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. 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 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. In clinical settings, tendinopathy describes impaired tendon healing characterised by pain, swelling, and impaired performance.
History and exam
Key diagnostic factors
- presence of risk factors
- insidious onset
- well-localised tenderness
Other diagnostic factors
- pain during activity
- tendon thickening
- tendon nodularity
- athletic training
- unsuitable equipment
- hard and high-friction playing surface
- increasing age
- fluoroquinolone treatment
1st investigations to order
- clinical diagnosis
Investigations to consider
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
- Rotator cuff tear
- Osgood-Schlatter's disease
- Sinding-Larsen-Johansson disease
- ACR appropriateness criteria: chronic elbow pain
- ACR appropriateness criteria: chronic shoulder pain
Rotator cuff injuryMore Patient leaflets
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