by Leach RE

Tendonopathy

(Tendonitis; Tendonosis)

Definition

Tendons connect muscle to bone and help move joints. Tendonopathy is an injury to the tendon. These injuries tend to occur in tendons near joints such as the knee, shoulder, and ankle. The injuries can include:
  • Tendonitis—An inflammation of the tendon. Although this term is used often, most cases of tendonopathy are not associated with significant inflammation.
  • Tendonosis—Microtears in the tendon tissue with no significant inflammation
The following tendons are often involved:
Tendonitis
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Causes

Tendinopathy is caused by overuse of a muscle-tendon unit. The strain on the tendon causes tiny tears that build up 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. It is also more common in older adults. 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
    • 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

You will be asked about your symptoms and medical history. A physical exam will be done.
Images may be taken of the tendon and bone. This can be done with:

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:

Supportive Care

The tendon will need time to heal. Supportive care may include:
  • Restricting activities. Normal activities will be reintroduced gradually.
  • Ice therapy to help relieve swelling
  • A cast, splint, or counterforce brace to support the tendon
  • Shoe inserts or orthotics
Prescription or over-the-counter medication may be advised to reduce pain. Cortisone injections may be used if other treatments do not alleviate pain.

Physical Therapy

A physical therapist will assess the tendon. An exercise program will be created to help recovery and to strengthen the muscles.

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

American College of Sports Medicine
http://acsm.org
FamilyDoctor—American Academy of Family Physicians
http://familydoctor.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 9, 2015.
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. Updated July 18, 2014. Accessed March 9, 2015.
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 9, 2015.
10/26/2010 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed: Massey T, Derry S, et al. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.
4/24/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Wise JN, Weissman BN, et al. American College of Radiology (ACR) Appropriateness Criteria for chronic foot pain. Available at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/ChronicFootPain.pdf. Updated 2013. Accessed March 9, 2015.

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