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Tendinopathies
1.6k Plays2 years ago
Does it matter if it is a tendinitis vs a tendinosis? Josh and Miranda discuss this topic.
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Transcript
Introduction to Tendon Issues
00:00:07
Speaker
Hey guys, I'm Josh. And I'm Miranda. And today we are going to be talking about tendinopathies. And Josh and I are going to be breaking down what's the difference between itis, synovitis, those types of things. And when Josh said if he wanted to do this topic, I was saying, why does it matter? Do we care about itis versus apathy? And so Josh is going to break it down for us today and tell us why we care and why we should care.
00:00:35
Speaker
Okay.
Why Differentiate Tendon Problems?
00:00:36
Speaker
So Miranda said she's listened to a bunch of podcasts on this and she thinks, does it matter? Does it? And so let's talk about a little bit. It does matter to an extent. It does matter so that we know what we're treating and why we're treating it. But then on the other side of that coin is honestly, a lot of the treatments kind of look the same. So
00:00:54
Speaker
Let's talk about our terms first.
Defining Tendinopathy
00:00:56
Speaker
A tendinopathy is just a dysfunction within the tendon. So when a patient walks in and they've got a list of tendonitis or trigger, figure, whatever, those things are all tendinopathies. Anything that is a problem with a tendon, tendinopathy.
00:01:09
Speaker
And then we get some other little terms inside there. There's three we're going to talk about today. One is a tendinosis. And a tendinosis is a degradation of the collagen fibers within the tendon. Overstress, overwork, starts to get little tears, and it goes from a type one to type three fibers within that tendon, not
00:01:29
Speaker
all at once, but some of those fibers start to degrade and turn back into a type 3 fiber. When that happens, they're easier to tear. You get those tears then scar over and you get adhesions to the fascia layer that doesn't have the light elasticity that it should, not as much as muscles, less elasticity, tighter, more pain-ridden
00:01:50
Speaker
function. That's more like lateral epicondylalgia. That's more like the kind of tendon dysfunction you have, this persistent long pain. If you can catch it before the degradation happens all that much and catch it early, great, your recovery is much better. If not, then you have to go into this longer term rehab.
Understanding Tenosynovitis
00:02:06
Speaker
Another term is a tenosynovitis or tenovaginitis and that's more like trigger finger. That is an inflammation of the tendon sheath that the tendon travels through. So that's trigger finger where typically under A1 pulley that tendon sheath inflames and catches as it tries to go through that pulley.
00:02:23
Speaker
That's also dequeir veins or that radial, um, tinnosynovitis, where the, those two tendons, as they pass under that first dorsal compartment, there is a tendon sheath there and that can inflame. It doesn't necessarily catch every once in a while you'll have a patient where they have like a trigger effect there. More likely it's just inflammation and pain, but that's a tinnosynovitis.
Can Tendons Really Inflame?
00:02:44
Speaker
And then we've got tendinitis and the suffix of the end of that itis means inflammation.
00:02:51
Speaker
Well, there's articles that disagree on both sides of that. And you can get super caught up in the details in the weeds. There's an article, there's a ton of them. One of them by Reese in 2014 says, tendons do not have the vascularity to inflame. It is not possible for them to go through inflammation. But then there's other newer articles that say they can have some inflammation. So when a patient comes in and says, I have tendonitis, or the doctor script says, tendonitis of the wrist.
00:03:18
Speaker
I could call them out and be all academic about it and say, you don't have tendonitis. They don't care. The patients don't care.
Does the Condition Name Matter?
00:03:25
Speaker
Call it tendonitis. Know in your head, I may be working through a tenicinovitis because it's an inflammation of the synovial sheath. I'm working through a tendinosis. They have pain in their tendons. That's what they care about. That's what they're coming to us to see treatment for. So it's not necessarily that what we're going to call in the clinic matters, but what I do for treatment might change.
00:03:45
Speaker
Right. So when you're talking about these terms, we're talking about what's occurring at a cellular level, right? Yes. So what's happening when you break down these structures? And not to say that. It does matter, I think, when we're studying it to know what treatments are effective. So I think those scientists that are in the lab, these are the details that they really need to know, right? But from day to day, you're probably doing very similar things, I imagine, for synovitis versus
00:04:11
Speaker
tendinosis. So I want you to tell us what you're doing differently and then how are you diagnosing it differently, right? So how do you know it's not a, you know, for a trigger finger, how do you know it's not inflammation of the synovium versus, you know, a decrease in the actual space and anosis?
Diagnosis Based on Pain Location
00:04:30
Speaker
Yeah, so honestly, I'm going more by the the trends of the area. If I know it's in that pulley area where I've got bulk of synovial sheath, or at de quervains, where I've got that bulk traveling under the extensor retinaculum, then I know it's more likely an inflammation of the sheath.
00:04:46
Speaker
If I've got it more at the origin of the tendon as it comes off of the bony structure, that's more likely to be a tendinosis, like a carpal boss out of the second and third metacarpal bases. That's more of a tendinosis where it gets all junky and bound up.
Management Strategies for Tendon Issues
00:05:04
Speaker
It's more based on where it is, but I could have a tendinosis happening in the synovial sheath, just far less common of that. So what am I doing for treatment? I'm more likely to immobilize a tenosynovitis, like a trigger finger, just to stop the aggravation of that synovial sheath. So for a decuar veins, I'm going to put them in a foreign based thumb spica and say, I don't need to mobilize it entirely.
00:05:29
Speaker
You're gonna come out and do some light exercises like I would out of a trigger finger splint to keep PIP from getting stiff. I'm gonna come out of there occasionally, but for a couple of weeks, let's stop poking the bear and make that calm down a little bit. For a tendinosis, like a tennis elbow kind of thing, if it's really, really bad, I might immobilize it in a wrist support, but more likely I'm gonna say, let's do the things that break up scar. And immobilization doesn't necessarily break up scar. It can keep us from making it worse if it's in, you know,
00:05:59
Speaker
DEF CON 1 status, but I'll work on scar management and massage. I'll work on range of motion to lengthen those tissues back out longitudinally. I'll work on some other things to manage scar as opposed to primarily mobilization. I think that's a good delineation of how you would handle it differently. And do you think it depends on the stage that they're at? Yeah, for sure. I mean, we can have a whole other podcast on what to do for a trigger finger when they come in and they are locked down and not moving.
00:06:29
Speaker
That's not something I can manage conservatively. They're like at a stage five on our tennis and wider scale of trigger finger. If they're stage five, I can't do so much with that. If they're really light, I don't need to do a whole lot of treatment hands-on manual stuff. I may just say, wear this overlaid at night and that's going to get you out of it. On a tendinosis
00:06:49
Speaker
spectrum. Yeah, if they're really involved, and they have to lift their toolbox and swing a hammer every day, then I might put them in risk support and say, Listen, I know you can't behave. I know you can't follow all of our recommendations, because you got to pay the bills. But if you can do it with a splint on, it's going to way decrease the amount of load and stress you're putting on the structure that is in pain and dysfunction. So if they're really far off down that down that scale, then for tendinosis, I'll immobilize it if I need to.
Splinting Techniques for Tendon Support
00:07:16
Speaker
Right, and then for the tendinosis, have you done any relative motion splinting? I know you talked about the wrist support. What do you feel about the RMOs for these? You know, that's not something I have a ton of exposure to. I haven't seen a lot with that. How about you? Is that something you're doing a ton of?
00:07:31
Speaker
I mean, I wouldn't say a ton, but every once in a while I feel like it unloads the tendon just enough. I'll usually do the long finger and it unloads it just enough so it's not too much as immobilizing the wrist. It's kind of a step in between doing total wrist immobilization versus doing nothing, right? So you have less loading and then they still get a movement at where they can stretch those structures. So I do think it's a good choice and a good choice for someone that maybe, like you said, someone that has to be a little more active.
00:08:00
Speaker
Okay,
Counterforce Straps: Effective or Not?
00:08:01
Speaker
all right. What about a counterforce strap or the little strap around the forum that we see all the time? Are you a fan of those?
00:08:07
Speaker
No, but I have patients love them. So, you know, if someone says they're really loving it, I don't, I'm not like, if someone feels like something is helping, um, you know, unless it's obviously not helping or causing other problems. Um, I think if intuitively it's helping them unload those forces a little bit, then okay, fine. But I never really give them out. But I think, you know, I'm not even sure what the research says on those. What about you? You might know more about this.
00:08:32
Speaker
I'm not a fan of it. I don't have a ton of research. It's more anecdotal. So the structure of it is it's supposed to hold everything together so that one injured tendon origin can't get as much excursion. But when they do any medium to heavy loading, it's still going to blow through that. So if they feel like the compression is helpful, great. Compression can alleviate pain. That's fantastic.
00:08:55
Speaker
but I don't give them out because I feel like it treats a symptom, not the cause. Um, but again, if they feel like it's helpful, more power to them, you go for it and maybe just makes it more conscious of, of, um, stick into those precautions we've given them. Yeah. And that might be a good topic to do. Um, you know, try to find some articles on counter course brace pros and cons or something. You don't see what the research actually says cause I don't know actually. Yeah. Good things to look up. We're always coming up with more things to investigate, you know, always learning, right? Yeah. Yeah. That'd be a good student project.
Engaging the Audience
00:09:26
Speaker
Alright guys, if you have suggestions for things you'd like us to cover, let us know at info at handtherapyacademy.com or you can find us online at handtherapyacademy.com. We'd love to hear from you guys and let us know what you think.