Acute. Chronic. Tendinopathy: Acute vs. Chronic Differences in Anatomy, Symptoms & Treatment
|
|
- Hortense Snow
- 5 years ago
- Views:
Transcription
1 Tendinopathy: Acute vs. Chronic Differences in Anatomy, Symptoms & Treatment Science and Management Symposium SAM 2018 Marlene Reid, DPM FACFAS, FACFAO, FASPS Tendinopathy Tendinopathy is a failed healing response of the tendon, with haphazard proliferation of tenocytes, intracellular abnormalities in tenocytes, disruption of collagen fibers, and a subsequent increase in noncollagenous matrix. The term tendinopathy is a generic descriptor of the clinical conditions (both pain and pathological characteristics) associated with overuse in and around tendons. Acute Overuse Sudden/gradual onset pain Edema, erythema Superficially tender Tendinitis Chronic Long term Deeper pain Aching pain Less related to activity Tendonosis Acute vs. Chronic: Understanding the differences 1
2 Tendonitis: Acute Reaction to excessive force or load beyond its capacity to bear causing traumatic strain or tear Recent onset of pain with localized edema, erythema due to inflammation History of acute injury or repetitive injury Pain from passive ROM Pain with motion against resistance Tendonitis: Basic Clinical Presentation is not enough for effective treatment! Phase of Healing: Determines Treatment I. Acute Inflammatory Response Cellular Response: First hours to days Hemostasis: vasoconstriction, platelets, coagulation, clot formation Inflammatory Reaction: vasodilation and cellular infiltration, degradation and phagocytosis Acute Symptoms: Edema, erythema Decrease muscle function from splinting pain with palpation from cellular rxn pain from muscle spasms pain with ROM pain with stretching pain with or without resistance Phase of Healing: Determines Treatment II. Subacute/Regeneration/Repair Collagen Proliferation: Day 2-4 thru 2 to 3 weeks Angiogenesis, granulation, collagen Granulation tissue forms Subacute Symptoms: Decrease edema and tenderness Decrease muscle function from guarding and weakness Easily reinjured due to fragile granulation tissue Pain with stretching initially then decreases as collagen builds Fills defect and produces new capillaries Fibroblasts produce collagen Early granulation tissue is very fragile Collagen (type III) increases tensile strength 2
3 Acute Presentation typical to ER or PCP Subacute Presentation typical to podiatrist Standard Treatment: RICE Reduce edema Reduce mobility of tendon and muscle Considerations: NSAID use - controlling vs. allowing inflammation When does the subacute phase end and the remodeling phase begin?? Phase of Healing: Determines Treatment Phase III: Remodeling and Maturation Chronic Inflammation Scar Tissue Formation and maturation 2-3 Weeks to years Chronic phase of healing no inflammation Collagen Type III remodeled into Type I Collagen fibers realign Tensile Strength increases Scar tissue has 80% strength of normal due to irregular arrangement of fibers When to encourage mobilize?? Wolff s Law Bone grows in response to mechanical stress and tissue remodeling is dependent on the forces it is subjected to. Proper amounts of mobilization are required for normal healing and prevention of adhesions, BUT Excessive immobilization can cause excessive amounts of collagen, forming crosslinks that adhere to adjoining structures and cause further pain and degenerative changes. Do Some Immobilize Too Much? Do Some Immobilize Too Little? When is the proper time to start physical therapy? 3
4 When to Immobilize??? Mobilization too early in the rehabilitation (during Phase 2 of healing) program can interfere with healing if the tissue is reinjured before it is properly healed causing chronic irritation and a prolonged inflammatory response Mobilization too late in rehabilitation can cause adhesions, scar tissue and continued pain with resistance as the tendon can no longer bear its original load. Chronic Inflammation develops! Tendonosis is most commonly thought of as chronic tendonitis. Tendonosis is a relatively new diagnosis with much confusion. It is not known whether substages of tendonosis exist and whether it is an ongoing process or an end-stage. Rheumatology 2001; 40: Tendonosis is a term referring to intratendinous degeneration due to atrophy Tendinopathy=failed healing response, Lower Extremity Review 2013;Vol 5: Defining Tendonosis Tendonosis Intratendinous hypertrophyic collagen degeneration Non-inflammatory avascular Fatty degeneration atrophy Fiber disorientation Scattered vascular ingrowth local necrosis or calcification Very different from tendonitis!! Decreased function of the tissue Continued pain with use Palpable nodule Pain with after resistance or fatigue Persistent pain Duration of symptoms 4
5 Could it be caused by over healing - limiting inflammation and mobilization? Or is it caused by under healing and not allowing the enough supportive measures? Is it actually incomplete healing that needs a kick start? Tendonosis : Leftover tenopathy Other Considerations in Tendon Injury Lower Extremity Review, 2013 Volume 5: Genetic factors Family history of Achilles x5 risk for injury Specific genes over or under expressed-9 studies representing collagen protein encoding, matrix metaloproteinases (MMPs) and inflammatory signaling molecules COL5A gene encodes type 1 collagen fibrils Metabolic Considerations Diabetes>advanced glycation end products links with collagen fibers>increase degeneration Hormonal Influences in SFT Injury Conflicting Findings: Increased estrogen > lower collagen synthesis which may change structure and function Estrogen may>dec. firoblast biosynthesis>may decrease collagen density ACL rupture decreased with inc. estrogen Estrogen limits skeletal muscle fiber diameter 5
6 Fatty Degeneration of Tendonosis Heel Pain: Fasciitis vs. Fasciosis Symptoms drastically change after a few months Acute must be treated differently from chronic! Plantar Fasciitis: A Degenerative Process (Fasciosis) Without Inflammation, Harvey Lemont, et al. JAPMA, May/June 2003 Histiological Findings from heel spur surgery cases show no evidence of inflammation in all samples examined. Many samples showed fiber fragmentation and myxoid degeneration Podiatry Today September 2007 Steroid Injections: Are They Over-utilized in Athletes?..uses cortisone for chronic inflammatory conditions inflammatory conditions with a long, ongoing history will not have healthy tissue and the corticosteroid t id injection will cause further tissue degradation and possible rupture. Cortisone Controversy 6
7 Tendonosis is chronic pain characterized by hypovascularity and collagen degeneration that requires a treatment option designed specifically for these conditions. Treatments must Address Collagen Repair and Vascularity NOT inflammation Treating Tendonosis: Treatment should kick start an inflammatory process to convert chronic to acute Traumeel Injections: Homeopathy Prolotherapy: Proliferation of tissue with dextrose solution injection inflammatory response to the irritant Needling ESWT Coblation - Bipolar Radiofrequency (RF) Electrosurgery Platelet Rich Plasma (PRP) Amniotic Tissue injections Open Debridement and excision of necrotic tissue Identify the stage of healing the tendon is in. Providing supportive measures to allow the normal inflammatory response to occur. Initiating mobilization to tolerance allowing the tendon to function to the ability it is able to while encourage proper tissue modeling and repair. Recognizing when healing is chronic and needs to be converted back to active healing. Prevention of Tendonosis: Using What We Already Know 7
8 Tendonosis vs. Tendonitis: Understanding the difference between acute and chronic tendinopathy! Thank you 8
Treatment, Rehabilitation and Reconditioning Physiology of Tissue Repair
Treatment, Rehabilitation and Reconditioning Physiology of Tissue Repair PHYSIOLOGY OF TISSUE REPAIR Knowing when it is appropriate to begin rehabilitation and when it is acceptable to return to practice
More informationPlantar Fasciitis. What is Plantar Fasciitis: Anatomy of the Plantar Fascia: Problems with the Plantar Fascia:
Plantar Fasciitis What is Plantar Fasciitis: Plantar Fasciitis is one of the most common causes of heel pain in Los Angeles and globally. The Foot and Ankle Institute is a world leader in the research
More informationTendon & Ligament Application of PRP
Tendon & Ligament Application of PRP Sang Chul Lee, M.D, PhD. Department of Physical Medicine & Rehabilitation, Myongji hospital, Kwandong University College of Medicine Tendon and Ligament Low metabolic
More informationTOPAZ TM What you should know
TOPAZ TM What you should know Not for distribution in the United States. Need to know 2 Tendon: is a tough band of fibrous connective tissue that connects muscle to bone and is capable of withstanding
More informationInflammation is Not the Enemy
6/22/2017 Inflammation is Not the Enemy Sean Mulvaney, MD 1 6/22/2017 2 6/22/2017 Lascaux 7.4 Billion 3 This image cannot currently be displayed. 6/22/2017 Goals 4 ANTI INFLAMMATORY THERAPIES NSAIDS 5
More informationAMG Virtual CME Series Plantar Fasciitis Brian T. Dix, DPM, FACFAS Board Certified in Foot and Reconstructive Hindfoot & Ankle Surgery
AMG Virtual CME Series Plantar Fasciitis 11-9-17 Brian T. Dix, DPM, FACFAS Board Certified in Foot and Reconstructive Hindfoot & Ankle Surgery Anatomy 3 bands of dense connective tissue, which originate
More informationPRPP Injection Dora Street, Hurstville MBBS FACSP. Dr Paul Annett Sport & Exercise Medicine Physician
PRPP Injection Dr. Paul Annett MBBS FACSP Sport and Exercise Medicine Physician www.orthosports.com.au 29 31 Dora Street, Hurstville PRP injection - Outline Basic science PRPP preparations Literature Patient
More informationRicardo E. Colberg, MD, RMSK. PM&R Sports Medicine Physician Andrews Sports Medicine and Orthopedic Center American Sports Medicine Institute
Ricardo E. Colberg, MD, RMSK PM&R Sports Medicine Physician Andrews Sports Medicine and Orthopedic Center American Sports Medicine Institute Pathophysiology of chronic orthopedic injuries Definition of
More informationCommon Tendon Disorders of the Upper Extremity. Mark Tait MD
Common Tendon Disorders of the Upper Extremity Mark Tait MD Tendonitis History Pain and swelling (any tendon, any location) Overuse Physical examination findings Localized swelling Pain with resistance
More informationCommon%Work%Related%Foot% and%ankle%problems
Common%Work%Related%Foot% and%ankle%problems Dr. George H. Theodore Massachusetts General Hospital Harvard Medical School Foot and Ankle Consultant Boston Red Sox New England Patriots Boston Bruins Work%Related%Foot%and%Ankle%
More informationDisorders of the Achilles tendon The ageing athlete
Disorders of the Achilles tendon The ageing athlete John P. Negrine F.R.A.C.S. Foot and Ankle Surgeon Orthosports Sydney The Bad news Maximum heart rate decreases VO2 Max decreases Runners when compared
More informationORTHOPEDICS BONE Recalcitrant nonunions In total hip replacement total knee surgery increased callus volume
ORTHOPEDICS Orthopedics has to do with a variety of tissue: bone, cartilage, tendon, ligament, muscle. In this regard orthopedic and sports medicine share the same tissue targets. Orthopedics is mostly
More informationPLATELET- RICH PLASMA (PRP) INJECTIONS
PLATELET- RICH PLASMA (PRP) INJECTIONS Platelet-rich plasma (PRP) injections have become an extremely popular treatment option for patients with chronic tendon injuries. Although PRP injections have received
More informationHIGH PERFORMANCE CENTRE FOR SPORTS RECOVERY
HIGH PERFORMANCE CENTRE FOR SPORTS RECOVERY EDMONTON BREWERY DISTRICT DOWNTOWN Edmonton s First Boutique Physiotherapy Clinic WHAT SETS US APART? NO ATHLETE IS TRULY TESTED UNTIL THEY VE STARED INJURY
More informationPRP vs Steroid Injection for Heel Pain
PRP vs Steroid Injection for Heel Pain Faculty Lawrence M. Oloff, DPM, FACFAS Team Podiatrist, San Francisco Giants San Francisco, California Thomas Chang, DPM Clinical Professor / Part Chairman Department
More informationServers Disease (Calcaneal Apophysitis ) 101
Servers Disease (Calcaneal Apophysitis ) 101 Servers Disease Causes a disturbance to the growing area at the back of the heel bone (calcaneus) where the strong Achilles tendon attaches to it. It is most
More informationHemostasis Inflammatory Phase Proliferative/rebuilding Phase Maturation Phase
The presenters are staff members of the CHI Health St. Elizabeth Burn and Wound Center. Many of the products discussed are used in our current practice but we have no conflict of interest to disclose.
More informationTreatment of Lateral Elbow Tendinopathy: Medical and Surgical Interventions
APPENDIX G Treatment of Lateral Elbow Tendinopathy: Medical and Surgical Interventions The purpose of this document is to provide information for physiotherapists of common medical and surgical interventions
More informationAchilles Tendon Anatomy. Achilles Tendon Anatomy. Acute Achilles Rupture. Acute Achilles Rupture 8/19/14. Primary plantarflexor
Disclosure Conditions of the Achilles Tendon Brian Clowers, M.D. I have no financial relationships that would influence the content of this presentation Oklahoma Sports and Orthopedic Institute September
More informationPLATELET-RICH PLASMA FOR TREATING CHRONIC TENDINOPATHY
PLATELET-RICH PLASMA FOR TREATING CHRONIC TENDINOPATHY Written by Jean-François Kaux, Belgium Tendinopathy is a major problem in medicine and sports traumatology 1. It is due, inter alia, to mechanical
More informationmechanical stresses on the tendon with repetitive loading
Tendinopathy.. How does it happen? mechanical stresses on the tendon with repetitive loading Impingement of the tendon between adjacent structures (bones, ligaments) and impaired blood supply Presentation
More information3/6/2012 STATE OF THE ART: FOOT AND ANKLE GENERAL KNOWLEDGE 1. TRASP REHABILITATION CONTENTS. General knowledge Trasp Prevention
STATE OF THE ART: FOOT AND ANKLE ILITATION Fabienne Van De Steene. CONTENTS General knowledge Trasp Prevention Rehab Ankle sprain CAI Achilles tendon Plantar fasciitis Take home message 2 1. TRASP Ankle
More informationA Patient s Guide to Plantar Fasciitis
A Patient s Guide to Plantar Fasciitis 15195 Heathcote Blvd Suite 334 Haymarket, VA 20169 Phone: 703-369-9070 Fax: 703-369-9240 DISCLAIMER: The information in this booklet is compiled from a variety of
More informationINSIGHTS INTO ACHILLES TENDINOPATHY
C H A P T E R 1 4 INSIGHTS INTO ACHILLES TENDINOPATHY Steven R. Carter, DPM TERMINOLOGY The terminology used to describe Achilles tendon pathology can be misleading and sometimes confusing. Often we use
More informationNorth Texas Musculoskeletal Medicine Enhancing the body s innate ability to heal
Enhancing the body s innate ability to heal Ntxmsk.com 817.416.0970 Dennis E. Minotti II, D.O. Thank you for your interest in, procedures that are radically changing treatment of musculoskeletal conditions.
More informationNon Surgical Management of Soft Tissue Injuries. Megan LeFave, DVM cvma
Non Surgical Management of Soft Tissue Injuries Megan LeFave, DVM cvma Non Surgical Management of Soft Tissue Injuries Biomechanical Principles Common front limb and hind limb injuries In hospital treatments
More informationPlantar fasciopathy (PFs)
Plantar fasciopathy (PFs) 2016. 04. 30. Jung-Soo Lee, M.D., Ph.D. Department of Rehabilitation Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea Anatomy of
More information3rd MuscleTech Network Workshop. Muscle injuries and repair: Current trends in research.
3rd MuscleTech Network Workshop. Muscle injuries and repair: Current trends in research. CONCLUSIONS AND CLOSING REMARKS Dr. Carles Pedret MUSCLE AND TENDON WORKSHOP HEALTH AND GENERAL POPULATION SPORTS
More informationtissue, Interventional non-vascular /ecr2014/C-1241
Effectiveness of Ultrasound-guided Platelet Rich Plasma (PRP) injections after needle tenotomy in the treatment of chronic tendinopathies : A prospective study. Poster No.: C-1241 Congress: ECR 2014 Type:
More informationA Patient s Guide to Platelet-Rich Plasma Treatment of Musculoskeletal Compliments of: The Central Orthopedic Group
A Patient s Guide to Platelet-Rich Plasma Treatment of Musculoskeletal Problems The Central Orthopedic Group 651 Old Country Road Plainview, NY 11803 Phone: 5166818822 Fax: 5166813332 p.lettieri@aol.com
More informationA Patient s Guide to Posterior Tibial Tendon Problems
A Patient s Guide to Posterior Tibial Tendon Problems Iain is a specialist in musculoskeletal imaging and the diagnosis of musculoskeletal pain. This information is provided with the hope that you can
More informationJMSCR Volume 03 Issue 01 Page January 2015
www.jmscr.igmpublication.org Impact Factor 3.79 ISSN (e)-2347-176x Management of Chronic Plantar Fasciitis using Hyperosmolar Dextrose Injection Authors Ansarul Haq Lone 1, Omar Khursheed 2, Shakir Rashid
More informationPlatelet Rich Plasma (PRP) injections. by Dr George Pitsis
Platelet Rich Plasma (PRP) injections by Dr George Pitsis Platelet Rich Plasma (PRP) injections have in the more recent years attracted significant attention as a clinical tools to assist with treatment
More informationA Patient s Guide to Achilles Tendon Problems
A Patient s Guide to Achilles Tendon Problems 264 Pleasant Street Concord, NH 03301 Phone: 6032243368 Fax: 6032287268 marketing.copa@concordortho.com DISCLAIMER: The information in this booklet is compiled
More informationA Patient s Guide to Platelet-Rich Plasma Treatment of Musculoskeletal Problems
A Patient s Guide to Platelet-Rich Plasma Treatment of Musculoskeletal Problems Iain is a specialist in musculoskeletal imaging and the diagnosis of musculoskeletal pain. This information is provided with
More informationMassive Rotator Cuff Tears Pathophysiology and Treatment Options. Mike Walton Consultant Shoulder Surgeon Wrightington Hospital
Massive Rotator Cuff Tears Pathophysiology and Treatment Options Mike Walton Consultant Shoulder Surgeon Wrightington Hospital Tendon Structure Tendons are mechanically responsible for the transmission
More informationAdjunctive Treatments for Tendinopathy. Brendan O Neill Sports Physician Anglesea Sports Medicine Unisports Sports Medicine
Adjunctive Treatments for Tendinopathy Brendan O Neill Sports Physician Anglesea Sports Medicine Unisports Sports Medicine About Me Sports Physician Unisports Sports Medicine Anglesea Sports Medicine BikeNZ
More informationKNEE INJURIES IN SPORTS MEDICINE
KNEE INJURIES IN SPORTS MEDICINE Irving Raphael, MD June 13, 2014 RSM Medical Associates Head Team Physician Syracuse University Outline Meniscal Injuries anatomy Exam Treatment ACL Injuries Etiology Physical
More informationPRP Basic Science. Platelets. Definition of PRP 10/4/2011. Questions that this talk aims to answer
PRP Basic Science Peter J. Moley, MD Hospital for Special Surgery October 5, 2011 Questions that this talk aims to answer 1. What is PRP? 2. What blood components are NOT in PRP? 3. What are the active
More informationPosterior Tibial Tendon Problems
A Patient s Guide to Posterior Tibial Tendon Problems 2350 Royal Boulevard Suite 200 Elgin, IL 60123 Phone: 847.931.5300 Fax: 847.931.9072 DISCLAIMER: The information in this booklet is compiled from a
More informationDr. Abigail R. Hamilton, MD
ACHILLES TENDINITIS Dr. Abigail R. Hamilton, MD ANATOMY The Achilles tendon is a strong tendon that connects the calf muscles to the heel. When the calf muscles contract, they pull on the Achilles tendon
More informationUNIT 2.- SPORT INJURIES: SYMPTOMS AND TREATMENT
UNIT 2.- SPORT INJURIES: SYMPTOMS AND TREATMENT Every year, millions of teenagers participate in high school sports. An injury to a high school athlete can be a significant disappointment for the teen,
More informationNursing Management: Musculoskeletal Trauma and Orthopedic Surgery. By: Aun Lauriz E. Macuja SAC_SN4
Nursing Management: Musculoskeletal Trauma and Orthopedic Surgery By: Aun Lauriz E. Macuja SAC_SN4 The most common cause of musculoskeletal injuries is a traumatic event resulting in fracture, dislocation,
More informationTrauma and Immobilization SCAR. Summary: Acute Inflammation & Healing. TRAUMA Wound Healing: Three Phases
Upper Extremity Stiffness and Contracture After Trauma Phil PT, PhD, FAPTA mcclure@arcadia.edu Trauma and Immobilization SCAR TRAUMA Wound Healing: Three Phases Inflammation (0-5 days) Fibroplasia (Repair,
More informationNorth Texas Musculoskeletal Medicine Enhancing the body s innate ability to heal
Enhancing the body s innate ability to heal Ntxmsk.com 817.416.0970 Dennis E. Minotti II, D.O. Thank you for your interest in, procedures that are radically changing treatment of musculoskeletal conditions.
More informationConservative Management of Joint Pain. John C. Hughes, D.O. Aspen Integrated Medicine
Conservative Management of Joint Pain John C. Hughes, D.O. Aspen Integrated Medicine Overview: Osteopathic Treatment of Joint Pain Osteopathic Medicine: DO defined, Principles DO techniques for knee, back,
More informationIntroduction to Biomedical Engineering
Introduction to Biomedical Engineering FW 16/17, AUT Biomechanics of tendons and ligaments G. Rouhi Biomechanics of tendons and ligaments Biomechanics of soft tissues The major soft tissues in musculoskeletal
More informationDr abedi yekta. Assistant Professor of Sports and Exercise Medicine Faculty of Medicine shahid beheshti University of Medical Sciences
Dr abedi yekta Assistant Professor of Sports and Exercise Medicine Faculty of Medicine shahid beheshti University of Medical Sciences Pain in midportion of Achilles tendon. Morning stiffness Tendinitis
More informationClinical Review Criteria
Clinical Review Criteria Autologous Platelet Derived Wound Healing Factors for Treatment of: Non Healing Cutaneous Wounds (Procuren) Non-Healing Fractures and the Associated GEM 21STM Device Platelet Rich
More informationAOFAS Resident Review Course September 28, Andrew J. Elliott, MD Assistant Attending Surgeon Hospital for Special Surgery Foot and Ankle Service
Course September 28, 2013 Andrew J. Elliott, MD Assistant Attending Surgeon Hospital for Special Surgery Foot and Ankle Service Disclosure I have a financial relationship with Bacterin. Its products are
More informationFoot and ankle update
Foot and ankle update Mr Ian Garnham Consultant Foot and Ankle Surgeon Whipps Cross University Hospital Hallux Rigidus Symptoms first ray and 1st MTP pain and swelling worse with push off or forced dorsiflexion
More informationPROLOTHERAPY Joel Berenbeim, D.O.
PROLOTHERAPY Joel Berenbeim, D.O. CSPOMM PROLOTHERAPY Prolos- To stimulate growth Prolotherapy involves the injection of irritant solutions into weakened or stretched ligaments which are a source of chronic
More informationA Patient s Guide to Plantar Fasciitis. Iain JS Duncan
A Patient s Guide to Plantar Fasciitis Iain is a specialist in musculoskeletal imaging and the diagnosis of musculoskeletal pain. This information is provided with the hope that you can better understand
More informationFROM BASIC SCIENCE. to ADVANCED TECHNOLOGY
FROM BASIC SCIENCE to ADVANCED TECHNOLOGY CONTENTS INTRODUCTION TO LASER THERAPY 1 PHYSIOLOGICAL EFFECTS OF LASER THERAPY 2-3 INFLAMMATION PATHWAY 4-5 CLINICAL EFFECTS OF LASER THERAPY 6-7 PAIN PATHWAY
More informationAchilles Tendinopathy: Medical and Surgical Interventions
APPENDIX D Achilles Tendinopathy: Medical and Surgical Interventions The purpose of this document is to summarize common medical and surgical interventions which may be considered for the management of
More informationPosterior Tibial Tendon Problems
A Patient s Guide to Posterior Tibial Tendon Problems 2659 Professional Circle Suite 1110 Naples, FL 34119 Phone: 239-596-0100 Fax: 239-596-6737 DISCLAIMER: The information in this booklet is compiled
More informationOveruse Injuries of the Upper Extremity. Overuse Injuries 7/23/2018. Peadiatric Overuse Sports Injuries. Al Hess, MD
Overuse Injuries of the Upper Extremity Al Hess, MD 7/21/2018 1 Overuse Injuries Everything? Not Trauma, infection, tumor, rheumatoid arthritis, osteoarthritis Onset of pain associated with repetitive
More informationPlatelet Rich Plasma (PRP) Dania Segreti, SPT Vanguard In-service - July 31, 2013
Platelet Rich Plasma (PRP) Dania Segreti, SPT Vanguard In-service - July 31, 2013 What is PRP? In medicine since 1970s First uses in bone healing began in late 1990s Gained popularity for tissue healing
More informationNorth Texas Musculoskeletal Medicine Enhancing the body s innate ability to heal
Enhancing the body s innate ability to heal Ntxmsk.com 817.416.0970 Dennis E. Minotti II, D.O. Thank you for your interest in, procedures that are radically changing treatment of musculoskeletal conditions.
More informationWOUND CARE UPDATE. -Commonly Used Skin Substitute Products For Wound. -Total Contact Casting. Jack W. Hutter DPM, FACFAS, C. ped.
WOUND CARE UPDATE -Commonly Used Skin Substitute Products For Wound Closure -Total Contact Casting Jack W. Hutter DPM, FACFAS, C. ped. Commonly Used Skin Substitute Products for Wound Closure why are they
More informationWhat can we agree upon?
What is tendinopathy and why does it happen? What can we agree upon? Clinical Pain with activity Tenderness upon palpation Swelling of tendon Impaired performance Structure - Imaging (US or MRI) Thickening
More informationIntroduction. Anatomy
the patella is called the quadriceps mechanism. Though we think of it as a single device, the quadriceps mechanism has two separate tendons, the quadriceps tendon on top of the patella and the patellar
More informationAcute Soft Tissue Injuries
Acute Soft Tissue Injuries Classic Soft-Tissue Injury Response Sequence: v inflammatory phase v proliferative phase v maturation phase Inflammation v pathologic process consisting of dynamic complex of
More informationORTHOPAEDIC SUMMIT 2016
Injuries to the Extensor Mechanism Quadriceps & Patellar tendon Pearls and Pitfalls M.Mike Malek, M.D. Washington Orthopaedic and Knee Clinic ORTHOPAEDIC SUMMIT 2016 Las Vegas, Nevada December 8, 2016
More informationSection 20: Fracture Mechanics and Healing 20-1
Section 20: Fracture Mechanics and Healing 20-1 20-2 From: Al-Tayyar Basic Biomechanics Bending Axial Loading Tension Compression Torsion Bending Compression Torsion 20-3 From: Le Fracture Mechanics Figure
More informationTIME S UP ON HEEL PAIN OPTIONS FOR CHRONIC FASCIAL AND TENDON INJURIES
TIME S UP ON HEEL PAIN OPTIONS FOR CHRONIC FASCIAL AND TENDON INJURIES ERIKA M. SCHWARTZ, DPM FOOT AND ANKLE SPECIALISTS OF THE MID -ATLANTIC WASHINGTON DC AND CHEVY CHASE, MD TENDON INJURY Tendon injuries
More informationEvidence Based Approach to the Treatment of Lower Extremity Tendinopathy. Cage SA, Gallegos DM, Eilers MA, Warner BJ
Evidence Based Approach to the Treatment of Lower Extremity Tendinopathy Cage SA, Gallegos DM, Eilers MA, Warner BJ Thank you PICO Question Patients Subjects suffering from lower extremity tendinopathy
More information9/14/16 PHASES OF HEALING. Mandatory Knowledge LEARNING OBJECTIVE. Understand Phases of Healing in Musculoskeletal Trauma
Mandatory Knowledge LEARNING OBJECTIVE Understand Phases of Healing in Musculoskeletal Trauma LEARNING OBJECTIVE Apply Phases of Healing knowledge in the evaluation and treatment of musculoskeletal complaints
More informationA calf strain often occurs when the calf muscles are working eccentrically ( working while under a stretch), such as coming down from a jump, and
A calf strain often occurs when the calf muscles are working eccentrically ( working while under a stretch), such as coming down from a jump, and also during the time when you are about to push off to
More informationUnit 9 MODALITIES AND REHABILITATION Mobility Worksheet
Unit 9 MODALITIES AND REHABILITATION Mobility Worksheet Name Period The selection of specific treatments is based on a variety of factors list four: What is the protocol for RICE? What are the purposes
More informationPlantar fasciitis occurs when the strong band of tissue that supports the arch of your foot becomes irritated and inflamed.
Plantar Fasciitis and Bone Spurs Plantar fasciitis (fashee-eye-tiss) is the most common cause of pain on the bottom of the heel. Approximately 2 million patients are treated for this condition every year.
More informationA Patient s Guide to Medial Epicondylitis (Golfer s Elbow) William T. Grant, MD
A Patient s Guide to Medial Epicondylitis (Golfer s Elbow) Dr. Grant is a talented orthopedic surgeon with more than 30 years of experience helping people return to their quality of life. He and GM Pugh,
More informationSurgical Wounds & Incisions
Surgical Wounds & Incisions A Comprehensive Review Assessment & Management Alex Khan APRN ACNS-BC MSN CWCN CFCN WCN-C Advanced Practice Nurse / Adult Clinical Nurse Specialist www.woundcarenurses.org 1
More information0RTHOPEDIC MASSAGE. Orthopedic Massage Benefits. Orthopedic Massage Applications
0RTHOPEDIC MASSAGE Orthopedic Massage involves therapeutic assessment, manipulation, and movement of locomotor soft tissues to eliminate pain and dysfunction throughout the body. It is more than a technique.
More informationCiprian Bardaş, Horea Benea, Artur Martin, Emergency County Hospital Cluj-Napoca, Romania Ortopaedics and Traumatology Clinic Cluj-Napoca, Romania
The traumatic rupture of the Achilles tendon an analysis of the modern methods of evaluation and treatment Ciprian Bardaş, Horea Benea, Artur Martin, Gheorghe Tomoaia Emergency County Hospital Cluj-Napoca,
More informationNew insights into the mechanisms of tendon injury
New insights into the mechanisms of tendon injury What is normal tendon? A extracellular matrix tissue Type 1 collagen Small amounts of CRITICAL proteins Ground substance Proteoglycans, glycoproteins Structures
More informationRecognizing common injuries to the lower extremity
Recognizing common injuries to the lower extremity Bones Femur Patella Tibia Tibial Tuberosity Medial Malleolus Fibula Lateral Malleolus Bones Tarsals Talus Calcaneus Metatarsals Phalanges Joints - Knee
More informationLASER THERAPY FOR PHYSIOTHERAPISTS
BioFlex Laser Therapy presents LASER THERAPY FOR PHYSIOTHERAPISTS Expand your knowledge. Build your practice. Did you know? Laser Therapy is one of the strongest evidence-based therapies according to Clinical
More informationTendinopathy from Overuse: Overview and a New(er) Treatment Option
Tendinopathy from Overuse: Overview and a New(er) Treatment Option Robert Flannery MD Assistant Professor, Division of Sports Medicine Department of Orthopedic Surgery, Case Western Reserve University
More informationMake sure you have properly fitting running shoes and break these in gradually. Never wear new running shoes for a race or a long run.
Common Running Injuries We are delighted that you have decided to run in the next Bath Half Marathon and very much hope that you have good running shoes, undertake a regular training programme and don
More informationShockwave Therapy. Leading Rehabilitation Technology
Excellence in Shockwave Therapy Leading Rehabilitation Technology Since its foundation in 2003, REMED has tried to care for the patients suffering from different types of physical pains all over the world
More informationPrinciples of Treatment. Case Studies. Principles of Treatment. Clinical Perspectives for the GP
Principles of Treatment Clinical Perspectives for the GP Case Studies 1. Jumping athlete with an acute exacerbation of chronic patellar tendinopathy major competition in 9 days time 2 week tournament 2.
More informationEvaluation of the wound healing response post deep dermal heating by fractional RF: INTRAcel
12th symposium of the Association of Korean Dermatologists (2009) 1 Evaluation of the wound healing response post deep dermal heating by fractional RF: INTRAcel Un-Cheol.Yeo, M.D. S&U Dermatologic Clinic,
More informationTissue repair. (3&4 of 4)
Tissue repair (3&4 of 4) What will we discuss today: Regeneration in tissue repair Scar formation Cutaneous wound healing Pathologic aspects of repair Regeneration in tissue repair Labile tissues rapid
More informationCompression Tension Shear
Bertram Zarins, MD Physics 3 Forces Compression Tension Shear Current Clinical Issues in Primary Care Bone resists all 3 forces Muscles, tendons, & ligaments resist tension Epi- Meta- Dia- Apo- Physis
More informationKey words: Laser, sprain, strain, lameness, tendon
MLS Master Class - Veterinary Imaging Presented by CelticSMR Ltd Free Phone (UK): 0800 279 9050 International: +44 (0) 1646 603150 AUTHOR DETAILS Carl Gorman BVSc MRCVS PUBLISHER DETAILS Mike Howe B Vet
More informationReview relevant anatomy of the foot and ankle. Learn the approach to examining the foot and ankle
Objectives Review relevant anatomy of the foot and ankle Learn the approach to examining the foot and ankle Learn the basics of diagnosis and treatment of ankle sprains Overview of other common causes
More informationROTATOR CUFF DISORDERS/IMPINGEMENT
ROTATOR CUFF DISORDERS/IMPINGEMENT Dr.KN Subramanian M.Ch Orth., FRCS (Tr & Orth), CCT Orth(UK) Consultant Orthopaedic Surgeon, Special interest: Orthopaedic Sports Injury, Shoulder and Knee Surgery, SPARSH
More information11/11/2016. Hip FAI & Core Muscle Deficiency: Diagnosis and Treatment. Disclosures. Differential Diagnosis. Consultant, Smith and Nephew
Hip FAI & Core Muscle Deficiency: Diagnosis and Treatment FORE Baseball Sports Medicine Game-Changing Concepts November 4, 2016 T. Sean Lynch, MD Assistant Professor New York-Presbyterian/ Columbia University
More informationAlex Garcia, MD Affinity Orthopedics and Sports Medicine
Alex Garcia, MD Affinity Orthopedics and Sports Medicine Intact Tendon Reactive Inflammatory Tendinopathy Degenerative Chronic Tendinopathy INSULT Neurovascular Mediation Reparative Process? Healed 3
More informationHospital NEO,Turku, Finland
Hamstring syndrome from fibrous band to tendinosis Sakari Orava, Janne Sarimo, Lasse Lempainen, Jyrki Heinänen Hospital NEO,Turku, Finland 1 Hamstring muscles- ANATOMY over two big joints pelvic stabilizers
More informationCalcific Tendonitis of the Shoulder
A Patient s Guide to Calcific Tendonitis of the Shoulder 2350 Royal Boulevard Suite 200 Elgin, IL 60123 Phone: 847.931.5300 Fax: 847.931.9072 DISCLAIMER: The information in this booklet is compiled from
More informationTendinosis & Subacromial Impingement Syndrome. Gene Desepoli, LMT, D.C.
Tendinosis & Subacromial Impingement Syndrome Gene Desepoli, LMT, D.C. What is the shoulder joint? Shoulder joint or shoulder region? There is an interrelatedness of all moving parts of the shoulder and
More informationWhat Internists Need To Know About Common Orthopedic Problems: Focus on Tendinopathy
What Internists Need To Know About Common Orthopedic Problems: Focus on Tendinopathy Rebecca Dutton, MD ACP Annual Meeting, November 2, 2018 Disclosures I have no relevant financial or non-financial relationships
More informationAnatomy. Causes. Where is. (the medial. develop? of the foot. How does tendonitis. Problems called the
Posterior Tibial Tendonn Problems Introduction Welcome to BodyZone Physiotherapy's patient resource about Posterior Tibial Tendonn Problems.. Because we use our feet continuously, tendonitis in the foot
More informationSHOULDER Highly mobile, so less stable. Abnormalities cloaked within extensive musculature, dx can be difficult Bony abnormalities less common than li
SPORTS MEDICINE CASES A quick tour of some local joints Featuring gco common o and unusual problems SHOULDER Highly mobile, so less stable. Abnormalities cloaked within extensive musculature, dx can be
More informationMr. Duy Thai Orthopaedic Surgeon, Melbourne VIC
Mr. Duy Thai Orthopaedic Surgeon, Melbourne VIC International Convention of the Vietnamese Physicians, Dentists and Pharmacists of the Free World Melbourne 8 10 August 2014 Conflict of Interest None Subacromial
More information