Treatment Guideline Chart

Tendinopathy is a clinical syndrome characterized by tendon thickening persistent localized tendon pain, swelling, and impaired performance.

It is usually is a temporary condition if treated early but may also be recurrent or chronic, with symptoms lasting over 3 months.

Principles of therapy include identification and elimination of the cause of tendinopathy, behavior modification to minimize or eliminate sources of continuing irritation, and specialist referral for appropriate follow-up care.

Goal of therapy is to reduce pain and to return function.


Tendinopathy References

  1. Andres BM, Murrell GA. Treatment of tendinopathy: what works, what does not, and what is on the horizon. Clin Orthop Relat Res. 2008 Jul;466(7):1539-1554. doi: 10.1007/s11999-008-0260-1. PMID: 18446422
  2. Pfefer MT, Cooper SR, Uhl Nl. Chiropractic management of tendinopathy: a literature synthesis. J Manipulative Physiol Ther. 2009 Jan;32(1):41-52. doi: 10.1016/j.jmpt.2008.09.014. PMID: 19121463
  3. Wilson JJ, Best TM. Common overuse tendon problems: a review and recommendations for treatment. Am Fam Physician. 2005 Sep;72(5):811-818. http://www.aafp.org/afp/2005/0901/p811.pdf. PMID: 16156339
  4. Schmidt MJ, Adams SL. Tendinopathy and bursitis. In: Marx JA, ed-in-chief. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, PA: Mosby, an imprint of Elsevier; 2009.
  5. Simons SM, Dixon JB. Biceps tendinopathy and tendon rupture. UptoDate Web Site. http://www.uptodate.com/index. Mar 2010. Accessed 21 Jun 2011.
  6. Khan K, Scott A. Overview of the management of overuse (chronic) tendinopathy. UptoDate Web Site. http://www.uptodate.com/index. Apr 2010. Accessed 21 Jun 2011.
  7. Khan K, Scott A. Overview of overuse (chronic) tendinopathy. UptoDate Web Site. http://www.uptodate.com/index. Feb 2011. Accessed 21 Jun 2011.
  8. National Institute for Health and Care Excellence. NICE interventional procedure guidance 438: Autologous blood injection for tendinopathy. NICE. http://www.nice.org.uk/nicemedia/live/11979/62470/62470.pdf. 2013. Accessed 12 Sep 2013
  9. Steele M, Norvell JG. Tendonitis. eMedicine Website. http://emedicine.medscape.com/article/809692-overview.
  10. Dimitrios S. Exercise for tendinopathy. World J Methodol. 2015 Jun;5(2):51-54. doi: 10.5662/wjm.v5.i2.51. PMID: 26140271
  11. Abat F, Alfredson H, Cucchiarini M, et al. Current trends in tendinopathy: Consensus of the European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) basic science committee. Part II: Treatment options. J Exp Orthop. 2018 Sep;5(1):38. doi: 10.1186/s40634-018-0145-5. PMID: 30251203
  12. Amako M, Arai T, Iba K, et al. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of lateral epicondylitis of the humerus - secondary publication. J Orthop Sci. 2022 May;27(3):514-532. doi: 10.1016/j.jos.2021.09.003. PMID: 34922804
  13. Canosa-Carro L, Bravo-Aguilar M, Abuín-Porras V, et al. Current understanding of the diagnosis and management of the tendinopathy: An update from the lab to the clinical practice. Dis Mon. 2022 Oct;68(10):101314. doi: 10.1016/j.disamonth.2021.101314. PMID: 34996610
  14. Cook J, Young M. Biologic therapies for tendon and muscle injury. UpToDate. https://www.uptodate.com/. Aug 2022. Accessed 25 Jul 2023.
  15. Draper TR. Non-achilles ankle tendinopathy. UpToDate. https://www.uptodate.com/. Aug 2022. Accessed 25 Jul 2023.
  16. Gonzalez P. Biceps tendinopathy. Medscape. https://www.emedicine.medscape.com/. Feb 2021. Accessed 25 Jul 2023.
  17. Hyman GS. Jumper's knee. Medscape. https://www.emedicine.medscape.com/. Feb 2021.
  18. Jayanthi N. Elbow tendinopathy (tennis and golf elbow). UpToDate. https://www.uptodate.com/. Oct 2022.
  19. Maughnan K, Boggess B. Achilles tendinopathy and tendon rupture. UpToDate. https://www.uptodate.com/. Jun 2023.
  20. Martin R, Chimenti R, Cuddeford T, et al. Achilles pain, stiffness, and muscle power deficits: Midportion achilles tendinopathy revision 2018. J Orthop Sports Phys Ther. 2018 May;48(5):A1-A38. doi: 10.2519/jospt.2018.0302. Accessed 25 Jul 2023. PMID: 29712543
  21. Meleger A. Overview of soft tissue musculoskeletal disorders. UpToDate. https://www.uptodate.com/. Jun 2022. Accessed 25 Jul 2023.
  22. Moosmayer S. Calcific tendinopathy of the shoulder. UpToDate. https://www.uptodate.com/. Nov 2022.
  23. Scott A, Squier K, Alfredson H, et al. ICON 2019: International Scientific Tendinopathy Symposium Consensus: Clinical terminology. Br J Sports Med. 2020 Mar(54)(Suppl 5):260-262. doi: 10.1136/bjsports-2019-100885. PMID: 31399426
  24. Scott A, Rees J. Overview of overuse (persistent) tendinopathy. UpToDate. https://www.uptodate.com/. Nov 2022.
  25. Scott A, Purdam C. Overview of the management of overuse (persistent) tendinopathy. UpToDate. https://www.uptodate.com/. Jun 2021.
  26. Scott A, Backman LJ, Speed C. Tendinopathy: Update on pathophysiology. J Orthop Sports Phys Ther. 2015 Nov;45(11):833-41. doi: 10.2519/jospt.2015.5884. PMID: 26390273
  27. Simmons S, Dixon B. Biceps tendinopathy and tendon rupture. UpToDate. https://www.uptodate.com/. Feb 2023. Accessed 25 Jul 2023.
  28. Simmons S, Kruse D. Rotator cuff tendinopathy. UpToDate. https://www.uptodate.com/. Oct 2021.
  29. Agrawal D, Shah A, Mehta KD, et al. Role of nutritional supplements in the management of tendinopathies: focus on combination of type 1 collagen, vitamin C and mucopolysaccharides. Int J Res Orthop. 2020 Nov;6(6):1355-1361. https://dx.doi.org/10.18203/issn.2455-4510.
  30. Hijlkema A, Roozenboom C, Mensink M, et al. The impact of nutrition on tendon health and tendinopathy: a systematic review. J Int Soc Sports Nutr. 2022 Aug;19(1):474-504. doi: 10.1080/15502783.2022.2104130. PMID: 35937777
  31. Mac Auley DC. Ice therapy: How good is the evidence? Int J Sports Med. 2001 Jul;22(5):379-384. doi: 10.1055/s-2001-15656. PMID: 11510876
  32. Matthews W, Ellis R, Furness JW, et al. Staging achilles tendinopathy using ultrasound imaging: the development and investigation of a new ultrasound imaging criteria based on the continuum model of tendon pathology. BMJ Open Sport Exerc Med. 2020 Mar;6(1):e000699. doi: 10.1136/bmjsem-2019-000699. PMID: 32341798
  33. Petrofsky JS, Laymon M, Lee H. Effect of heat and cold on tendon flexibility and force to flex the human knee. Med Sci Monit. 2013 Aug;19:661-667. doi: 10.12659/MSM.889145. PMID: 23933600
  34. Steinmann S, Pfeifer CG, Brochhausen C, et al. Spectrum of tendon pathologies: Triggers, trails and end-state. Int J Mol Sci. 2020 Jan;21(3):844. doi: 10.3390/ijms21030844. PMID: 32013018
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