A
Abdomen
The front part of the body between the chest and the pelvis.
Abduct
To move a part away from the mid-line of the body.
Achilles tendonitis
The lay term used to describe chronic pain around the Achilles tendon region. It used to be thought that the pain was caused by an inflammatory response, hence the term ‘itis’. However modern thinking on tendon problems regards them as degenerative rather than inflammatory in nature. For this reason the more appropriate terminology is Achilles tendinopathy.
Acromio Clavicular joint
The joint between the Acromion, the bony prominence at the front of the shoulder blade and the Clavicle or Collar bone. It is part of the shoulder complex and it is commonly injured during a fall onto the shoulder.
Airway
Emergency device to help air enter the lungs.
Ambu bag
A self inflating bag used to get air into the lungs.
Ankle Arthroscopy
Refers to the technique used by orthopaedic surgeons whereby they insert a very small (2mm diameter) camera into the ankle joint. It is a minimally invasive surgical procedure, commonly known as keyhole surgery. It allows the surgeon to look directly inside the ankle joint and determine exactly what is wrong.
Anterior Cruciate Ligament
The Anterior Cruciate Ligament (ACL) lies deep within the knee joint, connecting the thigh bone with the shin bone. The function of the ACL is to prevent excessive forward movement of the shin in relation to the thigh and also to prevent excessive rotation at the knee joint. The ACL plays a major role in maintaining knee joint stability.
Anterior Talo-Fibular Ligament
Also known as the ATF ligament. It is the ligament on the outerside of the ankle that links the Talus and Fibula bones. Most commonly injured ligament during an inversion ankle sprain.
Antibodies
Molecules produced by the body which form the immune system. Each Antibody interacts with a specific Antigen as part of the body’s response to these ‘foreign’ substances.
Antigens
A toxin, foreign protein particle or bacteria that can trigger an immune response.
Antioxidants
Substances which are thought to protect cells from damage caused by ‘Free Radicals’. Free Radical damage may lead to Cancer. Antioxidants are abundant in fresh fruit and vegetables; and also in nuts, grains, meat, poultry and fish.
Arthrogram
Diagnostic imaging of a joint that has been filed with a contrast medium.
Arthroscopy
Arthroscopy refers to the technique used by surgeons whereby they insert a very small (2mm diameter) camera into the body. It is a minimally invasive surgical procedure, commonly known as keyhole surgery. It allows the surgeon to look directly inside the locality of the patient’s problem and determine exactly what is wrong.
Aspirate
To withdraw fluids from within the body using a needle and syringe.
B
Bentone 38
An organic chemical compound that is added to prevent waxy substances melting
Biomechanical
Relating to the mechanical characteristics of living tissue and body structures.
Bursa
(bur-sah) A small fluid-filled sac that is located in areas where tissues may rub together and cause friction.
Bursitis
(ber-sy-tis) Inflammation of a bursa. Usually caused by overuse.
C
Cancer
A general term related to the malignant disease process where tumours grow within body tissue.
Carbohydrates
The group of foods that provide the body with most energy. They are absorbed from sugars and starches and stored as Glycogen within the body.
Cardiac
Related to the heart.
Cardiovascular
Related to the heart and blood vessels.
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome, or CTS, is an overuse phenomenon and a common form of repetitive strain injury. The ‘Carpal Tunnel’ refers to a gap in the wrist bones through which muscles, blood vessels and nerves pass on their way to the hand from the forearm. This anatomical space is very limited to start with and the problem of Carpal Tunnel Syndrome arises when there is swelling within this small space.
Cervical spine
The neck.
Chafing
Irritation of the skin by friction by clothing or opposing skin surfaces.
Chartered Physiotherapist
A member of the Chartered Society of Physiotherapy, signified by the initials MCSP.
Chondromalacia Patella
Translated from Greek this means ‘abnormal softening of the articular cartilage of the knee cap’. This can produce painful symptoms at the back of the knee cap.
Chronic
A condition that persists for a long time.
Collagen
A protein based tissue that makes up the connective tissue of the human body. It is the principle component of skin, tendon, bone, ligaments and cartilage.
Collateral Ligaments
The ligaments at the side of a joint.
Colles Fracture
A wrist fracture, where the Radius is broken and the fragment at the wrist slips back producing what is called a dinner fork deformity.
Compartment Syndrome
A condition where the pressure within a muscle compartment becomes so elevated that the blood supply to the area is compromised. This can be chronic, due to overdeveloped muscles; or it can be acute due to trauma and bleeding into the compartment. Acute compartment syndrome is a medical emergency requiring urgent treatment within 12 hours.
Concentric Contraction
A muscle contraction where the muscle fibres are shortening.
Congenital
A condition that exists from birth.
Contracture
A pathological shortening of muscle tissue.
Contusion
A bruise.
Core stability
Refers to the ability to recruit specific stabilising postural muscles that support good posture. The key core stabilising muscles within the trunk and spine are the Transversus Abdominus and Multifidus muscle, as well as the muscles of the pelvic floor. By learning to recruit these muscles and maintain their contraction over a period of time, then muscular support to the pelvis, spine and trunk is improved. This removes abnormal forces on bones and joints and can therefore be effective at relieving and preventing pain.
Core strength
The ability to fix one part of the body through stable muscle contraction, while carrying out either a static or dynamic muscle contraction with another part of the body. In soccer and basketball this is best demonstrated by a player who is able to protect the ball by fixing the legs and trunk to shield the ball, while dynamically using an arm to resist an opponent. Core strenght exercises are an excellent method of improving postural control and functional muscle strength.
Corticosteroid
A naturally occurring steroid which reduces inflammation. Synthetic corticosteroids are given as injections to treat inflammatory conditions.
Cryotherapy
Ice therapy.The use of ice and ice water in the treatment of injury. Physiologically ice reduces metabolic activity within the tissues thus preventing secondary tissue damage; it also reduces pain signals to the central nervous system. Therapeutically ice therapy relieves pain and helps to reduce the development of swelling.
CT Scan
A CT (Computed Tomography) scan is a diagnostic imaging technique that shows slices of a persons anatomy. These can be reconstructed to show anatomical detail.’
Cyst
A closed sac of fluid.
D
Debridement
The act of removing all foreign and loose bodies from a joint or wound.
Defibrillator
Emergency machine to restore normal heart rhythm using an electric shock.
Degenerative Disc Disease
Arthritis of the spine. Characterised by dehydration and shrinkage of the inter-vertebral discs and the formation of bony spurs at the margins of the inter-vertebral joints. Symptoms include pain, stiffness and a reduced level of function.
Degenerative Joint Disease
Arthritis of a joint. This may be secondary to previous trauma or as a result of repetitive overuse. There is a gradual degeneration of the articular cartilage of a joint, accompanied by changes in the soft tissues surrounding the joint. Symptoms include pain, stiffness and a loss of function.
Dehydration
A net loss of bodily fluid, due to fluid intake failing to match fluid loss.
Delayed Union
The condition where it takes longer than usual for a fracture to heal.
Dermatologist
A doctor who specialises in the treatment of skin conditions.
Diabetes
A general term related to a range of conditions in which dysfunction of the release of Insulin from the Pancreas causes potentially harmful changes to blood sugar levels. Obesity is a major causative factor.
Diaphysis
The shaft of a ‘long bone’.
Dilate
The opening or stretching of a tubular structure.
Disc
The circular fibrocartilage plates that separate the vertebrae of the spine.
Disease
A dysfunctional process within the body that can be characterised by its specific signs and symptoms.
Dislocation
The displacement of a bone out of a joint. Usually caused by trauma, there is normally damage to the ligaments, joint capsule and soft tissues.
Diuretic
A substance that causes increased passing of urine.
Dysfunction
Abnormal functioning of a tissue or organ.
E
Eccentric Contraction
The contraction of a muscle where the muscle fibres are lengthening.
Eccymosis
A purple/red bruise of the skin caused by direct trauma.
Echocardiogram
A record produced by the use of ultrasound waves to investigate the action of the heart.
Effusion
Swelling of a joint.
Electrocardiogram
(ECG) A record of the heartbeat traced by recording the minute electric currents generated by the movement of the heart.
Electromygram
(EMG) A diagnostic test to evaluate the function of nerves to specific muscles.
Electrotherapy
Treatment of medical conditions by the use of electricity.
Epicondyle
A raised prominence on a bone. An epicondyle is usually an attachment point for a muscle, tendon or ligament.
Epicondylitis
Inflammation of soft tissue and bone at the epicondyle of a long bone. Lateral epicondylitis is commonly known as Tennis Elbow.
Epiphysis
The end area of a ‘long bone’. They are responsible for growth of the bone. These areas are made of cartilage and don’t ‘ossify’ or become bone until adulthood.
Ethyl Chloride
A local anaesthetic which is applied to the skin (but not open wounds).
Etiology
The study of the causes of diseases.
Eversion
The action of turning a body part outwards.
Eversion ankle sprain
Sprain of the ankle where the foot goes outwards and the weight of the body goes the other way. I causes damage to the inner-side of the ankle.
Extension
A movement whereby the body parts are brought into a straight position.
Extensor
A muscle which causes an extension movement.
Extensor tendons – of the wrist
The tendons on the back of the forearm that are a continuation of the muscles that extend (bend back) the wrist joint. These muscles are Extensor Carpi Radialis Brevis; Extensor Digitorum
Communis; Extensor Carpi Ulnaris; Extensor Digiti Minimi.
External bone stimulator
A device that uses electro-magnetic or ultrasonic waves to stimulate bone growth and healing. It is usually worn during sleep and is held in place with velcro straps.
External Rotation
A description for an anatomical movement where the the body part involved is rolled out, away from the mid line of the body.
Extrinsic
A factor or injury cause that is outside of the body.
F
Fascia
A fibrous sheath of tissue that encloses tissues and organs.
Fasciotomy
Surgical incision of the fascia. Primarily undertaken to relieve pressure within the fascia.
Femur
The thigh bone.
A specialised cell that arises following inflamation and is responsible for laying down Collagen that forms scar tissue.
Fibrocartilage
A type of cartilage that is made of thick collagen bundles that are seperated by narrow clefts. This tough cartilage is ideal as a ‘spacer’ or shock absorber in a joint. Fibrocartilage makes
up the knee meniscus and the labrum tissue of the hip and shoulder.
Fibula
The splint bone at the side of the shin.
Fine Motor Skills
Motor skills refer to a person’s ability to perform co-ordinated movements using a combination of muscle actions. Gross Motor Skills tend to be performed by large muscles and they produce bigger body movements such as running and jumping. Fine Motor Skills tend to be initiated by smaller muscles such as those in the hand and they produce actions such as picking something up between the thumb and fingers or unscrewing the top from a bottle.
Flat Feet
Medical term Pes Planus. Flat Feet is a condition in which the medial or inside border of the foot is more than usually close to the ground.
Flexion
The bending of a joint.
Flexor
A muscle that produces the movement of bending at a joint.
Fluoroscopy
A technique where the patient is placed between an x-ray beam and a fluorescent screen. This allows movement at joints within the body to be observed on the screen.
Fracture
A break of the bone.
Free Radicals
Unstable atoms within cells that may be implicated in the development of Cancer.
G
Gadolinium
A chemical element that is used as a contrast medium for scanning techniques such as MRI. It enhances certain aspects of the image, to aid the radiologist.
Glenohumeral
The shoulder joint.
Glenoid
The area of the shoulder blade that forms the ball of the ball and socket of the shoulder joint.
Glycogen
The store of Carbohydrate within the body. It is produced in the liver and primarily stored there. It is also stored in muscles, where it provides a reserve of energy.
Golfer’s Elbow
Also known as medial epicondylitis, golfer’s elbow is characterised by pain over the medial (inside) aspect of the elbow, which may radiate down the forearm. Despite the name this condition does not just affect golfers. In fact, this problem is most often associated with work-related activities. It is equally common in men and women, peaking in prevalence between the ages of 30 and 50.
Granulation Tissue
The fibrous tissue that forms from a blood clot as part of the inflammatory process. As it matures it becomes scar tissue.
Groin strain
The common term for an Adductor muscle strain.
Gross Motor Skills
Motor skills refer to a person’s ability to perform co-ordinated movements using a combination of muscle actions. Gross Motor Skills tend to be performed by large muscles and they produce bigger body movements such as running and jumping. Fine Motor Skills tend to be initiated by smaller muscles such as those in the hand and they produce actions such as picking something up between the thumb and fingers or unscrewing the top from a bottle.
H
Haemarthrosis
Bleeding within a joint.
Haematoma
A localised collection of blood within the tissues.
Haemorrhage
Bleeding.
Hard Callus
The solid mature mass of bone which forms from the Cartilage of the Soft Callus during bone healing.
Heart disease
Progressive damage to the heart and the blood vessels that supply it, caused by disease processes that are associated with poor diet and a sedentary lifestyle.
Heat Pack
A warm therapeutic pack used to relieve pain and muscle spasm.
Hernia
A protrusion of a body part through a break in the continuity of other tissue.
Hindfoot
The part of the foot directly under the shin bone. It is comprised of the Calcaneus (Heel bone) and Talus.
Hip Pointer
A bruise or contusion around the hip joint due to direct contact during sports.
Hot Pack
A warm therapeutic pack used to relieve pain and muscle spasm.
Hyaline Cartilage
The articular cartilage that covers the end of bones at the joints. It has a glassy, shiny appearance and is designed to allow friction free movement.
Hydrotherapy
Therapeutic exercises within the swimming pool.
Hyperextension
Extension of a joint to beyond the normal limit.
Hypotonic
A sports drink that has a lower concentration of sugars and salts, which means it is absorbed and digested rapidly.
I
Ice therapy
The use of ice and ice water in the treatment of injury. Physiologically ice reduces metabolic activity within the tissues thus preventing secondary tissue damage; it also reduces pain signals to the central nervous system. Therapeutically ice therapy relieves pain and helps to reduce the development of swelling.
Ilio-Tibial Band Friction Syndrome
Painful overuse condition that affects the outerside of the knee. It is caused by friction of the IlioTibial Band – the large fibrous sheath that runs down the outer aspect of the thigh – from rubbing against the widest prominence of the thigh bone.
Immobilisation
Ensuring there is no movement of a body part. This may be through strapping or using a plaster cast.
Impingement syndrome
Impingement syndrome is a painful condition that commonly affects the shoulder. As the arm is raised the head of the Humerus bone rotates round in the shoulder joint and the space between it and the
‘Acromion’ becomes restricted. This can lead to impingement of the muscles, tendons and bursa that lies within the space.
Incision
A surgical cut through skin and soft tissue.
Inflammation
The body’s natural response to injury and tissue damage. It is characterised by pain, swelling, heat, redness and loss of function. It is the first stage of the body’s natural healing response.
Insulin
A hormone released by the Pancreas which regulates the breakdown of Carbohydrates. Insulin deficiency can lead to Diabetes.
Internal Rotation
A description for an anatomical movement where the body part involved is rolled inwards, towards the mid line of the body.
Interosseous Membrane
A band of ligament tissue, or band of fibrous tissue that connects two bones.
Intramedullary
Pertaining to the marrow cavity (centre) of a bone.
Intramedullary nail
A reamed metal (usually Titanium) nail that is surgically inserted through the marrow cavity (centre) of a bone, in order to fixate a fracture of that bone.
Intramedullary screw
A metal (usually Titanium) screw that is surgically inserted through the marrow cavity (centre) of a bone, in order to fixate a fracture of that bone.
Inversion
The action of turning a body part inwards.
Inversion ankle sprain
Sprain of the ankle when the foot goes inwards and body weight goes forward and outwards. This produces damage to the outerside of the ankle.
Isokinetic
A muscle contraction where there is the same resistance provided throughout the range of movement.
Isometric Contraction
A muscle contraction where there is no change in the length of the muscle fibres and there is no movement at the involved joints.
Isotonic
A muscle contraction without an appreciable change in muscle tension, where the muscle fibre length shortens.
Itis
A suffix that denotes inflammation of a part of the body.
J
Joint
The site of a junction of two or more bones of the body.
Joint Capsule
A membranour sac that encloses synovial joints.
Joint Mobilisation
The passive movement of a joint in order to restore range of movement or to relieve pain. This can be passive, where the therapist controls movement; or active, where the patient controls movement.
K
Kyphosis
The medical term for the ‘hunchbacked’ posture. This is an increased curvature of the thoracic spine, which can be due to poor postural habits or pathological processes.
L
Labrum
The circular shaped cartilaginous rim that lines ball and socket joints such as the hip and shoulder, in order to increase joint congruency and stability.
Lanolin
A derivative of wool. Lanolin is used as a cream to soothe the skin following a rash, cracked nipples, dry skin and minor cuts, burns and abrasions.
Lateral
An anatomical term for structures furthest from the mid line of the body.
Lateral Collateral Ligament
The ligament on the outer side of the knee joint. It runs from the Lateral Condyle of the thigh bone to the head of the Fibula in the knee. The function of the ACL is to prevent excessive forward movement of the shin in relation to the thigh and also to prevent excessive rotation at the knee joint.
Lesion
A broad term to describe damage to body tissue.
Ligament
A band of strong fibrous tissue, which connects bones together at joints and acts as a passive restraint to excessive movement at that joint.
Ligaments
Strong fibrous bands comprised of collagen tissue which link bones together and provide stability to joints. When ligaments are injured it is referred to as a ‘sprain’.
Lumbago
A commonly used term for low back pain.
Lumbar Vertebra
The five bones that make up the lower part of the spine, located just above the Sacrum.
Lumbo-Sacral
The lumbar spine and Sacrum – the lower back.
Lymph
Liquid found in the lymph vessels of the lymphatic system. It is comprised primarily of water, plasma proteins and blood cells.
Lymphatic System
The vessels, nodes and ducts that make up the system which collects ‘lymph’ fluid from tissues all around the body. This fluid is eventually returned to the blood circulatory system via the liver. This is one of the body’s primary defence mechanisms where bacteria and toxins are removed from tissues and processed.
M
Malleolus
The rounded bony prominences located on either side of the ankle.
Manipulation
The forceful passive thrust of a joint into the end of it’s physiological range of movement. Usually undertaken by a skilled manual therapist, such as a chartered physiotherapist or an osteopath.
Massage
Mobilisation of the soft tissues using stroking, kneading and percussion techniques.
Medial
An anatomical term for structures nearest to the mid line of the body.
Meniscectomy
Surgical excision of the meniscus of the knee joint.
Meniscus
The semi circular shaped fibrocartilage ‘spacer’ within the knee joint. Its function is to act as a shock absorber and increase the congruency of the knee joint.
Metaphysis
The wider part towards the end of a ‘long bone’.
Metatarsal
The five Metatarsal bones of the foot are located between the ankle region and the toes. Due to their position they are commonly injured in soccer due to direct trauma. Stress fractures of the Metatarsal bones are fairly common in sporting individuals.
Metatarsalgia
A vague term for pain in the region of the Metatarsal bones of the foot.
Microtrauma
Microscopic trauma and damage to tissue following physical exertion.
Motor skills
Motor skills refer to a person’s ability to perform co-ordinated movements using a combination of muscle actions. Gross Motor Skills tend to be performed by large muscles and they produce bigger body movements such as running and jumping. Fine Motor Skills tend to be initiated by smaller muscles such as those in the hand and they produce actions such as picking something up between the thumb and fingers or unscrewing the top from a bottle.
MRI
Magnetic Resonance Imaging. A non invasive imaging technique to help doctors visualise the tissues, organs and joints of the body.
MRI Scan
Magnetic Resonance Imaging scan. The body part to be scanned is placed within the magnetic field of a super magnet and radio waves are fired at the patient. Based on the distortion of the radio waves (dependent on density and fluid content) a computerised image of the body part is produced. This is used in the diagnosis of numerous sports injuries.
Muscle
Specialised tissue with contractile properties that is responsible for movement and locomotion.
Myositis Ossificans
A condition where calcium is deposited within muscle tissue. It usually occurs subsequent to a haematoma or bleed within muscle tissue, commonly known as a dead leg. It is also more likely to occur if massage is used too early in the treatment of a dead leg. This is because the pressure of the massage can re-start bleeding in the tissues, as the calcium deposits are derived from the blood clotting process.
N
Neoprene
Neoprene is a synthetic rubber polymer that is extremely wear resistant. It has thermal insulating properties which help to make it a perfect material for use as a joint or muscle support.
Neovascularisation
The formation of new blood vessels in abnormal tissue.
Nerve
The cord like structures, comprised of nerve cells, that transmit impulses between the central nervous system and other parts of the body. Nerves are classified as sensory, motor or mixed nerves. Sensory nerves send signals from specialised receptor cells located around the body to the central nervous system for processing. Motor nerves carry signals from the central nervous system which cause muscular contractions that produce movement at a joint. Mixed nerves, as the name suggests, are comprised of both sensory and motor nerves.
Neuralgia
Pain caused by a problem with a nerve.
Neuritis
Inflammation of nerve tissue or nerves. This can cause local or referred pain and sometimes weakness, or aloss of sensation.
Neurologist
A specialist in neurology.
Neurology
The study of the nervous system and diseases of it.
Neuromuscular
Relating to the muscles and nerves.
Neuropathy
A general term used to describe dysfunction of peripheral nerves.
Non Union
The condition where, because of an impairment of bone healing, a fracture fails to heal. Non union fractures may require surgery.
NSAIDs
Non-Steroidal Anti-Inflammatory Drugs. A group of drugs that have a pain relieving, anti-fever and anti-inflammatory effect. Common examples are aspirin and ibuprofen.
O
Orthopaedic Consultant
A specialist doctor who treats conditions of the musculoskeletal system.
Orthopaedics
The medical specialty related to problems of the musculoskeletal system – the bones, joints and soft tissues.
Orthotic
A medical appliance or device, which is used to improve function.
Orthotic Arch Support
An insert that goes into your shoes to support the arch on the inside of the foot. Thes can be custom made or off the shelf.
Orthotist
A skilled professional who applies orthotic devices in order to improve function.
Osgood Schlatters
Osgood Schlatters disease is not a disease in the conventional sense. It is a depressingly common overuse injury that affects the upper part of the shinbone, just below the knee. It is most common in adolescents who are active in sports and can frustratingly cause an enforced lay-off for gifted sports people between the ages of 9 and 14 years. It is more common in males than in females.
Osteoarthritis
Degenerative joint disease, characterised by wear of the articular surface of a joint. This can occur due to repeated overuse, but the incidence and onset of osteoarthritis is increased secondary to trauma, such as major ligamentous injury or meniscal injury in the knee.
Osteoblasts
Cells found in bone that are responsible for producing bone tissue.
Osteochondrosis
Localised dysfunction of the area of bone where muscles and tendons attach. These areas are known as ‘Apophyses’. This condition is most common in children. It is characterised by pain during local degeneration of the bone, followed by regeneration. This condition is also known as ‘Traction Apophysitis’, an example of it is Osgood Schlatters disease.
Osteoclasts
Cells found in bone that are responsible for re-absorbing bone tissue.
Osteomyelitis
Inflammation and potential destruction of bone caused by a bacterial infection. This sudden infection can be secondary to a skin wound or even a throat infection. It is characterised by severe pain and generalised fever, and the consequences can be very serious. Prompt treatment with anti-biotics is required.
Osteoporosis
A bone disease characterised by decreased bone mineral density. This can be due to hormonal changes, common during the menopause in women, or due to dietary deficiencies; but there are many other causes. The decreased bone mineral density leads to an eventual loss of height, postural changes and can pre-dispose people to fractures.
Disuse osteoporosis is a common condition in patients who have been immobilised due to an injury. Because the bones have not been subject to the normal stresses of weight bearing, then the body lays down less bone and there is a localised area of relative osteoporosis. This resolves with a gradual return to activity.
Overtraining Syndrome
Physical and emotional symptoms due to overtraining and a lack of rest in athletes. Symptoms include muscle soreness, persistent fatigue, mood changes and illness. Frequently these contribute to underperformance, which the athlete often responds to by training harder, thus entering into a vicious cycle.
Overuse Injury
An injury where the primary causative factor is a training volume that it too high or too frequent, particularly where repetitive actions or movements are practised.
P
Pancreas
A gland positioned behind the stomach. It secretes the hormone Insulin, which regulates Carbohydrate breakdown. The Pancreas is also involved in the digestion of Fats and Proteins.
Parathesia
Pins and needles or prickling sensation.
Patella
The knee cap.
Patella tendinopathy
Patella tendinopathy is usually characterised by degeneration of the tendon (tendonosis) as evidenced at surgical biopsy. This is a breakdown in the tendon, characterised by small, focal lesions within the tendon without an inflammatory response. The degeneration means that the tendon does no”
Patella
The knee cap.
Patella tendinopathy
Patella tendinopathy is usually characterised by degeneration of the tendon (tendonosis) as evidenced at surgical biopsy. This is a breakdown in the tendon, characterised by small, focal lesions within the tendon without an inflammatory response. The degeneration means that the tendon