Tendinopathy

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:

• Achilles —back of heel
• Biceps in the shoulder
• Patellar tendon (attached to the kneecap)
• Rotator cuff in the shoulder
• Wrist extensors near the elbow (on the outside)
• Wrist flexors near the elbow (on the inside)

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:

• Housework
• Physical labor—especially those with repetitive motions
• Sport activities

Factors that increase your chance of tendinopathy include:

• Advancing age
• Alignment abnormalities of the leg
• Decreased flexibility
• Muscle imbalance
• Overweight
• Sex: female

Symptoms include:

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

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:

• MRI scan —to confirm the diagnosis and show the amount of damage to the tendon (more likely when symptoms continue despite treatment)
• X-rays —to look for calcium deposits in the tendon

Treatment depends on:

• Length of time symptoms have lasted
• Severity of symptoms
• The tendon involved

Treatment may include:

• Over-the-counter medicines for pain, such as acetaminophen , ibuprofen
• Avoiding the activity that is responsible
• Cast or splint for immobilization of the affected area
• Counterforce brace over the painful tendon
• Gentle stretching of the tendon
• Ice after activity
• Reduce shock vibration on the joint
• Rest for the affected tendon
• Shoe orthotics for foot alignment problems
• Strengthening of the involved muscle
• 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

To prevent tendinopathy:

• Gradually increase the length of time and intensity of activities.
• Gradually work yourself into shape for a new activity.
• If you have a tendon that has been a problem, gradually stretch out that muscle/tendon unit.
• 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.
• Strengthen the muscle to which the tendon is attached.
• Warm-up the affected area before activity.