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REHABILITATION TENDON INJURIES
TENDON INJURIES: AN OVERVIEW
BY DR CATHY SPEED, BMEDSCI MA DIP SPORTS MED PHD FRCP FFSEM (I) (UK)
Tendinopathies are very common injuries in sport and represent a large component of chronic injuries that affect function. They can be challenging injuries to manage, and recurrence and chronicity are common. The management of tendinopathies has been impaired by a lack of a specific diagnostic classification system, limited insight into the underlying pathophysiology, and non-specific management strategies. Accurate diagnosis and classification of the injury, identification and correction of the underlying causes, and promotion of healing, particularly through rehabilitation including eccentric work, are the optimal strategies for managing tendinopathies. This article gives an update on clinically relevant aspects of the diagnosis and management of tendinopathies.
INTRODUCTION Tendinopathies (disorders of tendons) are one of the most common forms of injury seen in sport. They represent a large component of chronic injuries affecting function. Our understanding of tendinopathies has been impaired by a lack of a specific diagnostic classification system, limited insight into the underlying pathophysiology, and non-specific (and often incomplete) management strategies.
Tendon Tertiary fibre bundle
Secondary fibre bundle (fascicle)
Primary fibre bundle (subfascicle)
Collagen fibre
Collagen fibril
Epitenon Endotenon
Figure 1: The hierarchical structure of tendon. Groups of fibres form the fascicles, which are surrounded by the endotenon, a loose connective tissue layer. The tertiary bundles of fascicles are surrounded by another connective tissue layer, the epitenon, and a double-layered covering, the paratenon (not shown)
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STRUCTURE OF TENDONS Tendons are composed mainly of type I collagen fibrils, small amounts of type III collagen, elastin, fibrocytes, water and glycosaminoglycans. The glycosaminoglycans form proteoglycans by binding to proteins. A simplified representation of the hierarchical structure of the tendon is shown in Fig. 1.
The tendons that cross the wrist and ankle are invested with a proper