Tendinopathies

Tendinopathies are a spectrum of tendon disorders characterized by chronic pain and dysfunction resulting from a failed healing response to repetitive strain. The term encompasses conditions previously called tendinitis and tendinosis, reflecting degenerative changes rather than acute inflammation. Tendinopathy can affect many tendons, with common sites including the lateral elbow, shoulder, patellar tendon, and Achilles tendon.

Symptoms are typically localized tendon pain that worsens with activity and improves with rest; morning stiffness is generally mild; swelling is variable. On examination, there may be focal tenderness, reduced strength, and sometimes tendon thickening. Diagnosis is clinical; imaging such as ultrasound or MRI can assess tendon structure and exclude other conditions.

Pathophysiology involves abnormal tendon loading leading to collagen disorganization, matrix degradation, and in some cases neovascularization and mucoid degeneration. Risk factors include repetitive overuse, sudden increases in activity, poor biomechanics, age, and systemic conditions like diabetes or obesity.

Management emphasizes load modification and rehabilitation. First-line treatment includes structured, progressive loading programs (often eccentric exercises), activity modification, and physical therapy. Pain relief with NSAIDs is temporary. Corticosteroid injections may provide short-term benefit but can weaken tendon tissue and are generally avoided for long-term management; alternative injections have limited consistent evidence. Refractory cases may require surgical debridement or repair after months of unsuccessful conservative care.

Prognosis varies; most individuals improve with appropriate rehabilitation, though symptoms can recur. Prevention centers on gradual progression of activity, proper technique, adequate recovery, and regular strengthening of the involved tendons and surrounding muscles.