Tendinopathy

Tendinopathy is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Clinical syndrome characterized by localized tendon pain
  • System(s) affected: musculoskeletal
ALERT
  • Tendinopathy is an umbrella term to include acute and chronic tendon pain and has replaced tendinitis and tendinosis clinically. It has been hypothesized that tendinopathy occurs in a continuum (1).
  • Tendinitis and tendinosis are histologic diagnoses (2). Enthesopathy is a change in the normal tissue architecture at the tendon–bone interface.
  • Tendinopathies can be pathologically classified as:
    • Tendinitis: acute inflammation of the tendon
    • Tendinosis: chronic degeneration of the tendon; also can be related to partial tendon rupture. Tendon thickening and tendon fiber disorganization are often present.
    • Tenosynovitis: inflammation of the tendon sheath
  • Common sites of overuse tendon injuries include
    • Knee: jumper’s knee (patellar tendon)
    • Shoulder: rotator cuff tendons
    • Ankle: Achilles and posterior tibialis tendons
    • Hip: hamstring tendons
    • Elbow: lateral epicondylitis (tennis elbow) that is extensor tendons; medial epicondylitis (golfer’s elbow) that is flexor tendons and triceps (3)

Epidemiology

Incidence
  • Tendinopathy more common in athletes or active people, especially in age group >35 years old
  • Aging tendons are less able to absorb energy, predisposing to injury.
  • Major risk factors for tendinopathy include age, load on tendon, and biomechanical abnormalities.
  • Gender influences incidence of specific tendinopathies likely related to biomechanical factors. Example: patellar tendinopathy 5 times more common in males than female jumping athletes; rotator cuff and lateral epicondylitis tendinopathy equal for males and females
  • Genetics may play a role in development of tendinopathy.

Pediatric Considerations
Tendon is more stable than the epiphyseal plate in children. Consider growth plate avulsion fractures following trauma in children (3). Tendinopathy is uncommon in children with open growth plates.

Prevalence
Common outpatient musculoskeletal complaint—7% of all visits (4)[C]

Etiology and Pathophysiology

  • Increased repetitive stress on the tendon increases risk of injury.
  • Exact causes are theoretical (1,3).
  • Overuse injuries involve incomplete and disorganized tendon and soft tissue repair mechanisms. This results in a susceptible tendon lacking strength and extracellular tissue organization (2).
  • Acute tendon injury has triphasic healing response of inflammation, proliferation, and maturation.

Risk Factors

  • Extrinsic factors
    • Training errors (most common)
    • Improper footwear/equipment (next most common)
    • Hard or irregular training surfaces
    • Environmental conditions
  • Intrinsic factors
    • Malalignment
    • Limb length discrepancy
    • Muscular imbalance
    • Muscular insufficiency

General Prevention

Preparticipation screening to identify patients at risk for injury, warm-up sessions, core and supporting muscle strengthening, safe activity environment, protective equipment using appropriate braces/taping, and health education have all been shown to prevent injury.

Commonly Associated Conditions

  • Bursitis (common)
  • Arthritis
  • Apophysitis

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