsions develop

PT for Patellar Tendonitis

eccentric exercsies lessening symptoms strenghtening hips LE imbalances

Key location patellar tendonitis

inferior pole of the patella proximal 1/3 of tendon

Physical Exam Findings Achilles Tendonitis

inflammation strength and ROM THOMPSON TEST single leg hop single leg calf raise

paratendonosis

inflammation of the paratenon sheath of the achilles tendon thickening of tendon looks like an olive crepetis under tendon RESPONDS WELL WITH STENOSIS AND EXCISION OF PARATENON

PLASMA injections/ STEM CELLS

injection of immature cells can increase the inflammatory responce and stimulate healing

Differential Diagnosis Achilles Tendonitis

is it tendonopathy or perateondonipathy can progress to rupture

Clinical Presentation OSD

knee pain and tenderness localized at tibial tuberoisty followed by signs of swelling tightness of quads and hamstrings pain present after activity and stops with rest force on knee extensors lead to more aggrivation of tibial tuberosity typically unilateral but 20-30% can be bilateral

Braces work to

offlead the force that is resulting in pain/injury

Clinical Presentation Achilles Tendonitis

overall pain and tightness throughout the achilles region specifically 3-6 cm away from calcaneal insertion in the tendon worse at beginig of activity then gradually gets worse

Patellar Tendonosis Definition

overuse injury that occurs with the continuation of running jumping agility sports and activity NON INFLAMMATORY CHRONIC DETERIORATION OF PATELLAR TENDON

Patellar Tendonitis definition

overuse of the musculotendinous patellar unit attaching an individals patella to their tibial tuberosity

Physical Examination OSD

palpation pain history observation increased bony protuberance of tibial tuberosity ELYs test for quad tightness symptoms aggrivate with walking running jumping

Differential Diagnosis Patellar Tendonitis

patellarfemoral syndrome osgood schlatter osteochondritis dissecans

Treatment Patellar tendonitis

physical therapy first resort surgical intervention becomes an option when pain and discomfort persist or intensity after the supervised exercise program

Pathophys Osgood Schlatter

repetative runner/jumper requiring repeated contractions of the quadriceps an extra articular osteochondral stress fracture AKA microavulsion occurs at the tibial tuburcle during repair of stress fracture new bone is laid down in the avulsion space and may result in a deviated and prominent tibial tuburcle

Microtears Patellar tendonitis

result from overuse of the patellar tendon creating a discontinuit in the configuration of the collagen that comprises the tendon the discontinuity in the collagen inhibits its ability to smooth the process of weight bearing leading to an inflammatory cascade to alleviate mechanical damage

Differential Diagnosis OSD

sinding larsen johanssen viral synovitis hoffas syndrome synovial plica injury tibial tuburcle fracture bone tumor patellar avulsion/rupture patellofemoral syndrome infectious apophytis osteomyelitis of the proximal tibia pain can subside with age and closing of epipohyseal plate

Internal factors that can result in Patellar Tendonitis

strength imablance lack of flexibiliity postural misalignments faulty foot structure

PT OSD

strengthen and improve flexibility of quads hamstrings IT band Gastroc high intensity quadriceps strengthening should be avoided to reduce stress

Achilles tendonitis definition

tendon pain and discomfort inflammatory condition of the achilles tendon and in the progressive deterioration of the tendon in tendonopathy

you can have ________ and ________

tendonopathy and paratendonopathy

Inflammation in achillies tendonitis can be present in both

the tendon itself or the sheath around the tendon known as the paratenon

Diagnostic Studies OSD

xray to examine tibial tuburcle rule out fracture superficial ossicle in patellar tendon irregular ossification of proximal tibial tuberosity thickening of patellar tendon soft tissue edema Ultrasound can be used to id cartilage and bony surfaces