Do you have shoulder, elbow, knee or ankle pain, but you don’t have arthritis? Have you had an injury in one of those areas in the past that flares up with strenuous activity? Maybe you’ve had steroid injections with benefits but they no longer help? If so, you likely have tendinopathy.
Tendinopathy is a general term characterized by a combination of pain, swelling, and impaired performance. Tendons are rope-like structures that connect your muscle to bone. They are similar in structure to ligaments which connect bone to bone. When your muscles tighten and relax, your tendons and bones move. One example of a tendon is your Patellar tendon, which attaches to your knee cap to your lower leg and causes knee movement. If you have pain and/or swelling in that area, you might have Patellar tendinopathy, also known as “Jumper’s knee”.
The term Tendinopathy is often used to include both tendinitis (tendonitis) and tendinosis. However, tendinitis means inflammation of your tendon. It’s a painful injury that can either be short-term (acute) or progress to a long-term (chronic) condition. You may develop tendonitis after a sudden injury like lifting a heavy weight or from repetitive activities that cause micro-tears in your tendons over time. Tendinosis is the breakdown (degeneration) of the collagen fibers in your tendon. It occurs when the acute phase of healing has ended (six to eight weeks) but has left the area insufficiently healed and is often the result of tendon overuse making it a long-term (chronic) condition.
Common sites for tendinopathy include the rotator cuff (supraspinatus tendon), wrist extensors (lateral epicondyle), wrist flexors (medial epicondyle), patellar and quadriceps tendons, and the Achilles tendon. In athletes, common locations include the Achilles and patellar tendons. In the general population, the Achilles and lateral epicondyle are the most commonly affected.
Who's at risk?
Tendinopathy affects about 2% to 4% of the general population. While it affects people of all ages, some people are more likely than others to develop tendinopathy. Higher risk groups include:
Signs and Symptoms
Symptoms can vary from dull aches or pains with local joint stiffness and swelling to burning that surrounds the inflamed tendon. Swelling is often associated with heat, redness and pain on palpation. The pain and swelling are typically aggravated by exercising or with a specific movement and results in impaired performance. You may have tendinopathy if you're experiencing some or all of the following symptoms:
Successful treatment requires an accurate diagnosis. The first steps are obtaining a history and performing a thorough focused physical examination. The history will focus on the pains location, duration, type, severity, aggravating and alleviating factors. The physical examination will locate the site of redness, swelling and tenderness to palpation. Range of motion and strength will be tested. The examiner will also perform special tests that point to pathology in specific structures, such as the rotator cuff.
While diagnosis can be made from reported history and physical examination, additional information may be needed. Imaging tests such as Ultrasound or MRI may be ordered. Ultrasound can be used to evaluate tissue strain, as well as other mechanical properties such as disorganized tendon fibers and tears. MRI provides a detailed image of soft tissue revealing the general health or injury in the tendon.
The treatment for your tendinopathy depends on the type you have and which tendon is involved. The treatment for both types may include activity modification, relative rest, ice, stretching and strengthening.
Common treatment for tendinitis:
Common treatment for tendinosis:
The prognosis for people with tendinopathy is usually very good. Most people recover without the need for invasive treatment or surgery. However, tendinopathy can return if you have another injury or continue to perform repetitive tasks. In recurrent cases, steroid injections are often offered. However, they have not been shown to have any long-term benefit. The best option currently available for resolution is platelet rich plasma injection.
Wondering if you’re a candidate for PRP injections? To find out, schedule a free introductory call.