Painful conditions occurring in and around tendons in the lower limbs in response to overuse.
Common Examples of Lower Limb Tendinopathies
1. Achilles tendinitis
2. Patellar tendinitis
3. Plantar fasciitis
- Attaches to calcaneus
- Plantar flex - calf muscle tighten
- Frequent jumping activity eg basketball
- Constant pushing off foot eg running or dancing
- AKA jumper knee - Pain in anterior knee, at the attachment to patella (lower pole)
- Overuse injury on extensor mechanism involving quadriceps muscle and patellar tendon
- Athletes eg. basketball, volleyball, soccer
Pathology of Patellar Tendinitis
It occurs when repeated stress is placed on patellar tendon. The stress results in tiny tears in the tendon, which the body attempts to repair. But as the tears in the tendon become more numerous, they cause pain from inflammation and a weakening of the tendon structure.
Inflammation of the plantar fascia on the sole of the foot.
Same pathology as patellar tendinitis: microtears > healing.
Risk Factors for Plantar Fasciitis
- Pes planus (flat foot)
- Pes cavus (high arched foot)
- Prolonged standing
- Walking on hard surfaces
- Faulty shoes
Tendinopathies of Upper Limbs
- Tennis Elbow
- Golfer's Elbow
- Painful Arc Syndrome
- Frozen Shoulder
- Calcific Tendinits
- Bicipital Tendinitis
- De Quervain's Tenosynovitis
golfers elbow= medial epicondyl:
flexor carpi ulnaris and radialis, palmaris longus, flexor digitorum superficialis
tennis elbow= lateral epicondyl: seven superficial muscles of posterior forearm and the supinator
Overuse or microtrauma of forearm extensors (esp. extensor carpi radialis brevis) and supinators.
Pain when pt extends wrist against resistance w elbow extended and forarm supinated.
Weakness in wrist and hand.
NOT RELATED TO TENNIS in 95% of cases.
Overuse or microtrauma of wrist flexors (esp. pronator teres) and forearm pronators,
Painwhen resisted wrist pronation and wrist flexion.
Point tenderness over medial aspect of the elbow.
Frozen Shoulder (Adhesive Capsulitis)
Shoulder capsulebecomes inflamed, thickened and contracted d/t overuse.
↓ ROM, pain and scar tissue formation btw musclelayers of the shoulder joint and shoulder girdle.
3 Stages of Frozen Shoulder
Inflammatory Phase (3 weeks to 3 months)
Severe shoulder pain
Gradual ↓ ROM
Freezing Phase (3 weeks to 9 months)
Pain ↑ till plateau
ROM continues ↓
Frozen Phase (6 months to a year)
Fixed loss of motion (Stiffness)
Review: Frozen Shoulder
Cause: unknown, autoimmune?, diabetics
F>M, middle aged, bilateral
Common fibrotic ligament lose elasticity = tight, fibrotic joint capsule
Tender, subacromial, decreased ROM, passive external rotation, good strength