Tendinopathy

Last reviewed: 9 Nov 2022
Last updated: 13 May 2022

Summary

Definition

History and exam

Key diagnostic factors

  • insidious onset
  • well-localized tenderness
More key diagnostic factors

Other diagnostic factors

  • pain during activity
  • tendon thickening
  • tendon nodularity
  • crepitus
Other diagnostic factors

Risk factors

  • athletic training
  • unsuitable equipment
  • hard and high-friction playing surface
  • increasing age
  • fluoroquinolone treatment
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • ultrasound
  • MRI
  • x-ray
More investigations to consider

Treatment algorithm

ACUTE

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

Contributors

Authors

James H-C. Wang, PhD
James H-C. Wang

Professor and Director

MechanoBiology Laboratory

Department of Orthopaedic Surgery

University of Pittsburgh School of Medicine

Pittsburgh

PA

Disclosures

JHW declares that he has no competing interests.

Benjamin B. Rothrauff, MD, PhD

Research Fellow

UPMC Center for Sports Medicine

University of Pittsburgh

Pittsburgh

PA

Disclosures

BBR declares that he has no competing interests.

Kevin J. Byrne, MD

Research Fellow

UPMC Center for Sports Medicine

University of Pittsburgh

Pittsburgh

PA

Disclosures

KJB declares that he has no competing interests.

Acknowledgements

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.

Disclosures

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

Peer reviewers

Per Renström, MD

Professor Emeritus

Karolinska Institute

Stockholm

Sweden

Disclosures

PR declares that he has no competing interests.

  • Tendinopathy images
  • Differentials

    • Rotator cuff tear
    • Osgood-Schlatter disease
    • Sinding-Larsen-Johansson disease
    More Differentials
  • Guidelines

    • ACR appropriateness criteria: chronic elbow pain
    • ACR appropriateness criteria: chronic shoulder pain
    More Guidelines
  • Patient leaflets

    Rotator cuff injury

    More Patient leaflets
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