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