Overuse Injuries

Characteristics

• Injury microscopic repetitive to the tissue
  
• Gradual onset and increase in symptoms make these difficult to identify early
  
• Consequences: include loss of time in activity, reduced function, pain, and psychological exhaustion
  
• Female athletes at greater risk

Tendinopathy

• Noninflammatory Condition!
• -overload tissue –> damage
• Rotator cuff tendinopathy, epicondylosis, patellar tendinosis, Achilles tendinosis
• Etiopathogenic theory suggesting insufficient tensile strength of the tendon exposed to external loads that cause progressive damage
• Typically insidious onset of pain and symptoms lasting > 6 weeks

Shoulder Impingement

• Etiology:
  • Rotator cuff
    
  • -> 35 yo
    
  • Pain with overhead activity
    
  • Supraspinatus tendon most commonly involved followed by infraspinatus
• Physical Tests:
  • Neer’s Test
    
  • Hawkin’s test
    
  • pain in position = positive
• Treatment:
  • Steroids:
    • relieves pain – that’s it. doesn’t help underlying condition
      
  • Physical Therapy

Adhesive Capsulitis

• Etiology:
  • Decreased passive and active range of motion
    
  • More stiffness than pain
    
  • associated with diabetes, heart disease, Parkinson’s disease
• Treatment:
  • Injections steroids or PO steroids-used early on and can be effective
    
  • PT- Codman’s, decrease pain and inflammation
  • AARO
  • Grade I Joint Mobilizations
  • Pt. education

Lateral Epicondylitis

• Treatment:
  • AKA: Tennis Elbow
  • most effective tx = eccentric strengthening
  • Eccentric Strengthening:
    • muscle is lengthened and an external force exceeds the force produced by the muscle, has been shown to be more effective than traditional concentric strengthening at minimizing muscle atrophy and improving muscle force production
  • Steroid Injections
    • provides pain relief acutely (8 weeks) but inferior to eccentric strengthening

Carpal Tunnel Syndrome

• Associated with:
  • RA
    
  • pregnancy
    
  • hypothyroidism
    
  • repetitive use
    
  • alcoholism
• Physical Exam:
  • flick sign – wakes up at night shakes wrist
    
  • Phalen’s sign, tinel’s test
    
  • weak thumb abduction
• Treatment:
  • wrist splints
    
  • ultrasound
    
  • yoga
    
  • steroid injection: beneficial 1-4 months (superior to oral corticosteroids)
    
  • surgical release – better than splinting at 6 months – its mostly to prevent progression

Trigger Finger

• Etiology:
  • Inflammation and thickening of the tendons of the finger makes it difficult to flex or extend the finger, may become stuck and then snap into position
    
  • most common
    • ages 4-6
    • woman
      
    • diabetics, RA
    • repetitive hand activities
• Treatment:
   
   
  • splinting finger in neutral position, analgesics
     
  • steroid injection for pain relief NNT = 3 (dexamethasone > triamcinolone)
    
  • lastly surgical release

Patella Femoral Syndrome

• Etiology:
  • Injury caused by abnormal patellar tracking
    
  • W > M
    
  • pain in anterior knee (peripatellar pain)
    
  • pelvifemoral dysfunction –> gluteal hop abductor and quad weakness
    
• Physical Exam:
  • lateral tracking of patella, crepitus
    
• Treatment:
  • Patellar taper vs physical therapy and activity modification (this is better)

Patellar Tendinosis

• AKA: Jumpers Knee
• Treatment:
  • most effective tx = eccentric strengthening
  • Eccentric Strengthening:
    • muscle is lengthened and an external force exceeds the force produced by the muscle, has been shown to be more effective than traditional concentric strengthening at minimizing muscle atrophy and improving muscle force production
  • Steroid Injections
    • provides pain relief acutely (8 weeks) but inferior to eccentric strengthening

Achilles Tendinosis

• Treatment:
  • most effective tx = eccentric strengthening
  • Eccentric Strengthening:
    • muscle is lengthened and an external force exceeds the force produced by the muscle, has been shown to be more effective than traditional concentric strengthening at minimizing muscle atrophy and improving muscle force production
  • Steroid Injections
    • provides pain relief acutely (8 weeks) but inferior to eccentric strengthening

Tarsal Tunnel Syndrome

• Etiology:
  • Through this tunnel pass the tibialis posterior, flexor hallucis longus, and flexor digitorum muscles with their surrounding synovial sheaths and the tibial nerve artery and vein.
    
  • provoked by subtalar pronation
    
  • Not plantar fasciitis – care
    
• Treatment:
  • • consider injection, correct biomechanics

Plantar Fasciitis

• Etiology:
  • an inflammation of the plantar fascia on the sole of the foot
    
  • heel pain, occurs in obesity
    
  • pain with dorsiflexion
    
  • worse with first steps after prolonged rest or first steps in AM
    
  • tender at medical calcaneal tubercle
• Treatment:
  • 1.) RICE, stretching, weight loss
    
  • 2.) physical therapy, deep myofascial massage
    
  • night splint use for 3 weeks
    
  • orthotics
    
  • steroid injection helps with pain

Morton’s Neuroma

• Etiology:
  • between heads of 3-4 metatarsals = most common
    
  • burning pain in forefoot, w/ toe numbness; palpable mass b/ metatarsals (mulder’s sign)
    
• Treatment:
  • shoes with wide toe box, low heels; orthotics, injections