Tendinopathy

Tendinopathy is a general term that describes tendon degeneration characterised 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 aetiology is unclear. Studies suggest it is an over-use condition leading to inadequate tendon repair that predisposes the tendon to micro-tears and degeneration.

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

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.

There are over 600 muscle-tendon units in the human body. Theoretically, tendinopathy can occur in any one of them. However, this monograph 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 patella tendons.

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

There are many terms used to characterise chronic tendon disorders. Tendonitis refers to a painful tendon with histological signs of inflammation within the tendon. Tendinosis is a localised intrinsic degeneration of unknown aetiology, characterised by localised swollen tendon nodes. Several studies have shown that tendon biopsies taken at surgery lack inflammatory cells. [1] Puddu G, Ippolito E, Postacchini F. A classification of Achilles tendon disease. Am J Sports Med. 1976 Jul-Aug;4(4):145-50. http://www.ncbi.nlm.nih.gov/pubmed/984291?tool=bestpractice.com [2] Järvinen M, Józsa L, Kannus P, et al. Histopathological findings in chronic tendon disorders. Scand J Med Sci Sports. 1997 Apr;7(2):86-95. http://www.ncbi.nlm.nih.gov/pubmed/9211609?tool=bestpractice.com [3] 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. http://www.ncbi.nlm.nih.gov/pubmed/9710855?tool=bestpractice.com In clinical settings, tendinopathy describes impaired tendon healing characterised by pain, swelling, and impaired performance. [4] Maffulli N, Khan KM, Puddu G. Overuse tendon conditions: time to change a confusing terminology. Arthroscopy. 1998 Nov-Dec;14(8):840-3. http://www.ncbi.nlm.nih.gov/pubmed/9848596?tool=bestpractice.com [5] Kountouris A, Cook J. Rehabilitation of Achilles and patellar tendinopathies. Best Pract Res Clin Rheumatol. 2007 Apr;21(2):295-316. http://www.ncbi.nlm.nih.gov/pubmed/17512484?tool=bestpractice.com [6] Khan KM, Cook JL, Kannus P, et al. Time to abandon the "tendonitis" myth. BMJ. 2002 Mar 16;324(7338):626-7. http://www.ncbi.nlm.nih.gov/pubmed/11895810?tool=bestpractice.com