450: Tendons

Tendinopathy

Pain in the tendons with movement or tension

collagen breakdown from overuse not inflammation

tendons are poorly vascularized

Lateral Epicondylosis/itis

Tennis elbow

painful extrinsic extensor tendons near elbow

painful to the touch

decreased grip strength

Lateral epicondylosis tests

Mill’s test

Maudsley’s test

Cozen’s test

Showed up Late to Maudsley’s Cosy Mill

Medial epicondylosis/itis

golfers elbow

painful flexor tendons near elbow

painful to the touch

painful grip/pronation

De Quervain tenosynovitis

thumb tendons

adductor pollicis longus

extensor pollicis brevis

painful thumb abduction/extension

De Quervain tests

Finkelstein’s test - resisting thumb abduction and painful first dorsal compartment

I Fink you did a great job, Kevin (thumbs up)

Trigger finger

flexor tendon issues during finger flexion, inflamed tendon or sheath makes movement through A1 pulley system difficult

Treatment for Tendinopathy

Pain free ROM

Tendinosis Oasis

O - Orthotic

A - Activity modification

S - Stretch

I - Ice

S -Strengthening

Lateral Epicondylosis OASIS

O - wrist cock-up splint

A - Modify task to rest the area, avoid painful movements

S - Stretch the area to regain limited ROM focus on TERT, pain-free

I - Use as needed for pain relief

S - Implement later, pain-free eccentric contractions only

Medial epicondylosis OASIS

O - Wrist cock-up splint (wrist neutral)

A - Modify tasks to rest the area, avoid painful movements

S - Stretch the area to regain limited ROM, focus on TERT, pain-free

I - use as needed for pain relief

S - implement later, pain-free eccentric contractions only

De Quervain Tenosynovitis OASIS

O - thumb spica, every night and as much as possible during the day

A - Avoid pain

S - AROM and PROM, tendon glides

I - as needed less needed for small muscles/tendons

S - Isometric first

Trigger Finger OASIS

O - MP extension 6-8 weeks day and night

A - avoid pain and trigger finger

S - AROM/ PROM a few times daily

I - As needed

S - less relevant for trigger finger

Teninopathy Keyline

Tendinitis OASIS

Extensor Tendon Zones

7 zones

zones alternate joint/interjoint areas

the number 1 looks like a finger, the number 7 looks like a bent wrist

thumb only has 5 zones

Tension-limiting mobility progression

1. Immobilization

2. PROM

3. AROM

concerned about tension in the tendons

Strictly controlled PROM

surgeon protocol

Zone 1 & 2 Injury

Mallet finger

immobilize with splint until cleared for ROM

Zone 3 & 4 Injury

Involves PIP

1 of the 3 possible protocols

Splint in antideformity position

Zone 5, 6, & 7 injury

Damage to extensor tendons between the MCPS and dorsal hand/wrist

1 of 3 possible protocols

Splint in full hand extension or pan splint

Extensor tendon injury Keyline

Full extension, no tension

tension-limiting mobility progression Breaks The Norm

Flexor tendon repair approaches

surgical repair differentiated by strand count

usually 2 or 4 but can be 6+

more threads = more stable

more stable = earlier PROM or AROM

Early immobilization for the flexor tendon

dorsal blocking splint

more rarely used

Early PROM flexor tendon

passive flexion

active extension within dorsal block splint

Early AROM flexor tendon

use dorsal block splint for most of the time

separate orthosis with wrist extension for gentle active flexion

Flexor Tendon injury Keyline

full flexion, no tension

the decision hinges on 2, 4 or more

Dupuytren’s contracture

progressive contracture into MP and PIP flexion

4th/5th digits

thickening of palmar fascia

addressed surgically

Dupuytren’s mend vs move

low-key and be relatively aggressive with mobilizing

post surgery immediate A/PROM

avoid strenuous activity and sports until healed

Treatment for Dupuytren’s

immediate A/PROM

light ADLs

MP extension splint at night

monitor for infection

avoid strenuous activity for 6 weeks

wound/scar management

watch for signs of. infection

once healed completely massage with lotion

Non-surgical treatment for dupuytren’s

conservative management

soft tissue mobilization

ultrasound

progressive stretching with heat

extension splint at night

Dupuytren’s contracture Keyline

Don’t be duped, dupuytren’s is no big deal

release to ROM to Rackets in 6 weeks