Tendinopathy
Tendinopathy | |
---|---|
Other names | physiotherapy[5] |
Prognosis | 80% better within 6 months for overuse tendinopathy[2] |
Frequency | Common[3][2] |
Tendinopathy is a type of
Causes may include an injury or repetitive activities.
Treatment may include rest,
Signs and symptoms
Symptoms include tenderness on palpation, swelling, and pain, often when exercising or with a specific movement.[12]
Cause
Causes may include an injury or repetitive activities.
Quinolone antibiotics are associated with increased risk of tendinitis and tendon rupture.[15] A 2013 review found the incidence of tendon injury among those taking fluoroquinolones to be between 0.08 and 0.2%.[16] Fluoroquinolones most frequently affect large load-bearing tendons in the lower limb, especially the Achilles tendon which ruptures in approximately 30 to 40% of cases.[17]
Types
- Achilles tendinitis
- Calcific tendinitis
- Patellar tendinitis (jumper's knee)
Pathophysiology
As of 2016, the
There are multifactorial theories that could include: tensile overload, tenocyte related collagen synthesis disruption, load-induced ischemia, neural sprouting, thermal damage, and adaptive compressive responses. The intratendinous sliding motion of fascicles and shear force at interfaces of fascicles could be an important mechanical factor for the development of tendinopathy and predispose tendons to rupture.[22]
The most commonly accepted cause for this condition is seen to be an overuse syndrome in combination with intrinsic and extrinsic factors leading to what may be seen as a progressive interference or the failing of the innate healing response. Tendinopathy involves cellular apoptosis, matrix disorganization and neovascularization.[23]
Classic characteristics of "tendinosis" include degenerative changes in the collagenous matrix, hypercellularity, hypervascularity, and a lack of inflammatory cells which has challenged the original misnomer "tendinitis".[24][25]
For chronic tennis elbow, histological findings include granulation tissue, microrupture, degenerative changes, and there is no traditional inflammation. As a consequence, "lateral elbow tendinopathy or tendinosis" is used instead of "
Cultures from tendinopathic tendons contain an increased production of
Longitudinal sonogram of the lateral elbow displays thickening and heterogeneity of the common extensor tendon that is consistent with tendinosis, as the ultrasound reveals calcifications, intrasubstance tears, and marked irregularity of the lateral epicondyle. Although the term "epicondylitis" is frequently used to describe this disorder, most histopathologic findings of studies have displayed no evidence of an acute, or a chronic inflammatory process. Histologic studies have demonstrated that this condition is the result of tendon degeneration, which causes normal tissue to be replaced by a disorganized arrangement of collagen. Therefore, the disorder is more appropriately referred to as "tendinosis" or "tendinopathy" rather than "tendinitis".[30]
Colour Doppler ultrasound reveals structural tendon changes, with vascularity and hypo-echoic areas that correspond to the areas of pain in the extensor origin.[31]
Load-induced non-rupture tendinopathy in humans is associated with an increase in the ratio of collagen III:I proteins, a shift from large to small diameter collagen fibrils, buckling of the collagen fascicles in the tendon extracellular matrix, and buckling of the tenocyte cells and their nuclei.[32]
Diagnosis
Symptoms can vary from aches or pains and local joint stiffness, to a burning that surrounds the whole joint around the inflamed tendon. In some cases, swelling occurs along with heat and redness, and there may be visible knots surrounding the joint. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiff the following day as muscles tighten from the movement of the tendon. Many patients report stressful situations in their life in correlation with the beginnings of pain which may contribute to the symptoms.[citation needed]
Medical imaging
Ultrasound imaging can be used to evaluate tissue strain, as well as other mechanical properties.[33] Ultrasound-based techniques are becoming more popular because of its affordability, safety, and speed. Ultrasound can be used for imaging tissues, and the sound waves can also provide information about the mechanical state of the tissue.[34]
Treatment
Treatment of tendon injuries is largely conservative. Use of
There is tentative evidence that low-level laser therapy may also be beneficial in treating tendinopathy.[37] The effects of deep transverse friction massage for treating tennis elbow and lateral knee tendinitis is unclear.[38]
NSAIDs
NSAIDs may be used to help with pain.[2] They however do not alter long term outcomes.[2] Other types of pain medication, like paracetamol, may be just as useful.[2]
Steroids
Steroid injections have not been shown to have long term benefits for tendonitis, but appear to improve pain and function in the short term more effectively than other treatments except NSAIDs.[39] They appear to have little benefit in tendinitis of the rotator cuff.[40] There are some concerns that they may have negative effects.[41]
Other injections
There is insufficient evidence on the routine use of injection therapies (autologous blood, platelet-rich plasma, deproteinised haemodialysate, aprotinin, polysulphated glycosaminoglycan, skin derived fibroblasts etc.) for treating Achilles tendinopathy.[42] As of 2014 there was insufficient evidence to support the use of platelet-rich therapies for treating musculoskeletal soft tissue injuries such as ligament, muscle and tendon tears and tendinopathies.[43]
Prognosis
Initial recovery from overuse tendinosus is usually within two to three months, and 80% will recover fully within three to six months.[2]
Epidemiology
Tendon injury and resulting tendinopathy are responsible for up to 30% of consultations to sports doctors and other musculoskeletal health providers.[44] Tendinopathy is most often seen in tendons of athletes either before or after an injury but is becoming more common in non-athletes and sedentary populations. For example, the majority of patients with Achilles tendinopathy in a general population-based study did not associate their condition with a sporting activity.[45] In another study the population incidence of Achilles tendinopathy increased sixfold from 1979–1986 to 1987–1994.[46] The incidence of rotator cuff tendinopathy ranges from 0.3% to 5.5% and annual prevalence from 0.5% to 7.4%.[47]
Terminology
Tendinitis is a very common, but misleading term. By definition, the suffix "-itis" means "inflammation of". Inflammation[48] is the body's local response to tissue damage which involves red blood cells, white blood cells, blood proteins with dilation of blood vessels around the site of injury. Tendons are relatively avascular.[49] Corticosteroids are drugs that reduce inflammation. Corticosteroids can be useful to relieve chronic tendinopathy pain, improve function, and reduce swelling in the short term. However, there is a greater risk of long-term recurrence.[50] They are typically injected along with a small amount of a numbing drug called lidocaine. Research shows that tendons are weaker following corticosteroid injections.
Tendinitis is still a very common diagnosis, though research increasingly documents that what is thought to be tendinitis is usually tendinosis.[51]
Anatomically close but separate conditions are:
- HLA B27 arthropathies such as ankylosing spondylitis, psoriatic arthritis, and reactive arthritis.[54][55]
Research
The use of a
A promising therapy involves eccentric loading exercises involving lengthening muscular contractions.[60]
Other animals
Bowed tendon is a horseman's term for tendinitis (inflammation) and tendinosis (degeneration), most commonly seen in the superficial digital flexor tendon in the front leg of horses.
Mesenchymal stem cells, derived from a horse's bone marrow or fat, are currently being used for tendon repair in horses.[61]
References
- ^ a b "Tendinopathy MeSH Browser". US National Library of Medicine. Retrieved 18 November 2018.
- ^ PMID 16156339. Archived from the original(PDF) on 2007-09-29. Retrieved 2007-04-02.
- ^ a b c d e f g h "Tendinitis". National Institute of Arthritis and Musculoskeletal and Skin Diseases. 12 April 2017. Retrieved 18 November 2018.
- ^ a b "Tendinitis". National Institute of Arthritis and Musculoskeletal and Skin Diseases. 12 April 2017. Retrieved 18 November 2018.
- ^ a b c "Tendinitis". National Institute of Arthritis and Musculoskeletal and Skin Diseases. 12 April 2017. Retrieved 18 November 2018.
- ^ "Tendinitis". National Institute of Arthritis and Musculoskeletal and Skin Diseases. 12 April 2017. Retrieved 18 November 2018.
- ^ "Tendinitis". National Institute of Arthritis and Musculoskeletal and Skin Diseases. 12 April 2017. Retrieved 18 November 2018.
- ^ "Fluoroquinolones and risk of Achilles tendon disorders: case-control study". British Medical Journal. 1 June 2002. Retrieved 21 September 2022.
- ^ a b "Tendinitis". National Institute of Arthritis and Musculoskeletal and Skin Diseases. 12 April 2017. Retrieved 18 November 2018.
- ^ a b c "Tendinitis". National Institute of Arthritis and Musculoskeletal and Skin Diseases. 12 April 2017. Retrieved 18 November 2018.
- PMID 11895810.
- S2CID 1810473.
- PMID 15116648.
- PMID 19479698.
- ^ FDA May 12, 2016 FDA Drug Safety Communication: FDA advises restricting fluoroquinolone antibiotic use for certain uncomplicated infections; warns about disabling side effects that can occur
- S2CID 24948660.
- PMID 28553748.
- S2CID 10794196.
- PMID 27127294.
- S2CID 10794196.
- PMID 32028937.
- S2CID 20575820.
- PMID 28846334.
- PMID 21144004.
- PMID 19591655.
- S2CID 3274396.
- PMID 1423702.
- S2CID 13511471.
- PMID 25383170.
- S2CID 22963436.
- S2CID 23469092.
- PMID 24571576.
- PMID 21030024.
- PMID 22542220.
- PMID 37169370.
- ^ "Weights, resistance bands and rest days are best for tendinopathy". NIHR Evidence. 15 February 2024.
- S2CID 10634480.
- PMID 25380079.
- PMID 19054817.
Conclusions: Steroid injections are well tolerated and more effective for tendonitis in the short-term than pooled other treatments, though similar to NSAIDs. No long-term benefit was shown.
- PMID 27469590.
- PMID 24074644.
- PMID 26009861.
- PMID 24782334.
- PMID 7787617.
- S2CID 206879020.
- ISSN 0001-6470.
- S2CID 74208378.
- ^ "Inflammation". The Free Dictionary.
- ^ "avascular". The Free Dictionary.
- PMID 23476034.
- PMID 22553479.
- PMID 16777577.
- ^ "Enthesitis". Enthesitis. The Free Dictionary. 2009. Retrieved 2010-11-27.
- S2CID 24724763.
- PMID 28292540.
- ^ "OrthoKids - Osgood-Schlatter's Disease".
- ^ "Sever's Disease". Kidshealth.org. Retrieved 2014-04-29.
- PMID 15555843.
- PMID 17289859.
- PMID 23006143.
- PMID 19412395.
External links
- Questions and Answers about Bursitis and Tendinitis - US National Institute of Arthritis and Musculoskeletal and Skin Diseases