Sports Medicine Book

Traumatic Injury

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Tendon InjuryAka: 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
  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
    2. Wilson (2005) Am Fam Physician 72(5):811

Tendinitis (C0039503)

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.
ConceptsDisease or Syndrome (T047)
ICD9726.90
EnglishBicepital tendonitis, Inflammatory disorder of tendon, Tendinitides, Tendinitis, Tendonitides, Tendonitis, Tendonitis bicepital
Spanishtendinitis, tendonitis
CreditsDerived 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.
ConceptsDisease or Syndrome (T047)
EnglishTendinopathies, Tendinopathy
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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