Tendon Injuries Topic 2

Topic 2 Tendon Injuries 1 TENDÓN • Fibril (10 and 500 nm) > fibres > endothenon (lax connective tissue) > epitenon • Endotenon, has blood and lymphatic vessels and nerves. • Total collagen: 95%. • Type I collagen, 70-80%. • Collagen is stabilised by the formation of cross-bridges, such as hydrox...

Topic 2 Tendon Injuries 1 TENDÓN • Fibril (10 and 500 nm) > fibres > endothenon (lax connective tissue) > epitenon • Endotenon, has blood and lymphatic vessels and nerves. • Total collagen: 95%. • Type I collagen, 70-80%. • Collagen is stabilised by the formation of cross-bridges, such as hydroxylysylproline and lysylpyridoline. 2 2 1 First stage, inflammatory (24 hrs) Monocytes and macrophages are recruited within the first 24 hours, and phagocytosis of necrotic materials at the injury site occurs. Second stage : proliferation (2 weeks) The tenocytes are involved in the synthesis of large amounts of collagen and proteoglycans at the site of injury. Third stage : maturation >2 weeks The tissue becomes more fibrous as a result of increased maturation of collagen and the fibrils become aligned in the direction of mechanical stress. 3 TENDINOPATHY • Two clinic forms : • Acute : tendonitis / tenosinovitis : traumatic incident where the tendon tears, either partially or fully, with signs of inflammatory reaction • Cronic : tendinosis / tenosinoviosis : overuse injury gradually develops over time, without clinical or histological signs of inflammation and disorganized healing reaction 4 4 2 TENDINOPATHY : Symptoms • Tendonitis : Acute • Pain, tenderness, redness, warmth, and/or swelling near the injured tendon. • Pain may increase with activity • Tendon crackling when it moves (this may be felt on palpation ) • • Tendinosis: Chronic • Pain and stiffness that may be worse during the night or when getting up in the morning. • Lump develops along the tendon • 90% cases 10% cases 5 6 3 7 Reduce Pain Improve muscle loads Patient education. Promote new tissue reparation 8 4 REDUCE PAIN •PRICE/POLICE •Iontoforesis, sonoforesis. •Trabajo isométrico según tolerancia •Movilización pasiva activo/asistida sin dolor. •Termoterapia suave a partir del 3 er día si no dolor. 9 9 Promote Reparation : Percutaneous electrolysis • Non-thermal electrochemical ablation through a cathodic flow in the region or clinical focus of the degenerated tendon. (Electrolysis) • EPI produces the dissociation of water, salts and amino acids of the extracellular matrix creating new collagen molecules 10 5 • Conservative approach • Low-cost • No equipment • Self-management • Effective • Alfredson Protocol 11 12 6 ROTURA TENDINOSA: – They usually settle in previously degenerated tendons. – Frequent in Achilles, patellar, rotator cuff and biceps brachii. – SURGERY + IMMOBILISATION for 2 to 6 WEEKS. Inmovilization pahse : – Scar treatment: US, massage, shock waves, radiofrequency. Movilization Phase: Readaptation to load and proprioception (apply usual tendinopathy protocol after pain remission). – Lymphatic drainage. – Passive mobilisation 13 13 Muscle Strain INFLAMATORY PHASE PHASE I MAXIMAL PROTECTION Rest + compression Limit painfull motion Control pain Isometrics PROLIFERATIVE PHASE PHASE II MODERATE PROTECTION Mechanical stimulus : US, stretching Isotonics Tendinopathy Limit tendón stress Promote tissue Reduce pain reparation Isometrics contraction Eccentrics Ligament Sprain Protect ligament Reduce swelling Pain control MATURATIVE PHASE PHASE II MINIMAL PROTECTION Increase stenght Eccentrics : plyomtretics Increase muscle loads Functional training Restor range of motion, Increase functional strength and flexibility level Basic propioception Advanced propioception 14 14 7