Tendinopathy

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 2 Oct 2025

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.

Definición

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]

Anamnesis y examen

Principales factores de diagnóstico

insidious onset
well-localized tenderness

Todos los datos

Otros factores de diagnóstico

pain during activity
tendon thickening
tendon nodularity
crepitus

Todos los datos

Factores de riesgo

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

Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

clinical diagnosis

Todos los datos

Pruebas diagnósticas que deben considerarse

ultrasound
MRI
x-ray

Todos los datos

Algoritmo de tratamiento

Agudo

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

Colaboradores

Autores

James H-C. Wang, PhD

Professor and Director

MechanoBiology Laboratory

Department of Orthopaedic Surgery

University of Pittsburgh School of Medicine

Pittsburgh

Divulgaciones

JHW declares that he has no competing interests.

Benjamin B. Rothrauff, MD, PhD

Research Fellow

UPMC Center for Sports Medicine

University of Pittsburgh

Pittsburgh

Divulgaciones

BBR declares that he has no competing interests.

Kevin J. Byrne, MD

Research Fellow

UPMC Center for Sports Medicine

University of Pittsburgh

Pittsburgh

Divulgaciones

KJB declares that he has no competing interests.

Agradecimientos

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.

Divulgaciones

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

Revisores por pares

Per Renström, MD

Professor Emeritus

Karolinska Institute

Stockholm

Sweden

Divulgaciones

PR declares that he has no competing interests.

Agradecimiento de los revisores por pares

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Divulgaciones

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Referencias

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Artículos principales

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. Resumen

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.Texto completo Resumen

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

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. Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales
- Rotator cuff tear
- Osgood-Schlatter disease
- Sinding-Larsen-Johansson disease
Más Diferenciales
Guías de práctica clínica
- ACR appropriateness criteria: chronic shoulder pain
- ACR appropriateness criteria: chronic elbow pain
Más Guías de práctica clínica
Folletos para el paciente
Rotator cuff injury
Más Folletos para el paciente
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Tendinopathy

Summary

Definición

Anamnesis y examen

Principales factores de diagnóstico

Otros factores de diagnóstico

Factores de riesgo

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

Pruebas diagnósticas que deben considerarse

Algoritmo de tratamiento

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

Colaboradores

Autores

James H-C. Wang, PhD

Divulgaciones

Benjamin B. Rothrauff, MD, PhD

Divulgaciones

Kevin J. Byrne, MD

Divulgaciones

Agradecimientos

Divulgaciones

Revisores por pares

Per Renström, MD

Divulgaciones

Agradecimiento de los revisores por pares

Divulgaciones

Referencias

Artículos principales

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales

Guías de práctica clínica

Folletos para el paciente

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión para acceder a todo el BMJ Best Practice