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A Comprehensive Approach in the Management of Patellar Tendinopathy

A Comprehensive Approach in the Management of Patellar Tendinopathy. Eric Greenberg, PT, DPT, CSCS Sports Medicine and Performance Center at The Children’s Hospital of Philadelphia King of Prussia, PA. What else do you want to ask your patient?.

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A Comprehensive Approach in the Management of Patellar Tendinopathy

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  1. A Comprehensive Approach in the Management of Patellar Tendinopathy Eric Greenberg, PT, DPT, CSCS Sports Medicine and Performance Center at The Children’s Hospital of Philadelphia King of Prussia, PA

  2. What else do you want to ask your patient?

  3. What is the significance of his skeletal maturity? A. Tendon is more prone to overuse in the skeletally immature B. Bone is more prone to overuse in the skeletally immature C. Bone and tendon are equally at risk for overuse in the skeletally immature D. Point me to the ultrasound!

  4. What goals would be appropriate for this patient?

  5. What objective data would you like to assess?

  6. Tendinitis v. Tendinopathy • Tendinitis: an acute inflammation of a tendon due to increased mechanical loading or friction • Three stages of healing • Inflammation, proliferation, maturation • Tendinopathy: chronic tendon overuse that is non-inflammatory in nature that effects the histology of the tendon • “Failed healing process” • Does not follow healing process, resulting in long term disruption of extracellular matrix • Result: inability to absorb loads or transmit forces Peers, KHE and Lysens, RJJ, 2005 Kountouris, A. and Cook, J., 2007 • Which is more consistent with the patient’s presentation?

  7. Managing Tendon Pain and Modification of Tendon Load Goal: To decrease reactivity to allow more active participation Which is NOT an example of how we can manage tendon pain or modify tendon loading? A. Activity modification/Active Rest B. Noxious e-stim C. Ice massage D. Progressive Resistive Exercise E. Bracing/Counter-force strapping

  8. Question • Which of these is NOT an issue to consider when recommending a patient administer iontophoresis independently at home? • The patient’s age • Use of a syringe • Possibility of skin irritation • Contamination of solution • All of the above are issues to consider

  9. Question • Should we stop treating this patient and refer back to the physician since he is not showing any functional improvement in IKDC scores? • Yes • No

  10. Additional Treatment Options for Tendinopathy • What other treatments can be used in conjunction? • Iontophoresis • What solution/medication would you chose to utilize? • Dexamethasone 0.4% • Acetic Acid 5% • Lidocaine 4% • Sodium Salicylate 2%

  11. Question • Which of these is NOT an issue to consider when recommending a patient administer iontophoresis independently at home? • The patient’s age • Use of a syringe • Possibility of skin irritation • Contamination of solution • All of the above are issues to consider

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