tendinopatiat

Tendinopatiat is a general term used to describe painful disorders of the tendons, arising from overuse or aging and often reflecting a failed healing response. The term covers degenerative changes (tendinosis) and, when present, inflammatory components (tendinitis), though inflammation is not always a prominent feature. Tendinopatiat can affect any tendon but are most common in the rotator cuff tendons of the shoulder, the Achilles tendon, the patellar tendon, and the lateral epicondyle of the elbow.

Pathophysiology and risk factors

Chronic overload leads to structural changes in tendon tissue, including disorganized collagen, increased ground substance, and voids within the tendon matrix. Neovascularization and altered cellular activity accompany these changes. Risk factors include repetitive jumping or throwing, sudden increases in activity, aging, poor conditioning, obesity, and certain metabolic conditions.

Clinical presentation

Patients typically report localized tendon pain that worsens with activity and improves with rest, along with stiffness, especially after periods of inactivity. Tenderness is often felt along the tendon, and strength may be reduced. Symptoms may persist for months if not addressed.

Diagnosis and imaging

Diagnosis is based on history and physical examination. Ultrasound or MRI can aid in confirming tendon thickening, hypoechoic areas, or degeneration, but imaging is not always required. Blood tests are not diagnostic for tendinopathy.

Management

A staged, evidence-based approach includes education, activity modification, and a structured loading program, often focusing on eccentric or heavy slow resistance exercises. Exercise therapy is central, with gradual progression over weeks to months. NSAIDs may relieve pain but do not cure the condition; corticosteroid injections offer short-term relief and may carry risks with repeated use. Platelet-rich plasma and surgical options are considered in select, persistent cases when conservative treatment fails.

Prognosis and prevention

Many individuals improve with orderly rehabilitation, though recurrence is possible. Prevention emphasizes gradual load increase, adequate recovery, conditioning, and addressing contributing factors such as footwear and training technique.