tendinopathy
TENDINOPATHY

Tendinopathy is a clinical syndrome characterized by tendon thickening and localized tendon pain, swelling or impaired performance.
It usually is a temporary condition if treated early but may also be recurrent or chronic.
Principles of therapy include: ddentification & elimination of the cause of tendinopathy, behavior modification to minimize or eliminate sources of continuing irritation, specialist referral for appropriate follow up care and to reduce pain & to return function

 

Introduction

  • A clinical syndrome characterized by tendon thickening & localized tendon pain, swelling, or impaired performance
  • Usually a temporary condition if treated early but may also be recurrent or chronic
  • Result either from acute trauma (eg rupture, laceration) or repetitive overload/overuse

Definition

Tendinitis
  • An inflammatory response that occurs in tendons after vascular disruption, resulting from microscopic, partial, or complete rupture of the tendon
    • Although inflammatory reactions exist, most patients have prolonged symptoms before consulting a physician & the acute inflammation has already subsided & has been replaced by disordered collagen arrangement w/ increased proteoglycan & neovascularization
  • Occur during acute stage & is usually not long-lasting
Tendinosis
  • Refers to the histopathologic finding of tendon degeneration
Overuse Tendinopathy
  • Most common type of tendon problem
  • Characterized by chronic degenerative changes in the tendon tissue that reflect scarring &/or failed healing response
  • The classic inflammatory reaction is typically absent in overuse tendinopathy, or only minimally present in adjacent peritendinous or bursal tissue

Signs and Symptoms

  • Pain
  • Weakness in the joint
  • Tenderness
  • Swelling, erythema, warmth

Risk Factors

  • Often divided into intrinsic factors which refer to the properties of an individual’s tendon or healing capacity & extrinsic factors which refer to the load placed on the tendon
  • Age
    • Tendons become less flexible w/ age & become more prone to damage
    • Increasing age is also associated w/ increased risk of delayed recovery
  • Gender
    • May be caused by a combination of hormonal influences, biochemical variables, sporting or occupational behaviors
  • Obesity
    • In general, overweight or obese patients have increased risk of developing tendinitis
  • Medical conditions
    • Patients w/ preexisting illness such as tendon lesions, arthritis, gout, thyroid disease & diabetes
  • Fluoroquinolone treatment
    • Several case reports of tendinopathy, particularly Achilles tendinopathy, & some reports of tendon rupture in patients receiving fluoroquinolone treatment
  • Work-related factors
    • Physical factors: intense, repeated & sustained exertion; insufficient recovery time between activities; starting a new job or returning to work after an extended period of time away; poor environmental conditions; inadequate equipment
    • Psychosocial factors: monotonous work, time pressure, high work load
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