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Soins

Les tendinopathies (prise en charge)

  Le traitement des tendinopathies ne peut se résumer à la simple prise d’anti-inflammatoires et au repos. Les données actuelles des connaissances impliquent une prise en charge multidisciplinaire faisant intervenir conjointement médecin, kinésithérapeute et ostéopathe.

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Tendinopathies (general care)

  The treatment of tendinopathies takes more than just having anti-inflammatory medication and a good rest. Current knowledge in this matter says that proper treatment should involve multidisciplinary general care with the joint efforts of a doctor, a physical therapist and an osteopath.

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Jocelyn-William LOUBRIAT

Medical Treatment:
As stated in our last article, only paratenonitis (damage of the peripheral elements of the tendon, synovial sheaths, bursa) is real inflammatory damage, whereas tendinosis and enthesopathies consist in disorganizations of the fibrous tissues without inflammation.

Non-steroidal anti-inflammatory drugs (NAIDs), whether taken orally or applicated on the skin, should therefore only be taken, if necessary*, shortly (10 to 15 days) after the beginning of the affection, mainly for their pain killer effect. Applying “tissue gel” (Flector Tissugel or Voltapatch Tissugel) enables continuous diffusion of the product and gives better results. 
(* some studies wonder about the necessity of a natural inflammatory process for an optimal healing process).

The infiltrations of corticoids should only be considered for paratenonitis if the symptoms persist after the first treatments, because even if they do produce good enough results for the peripheral elements (bursa, synovial sheaths…), they weaken the tendon’s structure and disturb the enthesis’ healing. They should therefore be banned from those other kinds of injuries.

In other words : no infiltration in the tendon or its insertion (enthesis),
okay for an infiltration in the bursa or the sheath.

 

Osteopathic treatment :
It aimes at searching and eliminating the potential causes of tendinopathies, such as a lack of balance of the articulations or the muscle chains, sources of compensation which may lead to the overloading of a tendon. Some visceral dysfunctions can also lead to the appearance of tendinopathies. The osteopath will work on restoring the loss of balance.

Physical therapy treatment :

Firstly, the physical therapy treatment should include a local treatment to stimulate healing and/or tissue regeneration and favour indolence. All the therapeutic “tools” mentioned below should be used to achieve better results.

  • Cryotherapy: analgesic and vascular functions
  • Shock waves: stimulation of the healing, as well as analgesic and vascular effects
  • Deep transverse massage (DTM): stimulation of the healing process, as well as analgesic and vascular effects
  • Stanish protocol: progressive solicitation of the tendon with eccentric contractions at various angles and speeds associated to stretching exercises in order to stimulate a better reconstruction of the tendinous fibres.
  • Other physiotherapies: ultrasound, cupping glass, hooking, electrotherapy… for their own effects.
Secondly, it should involve a general postural treatment (Mézières type) to complete the traditional sessions of physical therapy; osteopathy will need to be considered to limit the risks of recur.

Rest :
A strict rest doesn’t contribute to a good recovery, however, in case of tendinopathy, you must refrain from taking up training again (soliciting the injured area) too early. Cardiovascular upkeep by swimming, cycling, running, if there are no contraindications in relation to these activities (involving the injured area), will favour the return to training within the shortest delay.

 

Conclusion
The joint action of all actors responsible for the treatment of sportsmen and sportswomen will favour the return to training within the shortest delay. The earliness of general care will limit the shift to chronicity.
Therefore, as soon as pain appears, see a sports doctor.

In the next articles, we will cover the aspects of nutrition and of going back to training after a tendinopathy.


References :

BRUCHARD A., DUEE T. : Les lésions tendineuses : démarche thérapeutique. Profession Kinésithérapeute n°20, 2008.
CHANUSSOT J.C., DANOWSKY R.G. : Traumatologie du sport, Ed. Masson, 5ème éd., Paris, 1999.

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Conduite à tenir face à une douleur

resi_poutre
Quelle conduite adopter lors de la survenue d'une douleur du membre supérieur au cours d'une séance.

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Pulley taping with thermoformed sheets

strap-poulie61

This kind of taping makes it possible to tighten fingers much more than a usual taping, in order to increase the maintaining of the pulley without compromising vascularization.

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Dr Marc Haesevoets
Emergency physician and climber

This kind of taping makes it possible to tighten fingers much more than a usual taping, in order to increase the maintaining of the pulley without compromising vascularization.

Material:
- standard thermoforming sheet about 1,5 mm thick
- non-elastic adhesive strip e.g. Strappal or Omnitape

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1/ Cut up a small rectangular piece of thermoformable sheet to put it on the back of the phalanx.

Heat it and mould it on the back of the finger.
It is important that it goes a little beyond laterally and medially. The goal is to get more pressure of the strappal on the anterior-posterior axis (by increasing this diameter compared to the lateral-medial diameter and because it separates the strappal from the lateral and medial sides of the finger) to avoid the compression of the blood vessels.

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strap-poulie4

2/ Cut up the palmar sheet at the wished shape and mold it: it should also go a little beyond both sides and over the palm (at this level fold it a little on the palmar side not to hurt the skin when closing the hand). 
Heat and mold. 
Repeat the whole process to get a double thickness (the two sheets must fit perfectly together).
The overhang on the palm enables a better compression of the A2 pulley (under the first phalanx) because the first phalanx starts in the palmar area, well before the interdigital space. That is of course not the case for the A4 pulley (under the second phalanx).

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3/ Fix it with strappal.

To obtain the thermoformable material, you can ask the emergency service of a hospital if they can give you a little piece of sheet or even make the “orthosis” for you. You can also try to ask a podiatrist or a prosthetist.

The material is to be heated in hot water: the easiest way is to put the piece of sheet in a pan and on a cooktop. Once the sheet softens and its colour changes, you can get it out with a spoon. Dry it with a dish towel to remove the hot water, check regularly the temperature of the sheet and be careful not to get burnt. As soon as the temperature is bearable (after about 30 seconds), give the sheet its right shape. If the shape is not right, you can reheat it.

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How to treat a "Steak"

bouton How to treat a "steak"

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Jocelyn-William LOUBRIAT

steak

As a consequence of repeated friction on a hold, the skin suffers until the layers of the epidermis and of the dermis separates. This is provoked by the appearance of a pocket full of interstitial fluid. In fact, a “steak” is a blister.

A steak has a risk of bacterial superinfection due to the exposure of the deep layers of the epidermis. Therefore, it is important to treat it properly.

First of all, wash your hands with water and soap to wash away the dirt, the magnesia etc.

If the steak has not burst (appearance of a blister full of fluid), empty the blister (if possible use a sterile syringe, otherwise use a disinfected sewing needle), then with a pair of scissors that you have previously disinfected, excise the skin that has build the “roof” of the blister.

If the steak is open, cut off the dead skin in the same way with the scissors. Do not pull it up as to not increase the surface of the wound.

Then disinfect the wound with an antiseptic product that does not drain: Dakin’s Solution, Oxygenated Water, Biseptine, Dermal Betadine… Avoid eosin, which drains and Alcohol 70% which burns.

Next, apply a fatty cream like Homéoplasmine, Avibon (or possibly Biafine) in thick layers and protect the area with a sterile compress for the first night.
The Cicatryl ointment is also a good choice because of its antiseptic, anti-inflammatory and healing effects.

The following morning, clean again with the antiseptic product and apply a cream several times per day so the skin won’t dry and to encourage the healing process until the wound has healed. Do not protect the area with a plaster or a compress after the second day. The wound needs to breathe.

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Finger taping

bouton How to tape a finger

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Jocelyn-William LOUBRIAT
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Remove a small strip of one third of the strap (Strappal 4 cm or Omnitape 3,75 cm) of about 20 to 30 cm.
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Start at the distal end of the phalanx (=to the tip of the finger).
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Apply the strip around the phalanx by partially overlapping the previous layer and in the direction of the proximal end of the phalanx (=to the palm).

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The strip should cover the whole phalanx.
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The strips have to be tight to provide a good support. However make sure to not cut off blood circulation: if the finger becomes dark red, it is normal, but if it becomes purple-blue, take the strip off and bind it less tightly.
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Do the same for the second phalanx.

The aim of these two strips is to limit the strain on the pulleys. By themselves, they do not prevent a rupture. 
If it is done properly, that is if properly tightened, the support of a damaged pulley is very efficient.
Depending on the pain you feel in the finger, you can adapt the strapping by applying only one small strip to the phalanx in pain. Make the test, if it relieves the pain, persevere, if it does not, consult a specialist.

The following strapping will be done in case of fresh tenosynovitis or fresh pulley rupture. For a tenosynovitis, it is not compulsory to put the previous two strips, apply this last strip in double layer.
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Remove a small strip of two thirds of the width of the roll and apply it in the same way to include the first two phalanxes.
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This last strip restricts the flexion of the finger.
 

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Ice treatment - Cryotherapy

bainmain How to use Ice treatment 

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Jocelyn-William LOUBRIAT
 

Principles:

Cold has:

- analgesic effects (that ease pain) because a decrease in temperature slows down the nerves’ conductivity especially the conduction of the pain message. As it has no priority, it no longer reaches the brain.

- anti-inflammatory effects (fights the inflammation) in particular through its vasomotory action, because the blood’s purpose is to carry the nutritive elements in the tissues and to carry the waste out.

- vasomotory effects: ice treatment provokes first a vasoconstriction (decrease of the diameter of the blood vessels) and then a vasodilatation (increase of the diameter of the blood vessels). In addition to the anti-inflammatory action, the activation of the return circulation is the main element of recovery: it drains the residues of the muscular effort.

- myorelaxant effects: it appears that - like a reflex - ice cube massage of a muscle helps it relax.

Ice treatment may appear to be simple; however some rules must be respected. Furthermore you may not have thought about the most practical way to apply the ice depending on the area.

Here is therefore a simple, efficient and safe manner of how to apply an ice treatment.

Ice cube massage

Ice cube massage is used for:
- inflammatory conditions (tendinitis, residual pain after sprains…) +++
- contractures. +/-

Apply for about 5 minutes, 3 to 6 times per day (wait 1 hour before applying again), for 7 to 10 days (or longer if pain persists) to fight inflammations.
Application of an anti-inflammatory like Flector® Tissugel® right after the ice treatment is strongly recommended.

Attention: ice may freeze the skin. Make sure that the skin gets its colour back instantaneously when you put your finger on it.
In case of little wounds in the area (blisters, cuts, scrapes), avoid ice treatment.

Cold pack

phygenou A cold pack is used for:
- traumatisms like sprain, pulled or strained muscles, pulley rupture, punch…
- trophic phenomenons (following surgery of the knee, the ankle, the wrist…)
- the recovery.

Apply for 15 to 20 minutes, 3 to 6 times per day (wait 1 hour before applying again).

Attention: here again, ice may freeze the skin. Never apply the plastic immediately to the skin: cover it with a damp cloth (it allows a better conduction of the cold than a dry cloth).


Whether you have a “cold pack”, that you have purchased (in a drugstore or even in a supermarket), or a simple ice bag (a plastic bag filled with ice cubes and water –water allows to better mold the area-), or even a bag of frozen green peas, the use is identical.

Ice bath

glachevbainmain Ice bath is used for:
- traumatisms like sprain, pulley rupture.
- trophic phenomenons (following surgery of the ankle, the wrist…)
- the recovery.

A bath of 15 to 20 minutes, 3 to 6 times per day (wait 1 hour before starting again), to fight against inflammations.

Attention: do not enter you whole body in a bathtub of frozen water. Do you know what hyperthermia is?!

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Thumb taping

strap_pouce_5 How to tape a thumb  in sprain case

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Jocelyn-William LOUBRIAT
strap_pouce_1 Bandage a circular base around the wrist with a 4 cm strappal.
strap_pouce_2 With a half-width strip (obtained by tearing the 4 cm strip in 2).
Bind it around the joint at the base of the thumb from the base to the external side of the hand and come back on the inside, to…
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... finish on the base again.

The strip comes together behind the joint.
strap_pouce_4 Repeat it by moving the strip forward compared to the previous one.
strap_pouce_5 You can add extra layers depending on the stability you wish to have.

Attention: do not cut off blood circulation!

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