Tendinopathy

Обзор 
Теория 
Диагноз 
Лечение 
Последующее наблюдение 
Источники 

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Последний просмотренный: 6 May 2026

Last updated: 31 Oct 2024

Tendinopathy is a general term that describes tendon degeneration characterized by a combination of pain, swelling, and impaired performance.

Common sites include the rotator cuff (supraspinatus tendon), wrist extensors (lateral epicondyle) and pronators (medial epicondyle), patellar and quadriceps tendons, and Achilles tendon.

The exact etiology is unclear. Studies suggest it is an overuse condition leading to inadequate tendon repair that predisposes the tendon to microtears and degeneration.

Treatment consists of activity modification, relative rest, ice, stretching, and strengthening. Stretching and strengthening are best guided by a physical therapist.

Extracorporeal shockwave therapy or ultrasound-guided injection of platelet-rich plasma may be considered in recalcitrant tendinopathy, but their use remains controversial.

Those who do not improve with conservative therapy should seek surgical evaluation.

Определение

There are over 600 muscle-tendon units in the human body. Theoretically, tendinopathy can occur in any one of them. This topic will focus on the common sites including: the rotator cuff (supraspinatus tendon) in the shoulder, wrist extensors (lateral epicondyle) and pronators (medial epicondylitis) in the elbow, patellar and quadriceps tendon in the knee, and Achilles tendon in the heel.

In athletes, common locations for tendinopathy include the Achilles and patellar tendons.

In the general population, the Achilles and lateral epicondyle are the most commonly affected.

There are many terms used to characterize chronic tendon disorders. Tendonitis refers to a painful tendon with histologic signs of inflammation within the tendon. Tendinosis is a localized intrinsic degeneration of unknown etiology, characterized by localized swollen tendon nodes. Several studies have shown that tendon biopsies taken at surgery lack inflammatory cells.[1][2][3] In clinical settings, tendinopathy describes impaired tendon healing characterized by pain, swelling, and impaired performance.[4][5][6]

Анамнез и осмотр

Ключевые диагностические факторы

insidious onset
well-localized tenderness

Полная информация

Другие диагностические факторы

pain during activity
tendon thickening
tendon nodularity
crepitus

Полная информация

Факторы риска

athletic training
unsuitable equipment
hard and high-friction playing surface
increasing age
fluoroquinolone treatment

Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

clinical diagnosis

Полная информация

Исследования, проведение которых нужно рассмотреть

ultrasound
MRI
x-ray

Полная информация

Алгоритм лечения

Острый

shoulder with rotator cuff tendinopathy

shoulder with biceps tendinopathy

elbow with lateral epicondylitis

elbow with medial epicondylitis

knee with patellar tendinopathy

knee with quadriceps, iliotibial band, or popliteus tendinopathy

ankle with Achilles tendinopathy

Составители

Авторы

James H-C. Wang, PhD

Professor and Director

MechanoBiology Laboratory

Department of Orthopaedic Surgery

University of Pittsburgh School of Medicine

Pittsburgh

Раскрытие информации

JHW declares that he has no competing interests.

Benjamin B. Rothrauff, MD, PhD

Research Fellow

UPMC Center for Sports Medicine

University of Pittsburgh

Pittsburgh

Раскрытие информации

BBR declares that he has no competing interests.

Kevin J. Byrne, MD

Research Fellow

UPMC Center for Sports Medicine

University of Pittsburgh

Pittsburgh

Раскрытие информации

KJB declares that he has no competing interests.

Выражение благодарностей

Dr James H-C. Wang, Dr Benjamin B. Rothrauff, and Dr. Kevin J. Byrne would like to gratefully acknowledge Dr Kivanc Atesok, Dr Chad Griffith, Dr Garth N. Walker, Dr Chealon Miller, Dr Paulo H. Araujo, Dr Margaret S. Lo, Dr Márcio Albers, and Dr Freddie H. Fu, previous contributors to this topic. Unfortunately, we have since been made aware that Dr Freddie H. Fu is deceased.

Раскрытие информации

KA, CG, GNW, CM, PHA, MSL, and MA declare that they have no competing interests. FHF declared that he had no competing interests.

Рецензенты

Per Renström, MD

Professor Emeritus

Karolinska Institute

Stockholm

Sweden

Раскрытие информации

PR declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Список литературы

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Основные статьи

Almekinders LC, Temple JD. Etiology, diagnosis, and treatment of tendonitis: an analysis of the literature. Med Sci Sports Exerc. 1998 Aug;30(8):1183-90. Аннотация

Beaudreuil J, Dhénain M, Coudane H, et al. Clinical practice guidelines for the surgical management of rotator cuff tears in adults. Orthop Traumatol Surg Res. 2010 Apr;96(2):175-9.Полный текст Аннотация

Schepsis AA, Jones H, Haas AL. Achilles tendon disorders in athletes. Am J Sports Med. 2002 Mar-Apr;30(2):287-305. Аннотация

Kukkonen J, Joukainen A, Lehtinen J, et al. Treatment of nontraumatic rotator cuff tears: a randomized controlled trial with two years of clinical and imaging follow-up. J Bone Joint Surg Am. 2015 Nov 4;97(21):1729-37. Аннотация

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Отличия
- Rotator cuff tear
- Osgood-Schlatter disease
- Sinding-Larsen-Johansson disease
Больше Отличия
Рекомендации
- ACR appropriateness criteria: chronic shoulder pain
- ACR appropriateness criteria: chronic elbow pain
Больше Рекомендации
Лифлеты для пациента
Rotator cuff injury
Больше Лифлеты для пациента
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Использование этого контента попадает под действие нашего заявления об отказе от ответственности

Tendinopathy

Резюме

Определение

Анамнез и осмотр

Ключевые диагностические факторы

Другие диагностические факторы

Факторы риска

Диагностические исследования

Исследования, которые показаны в первую очередь

Исследования, проведение которых нужно рассмотреть

Алгоритм лечения

shoulder with rotator cuff tendinopathy

shoulder with biceps tendinopathy

elbow with lateral epicondylitis

elbow with medial epicondylitis

knee with patellar tendinopathy

knee with quadriceps, iliotibial band, or popliteus tendinopathy

ankle with Achilles tendinopathy

Составители

Авторы

James H-C. Wang, PhD

Раскрытие информации

Benjamin B. Rothrauff, MD, PhD

Раскрытие информации

Kevin J. Byrne, MD

Раскрытие информации

Выражение благодарностей

Раскрытие информации

Рецензенты

Per Renström, MD

Раскрытие информации

Peer reviewer acknowledgements

Disclosures

Список литературы

Основные статьи

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Отличия

Рекомендации

Лифлеты для пациента

Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice

Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice

Войдите в учетную запись, чтобы получить полноценный доступ к BMJ Best Practice