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TENDINOPATHY
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 Signs and Symptoms

Introduction

  • A clinical syndrome characterized by tendon thickening, persistent localized tendon pain, swelling, and impaired performance
  • Usually a temporary condition if treated early but may also be recurrent or chronic, with symptoms lasting over 3 months

Definition

  • May follow an initial period of inflammation known as tendinitis
  • Refers to a nonrupture tendon injury commonly resulting from repeated mechanical loading/overuse that occurs in workers and athletes (both recreational and professional)
Tendinosis
  • Refers to the histopathologic finding of tendon degeneration
Overuse Tendinopathy
  • Characterized by chronic degenerative changes in the tendon tissue that reflect scarring and/or failed healing response
  • The classic inflammatory reaction is typically absent in overuse tendinopathy or only minimally present in adjacent peritendinous or bursal tissue
  • Increased participation in sporting activities among middle-aged adults have led to increased incidence

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 and extrinsic factors which refer to the load placed on the tendon
  • Age
    • Tendons become less flexible with age and more prone to damage
    • Increasing age is also associated with increased risk of delayed recovery
  • Gender
    • May be caused by a combination of hormonal influences, biochemical variables and sporting or occupational behaviors
  • Obesity
    • In general, overweight or obese patients have increased risk of developing tendinopathy
  • Medical conditions
    • Preexisting illness such as tendon lesions or injury, anatomic and biomechanical abnormalities and comorbidities (eg arthritis, gout, cardiac disease, lipid disorders, thyroid disease and diabetes)
  • Medications
    • Several case reports of tendinopathy and tendon rupture commonly affecting the Achilles tendon in patients receiving fluoroquinolone treatment
    • Corticosteroids can impair local collagen synthesis that can lead to tendon atrophy and reduced tensile strength
    • Statins and aromatase inhibitors
    • Other drugs with potential tendon toxicity include Isotretinoin, anabolic steroids and antiretroviral drugs
  • Work-related factors
    • Physical factors:
      • Intense, repeated and sustained exertion, training errors, excessive movement and awkward posture during daily or occupational activities
      • Insufficient recovery time between activities or premature return to sport
      • Starting a new job or returning to work after an extended period of time away
      • Poor environmental conditions (eg cold weather, running surface)
      • Inadequate or poor quality equipment
    • Psychosocial factors (eg monotonous work, time pressure, high work load)
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