• Tendinopathy

    (Tendonitis; Tendinosis)

    Definition

    Tendons connect muscle to bone and help move joints. Tendinopathy is an injury to the tendon. These injuries tend to occur in tendons near joints such as knee, shoulder, and ankle. The injuries can include:
    • Tendinitis—an inflammation of the tendon. (Although this term is used often, most cases of tendinopathy are not associated with significant inflammation.)
    • Tendinosis—microtears (tiny breaks) in the tendon tissue with no significant inflammation.
    Tendinopathy and the associated pain may take months to resolve.
    The following tendons are often involved:
    Tendinitis
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    Causes

    Tendinopathy is caused by overuse of a muscle-tendon unit. The strain on the tendon causes very tiny tears that accumulate over time. These tears cause pain and can eventually change the structure of the tendon.
    Overuse can be the result of doing any activity too much, such as:
    • Sport activities
    • Physical labor—especially those with repetitive motions
    • Housework

    Risk Factors

    Factors that increase your chance of tendinopathy include:
    • Muscle imbalance
    • Decreased flexibility
    • Overweight
    • Advancing age
    • Sex: female
    • Alignment abnormalities of the leg

    Symptoms

    Symptoms include:
    • Pain, particularly with activity
    • Decreased motion of related joints
    • Local swelling

    Diagnosis

    The doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor will ask about your activity and the location of the pain.
    In the majority of cases your doctor will make a diagnosis based on the exam and history. If your symptoms are severe your doctor may order:
    • X-rays —to look for calcium deposits in the tendon
    • MRI scan —to confirm the diagnosis and show the amount of damage to the tendon (more likely when symptoms continue despite treatment)

    Treatment

    Treatment depends on:
    • Severity of symptoms
    • The tendon involved
    • Length of time symptoms have lasted
    Treatment may include:
    • Avoiding the activity that is responsible
    • Reduce shock vibration on the joint
    • Rest for the affected tendon
    • Ice after activity
    • Cast or splint for immobilization of the affected area
    • Counterforce brace over the painful tendon
    • Shoe orthotics for foot alignment problems
    • Gentle stretching of the tendon
    • Strengthening of the involved muscle
    • Over-the-counter medicines for pain, such as acetaminophen , ibuprofen
    • Topical pain medicines (eg, creams, patches) applied to the skin
    If inflammation (tendinitis) is suspected, your doctor may recommend:
    • Anti-inflammatory medications
    • Cortisone injection into the sheath of the tendon

    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 Academy of Family Physicians http://www.aafp.org/

    American Orthopaedic Society for Sports Medicine http://www.sportsmed.org/tabs/Index.aspx

    CANADIAN RESOURCES

    Canadian Orthopaedic Association http://www.coa-aco.org/

    Canadian Orthopaedic Foundation http://www.canorth.org/

    References

    American Orthopaedic Society for Sports Medicine website. Available at: http://www.sportsmed.org/tabs/Index.aspx .

    Patellar tendinopathy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated June 2008. Accessed May 11, 2009.

    Human Tendons . Human Kinetics; 1997.

    10/26/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Massey T, Derry S, Moore R, McQuay H. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.

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