by Leach RE

Tendinopathy

(Tendonitis; Tendinosis)

Definition

Tendons connect muscle to bone and help move joints. Tendinopathy is an injury to the tendon. These injuries tend to occur in tendons near joints such as knee, shoulder, and ankle. The injuries can include:
  • Tendonitis—An inflammation of the tendon. Although this term is used often, most cases of tendinopathy are not associated with significant inflammation.
  • Tendinosis—Microtears in the tendon tissue with no significant inflammation.
The following tendons are often involved:
Tendinopathy and the associated pain may take months to resolve. You may need medication for pain relief.
Tendonitis
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Causes

Tendinopathy is caused by overuse of a muscle-tendon unit. The strain on the tendon causes very tiny tears that accumulate over time. There can also be inflammation.
These tears cause pain and can eventually change the structure of the tendon.

Risk Factors

Tendinopathy is more common in women than in men. Factors that may increase your chance of getting tendinopathy include:
  • Overuse can be the result of doing any activity too much
  • Strenuous or repetitive activities
    • Sports
    • Physical labor
    • Housework
  • Physical problems
    • Muscle imbalance
    • Decreased flexibility
    • Overweight
    • Advancing age
    • Alignment abnormalities of the leg

Symptoms

Symptoms may include:
  • Pain in the tenon or surrounding area, particularly with activity
  • Decreased motion of related joints
  • Local swelling
  • Weakness

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done.
If your symptoms are severe, your doctor may need some images of the tendon and bone. Imaging tests may include:

Treatment

Treatment depends on:
  • Severity of symptoms
  • The tendon involved
  • Length of time symptoms have lasted
Talk with your doctor about the best treatment plan for you. Options may include:
  • Rest for the affected tendon
  • Ice after activity
  • Avoiding the activity that is responsible
  • Cast or splint for immobilization of the affected area
  • Counterforce brace over the painful tendon
  • Reduce shock vibration on the joint with shoe inserts
  • Shoe orthotics for foot alignment problems
Your doctor or physical therapist may recommend exercises or a rehabilitation program.

Medication

To manage pain or swelling, your doctor may recommend:
  • Over-the-counter pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory medication (NSAIDs)
  • Prescription pain relievers
  • Topical pain relievers, such as creams or patches that are applied directly to the skin
  • A medication called cortisone. It can be injected into the sheath around the tendon.

Prevention

To prevent tendinopathy:
  • Gradually work yourself into shape for a new activity.
  • Gradually increase the length of time and intensity of activities.
  • If you have a tendon that has been a problem, gradually stretch out that muscle/tendon unit.
  • Strengthen the muscle to which the tendon is attached.
  • If you have pain, do not ignore it. Early treatment can prevent the problem from becoming serious.
  • Learn to back off from activities if you are tired or not used to the activity.
  • Warm-up the affected area before activity.

RESOURCES

FamilyDoctor.org - American Academy of Family Physicians http://familydoctor.org

American College of Sports Medicine http://acsm.org

CANADIAN RESOURCES

Canadian Orthopaedic Association http://www.coa-aco.org

Canadian Orthopaedic Foundation http://www.canorth.org

References

Exercise-induced leg pain. American College of Sports Medicine website. Available at: http://www.acsm.org/docs/current-comments/exercis-inducedlegpain.pdf. Accessed March 18, 2013.

Mayor RB. Treatment of athletic tendinopathy. Conn Med. 2012;76(8):471-475.

Patellar tendinopathy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated November 3, 2012. Accessed March 18, 2013.

Patellar tendon tear. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00512. Updated August 2009. Accessed March 18, 2013.

10/26/2010 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed/what.php: Massey T, Derry S, et al. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.

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