Lecture 3 - Tendon Disorders Examination

increased activity
unaccustomed activity
excessive eccentric work
viral infection
underlying muscle cell damage
onset 24-48 hours after activity

sudden overstretch
sudden contraction
decelerating limb
insufficient warm up/stiffness
previous muscle injury
collagen disease
steroid use
injury to muscle belly

mild injury muscle/tendon fibers

partial disruption of fibers

full tearing of fibers

direct blow associated with blunt trauma
bruise

persistent tendon pain and loss of function related to mechanical loading

macroscopic discontinuity of load bearing tendons
partial/full thickness and size
any hole in the tendon

long finger tendons
inflammation around the sheath, affects tendons that go through a small space

inflammatory process of bursa from overload/friction/calcification

Supraspinatus
Subscapularis

RTC Tears
Pec Major Tears (Overload)
Biceps (Overload)
Common extensor tendon

largest of RTC muscles and the anterior stability of the shoulder
tears here are difficult to diagnose and can be extremely disabling

biological, social
specific to the individual
Systemic diseases, family history, obesity, age, limited or excessive joint mobility, muscle weakness, deficits in neuromuscular control

factors outside the individual
environment, training, occupation demands
overuse, sudden increase in activity or intensity of activity
intitation of new activities
lack of adequate recovery
highly repetitive movement
poor workplace ergonomics
medications

ext carpi radialis brevis
ext carpi radialis longus
ext digitorum

traumatic/atraumatic
new activities or work tasks
outcome measures

observation of posture/scapula, UE movement

contraction, palpation, stretch

PROM

Dynomometry vs MMT
Functional Performance measures: TFAST, Grip Dynamometry (painful vs normative)

local nociception

suspect tear

RTC: examine
-young refer, older referral depends
Biceps Distal - refer
Biceps LH - Referral depends

RTC - examine
-initiate conservative care, and watch
Biceps Distal: refer
Biceps LH: examine
-initiate conservative care and watch

pay attention to posture of upper quadrant, scapula mobility

pay attention to upper quadrant, and too much finger/hand effort
excessive utilization of extrinsic finger flexors and poor ST control are common impairments associated with LE pain
Limited shoulder girdle control and strength common cause of ME pain

excessive utilization of extrinsic finger flexors and poor ST control

Limited shoulder girdle control and strength

should point to contractile structure pain with active contraction
palpation and stretch to tendon or muscle

PROM both increased or decreased ROM can occur in presence of tendon disorders
RTC - GH joint necessary, elbow and neck if functional movement was altered
L/M elbow: elbow/forearm/wrist - shoulder girdle if functional movement was altered
joint play - only necessary if PROM was abnormal

MMT only if active motion not painful
ST muscles done modified resistance most often in presence of RTC disorders
HHD - gives information about how much force can be produced even when in pain

HHB + WW + GL
hand to head and back, wall wash, gallon lift

elbow flexed to 90 by waist

Drop arm
Empty Can (JOBE)
Initiation of Abduction
Horn blower's/Patte (ER Rotation Lag at 90)
Dropping sign (ER Lag)
Bear Hug/Belly Press

Painful arc
hawkinds kennedy
Neer's
Yokum
posterior impingement

Resisted supination external rotation
Biceps Load II

Cozen's - contraction of wrist extensor
Maudsly's - middle finger passive resistance
Mills - manual stretch to common extensor tendon

golfers stretch - length of flexor group of wrist
resisted wrist flexion in pronation

rule out lateral or medial instability (ligament injury)
rule out peripheral neuropathy radial or median

Pain >7/10
consistent night or resting pain
high disability scores
AROM<PROM
pain before end ROM

Pain 4-6/10
intermittent night or resting pain
moderate disability scores
AROM similar to PROM
pain at end ROM

pain < 3/10
no resting or night pain
minimal disability
AROM = PROM
Pain only with overpressure
pain only with increased exertion

Mild 20/50
Moderate 21/34
Severe 35+/50

Mild 16-45
Moderate 46-60
Severe 61+

unilateral signs and symptoms local to the elbow

bilateral signs and symptoms local to the elbow

diffuse elbow arm pain, combined with cervical, upper extremity or neuropathic pain

severe pain, severe disability, type 3

moderate pain, moderate disability, type 3

mild pain, low disability, type 1-2

mild to no pain
mild to no disability
type 1-2

no less than 12 weeks, can be upwards of 6 months to 1 year

are there impairments that would be amenable to PT

fatty infiltrate is a poor prognostic indicator for recovery and surgical repair
extension of tear is indicator for surgery