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most patients have prolonged symptoms before consulting a physician & the acute inflammation has already subsided & has been replaced by disordered collagen arrangement w/ increased proteoglycan & neovascularization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
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Rheumatology digital copy today!
DOWNLOAD
Editor's Recommendations
Most Read Articles
Jenny Ng, 22 Sep 2015

The Asia Pacific League of Associations for Rheumatology (APLAR), representing 12 countries across the Asia Pacific, recently published evidence-based recommendations for the treatment of Asian patients with rheumatoid arthritis (RA).

Stephen Padilla, 01 Dec 2017
Walking or cycling to work is protective against hospitalization for sciatica, whereas smoking and obesity increase the risk, according to a recent study.