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Tendinopathy

January 26, 2023

Not to be confused with Tenonitis.

Tendinopathy is a type of tendon disorder that results in pain, swelling, and impaired function.[3][1] The pain is typically worse with movement.[6] It most commonly occurs around the shoulder (rotator cuff tendinitis, biceps tendinitis), elbow (tennis elbow, golfer's elbow), wrist, hip, knee (jumper's knee, popliteus tendinopathy), or ankle (Achilles tendinitis).[3][7][2]

Tendinopathy
Other names[1] tendinosus[2]
Achilles tendon (a commonly affected tendon)
SpecialtyPrimary care
SymptomsPain, swelling[3]
CausesInjury, repetitive activities[3]
Diagnostic methodBased on symptoms, examination, medical imaging[4]
TreatmentRest, NSAIDs, splinting, physiotherapy[5]
Prognosis80% better within 6 months[2]
FrequencyCommon[3][2]

Causes may include an injury or repetitive activities.[3] Less common causes include infection, arthritis, gout, thyroid disease, diabetes and the use of quinolone antibiotic medicines.[8][9] Groups at risk include people who do manual labor, musicians, and athletes.[10] Diagnosis is typically based on symptoms, examination, and occasionally medical imaging.[4] A few weeks following an injury little inflammation remains, with the underlying problem related to weak or disrupted tendon fibrils.[11]

Treatment may include rest, NSAIDs, splinting, and physiotherapy.[5] Less commonly steroid injections or surgery may be done.[5] About 80% of patients recover completely within six months.[2] Tendinopathy is relatively common.[3] Older people are more commonly affected.[10] It results in a large amount of missed work.[2]

Signs and symptoms

Symptoms include tenderness on palpation, swelling, and pain, often when exercising or with a specific movement.[12]

Cause

Causes may include an injury or repetitive activities.[3] Groups at risk include people who do manual labor, musicians, and athletes.[10] Less common causes include infection, arthritis, gout, thyroid disease, and diabetes.[9] Despite the injury of the tendon, there are roads to healing which includes rehabilitation therapy and/or surgery.[13] Obesity, or more specifically, adiposity or fatness, has also been linked to an increasing incidence of tendinopathy.[14]

Quinolone antibiotics are associated with increased risk of tendinitis and tendon rupture.[15] A 2013 review found the incidence of tendon injury among those taking fluoroquinolones to be between 0.08 and 0.2%.[16] Fluoroquinolones most frequently affect large load-bearing tendons in the lower limb, especially the Achilles tendon which ruptures in approximately 30 to 40% of cases.[17]

Types

Pathophysiology

As of 2016 the pathophysiology of tendinopathy is poorly understood. While inflammation appears to play a role, the relationships among changes to the structure of tissue, the function of tendons, and pain are not understood and there are several competing models, none of which have been fully validated or falsified.[18][19] Molecular mechanisms involved in inflammation includes release of inflammatory cytokines like IL-1β which reduces the expression of type I collagen mRNA in human tenocytes and causes extracellular matrix degradation in the tendon.[20] However in a recent systematic review, signs of chronic inflammation, including either the presence of inflammatory cells or an increase in inflammatory markers, were observed in the majority of tendons with tendinopathy.[21]

There are multifactorial theories that could include: tensile overload, tenocyte related collagen synthesis disruption, load-induced ischemia, neural sprouting, thermal damage, and adaptive compressive responses. The intratendinous sliding motion of fascicles and shear force at interfaces of fascicles could be an important mechanical factor for the development of tendinopathy and predispose tendons to rupture.[22]

The most commonly accepted cause for this condition is seen to be an overuse syndrome in combination with intrinsic and extrinsic factors leading to what may be seen as a progressive interference or the failing of the innate healing response. Tendinopathy involves cellular apoptosis, matrix disorganization and neovascularization.[23]

Classic characteristics of "tendinosis" include degenerative changes in the collagenous matrix, hypercellularity, hypervascularity, and a lack of inflammatory cells which has challenged the original misnomer "tendinitis".[24][25]

Histological findings include granulation tissue, microrupture, degenerative changes, and there is no traditional inflammation. As a consequence, "lateral elbow tendinopathy or tendinosis" is used instead of "lateral epicondylitis".[26]

Examination of tennis elbow tissue reveals noninflammatory tissue, so the term "angiofibroblastic tendinosis" is used.[27]

Cultures from tendinopathic tendons contain an increased production of type III collagen.[28][29]

Longitudinal sonogram of the lateral elbow displays thickening and heterogeneity of the common extensor tendon that is consistent with tendinosis, as the ultrasound reveals calcifications, intrasubstance tears, and marked irregularity of the lateral epicondyle. Although the term "epicondylitis" is frequently used to describe this disorder, most histopathologic findings of studies have displayed no evidence of an acute, or a chronic inflammatory process. Histologic studies have demonstrated that this condition is the result of tendon degeneration, which causes normal tissue to be replaced by a disorganized arrangement of collagen. Therefore, the disorder is more appropriately referred to as "tendinosis" or "tendinopathy" rather than "tendinitis".[30]

Colour Doppler ultrasound reveals structural tendon changes, with vascularity and hypo-echoic areas that correspond to the areas of pain in the extensor origin.[31]

Load-induced non-rupture tendinopathy in humans is associated with an increase in the ratio of collagen III:I proteins, a shift from large to small diameter collagen fibrils, buckling of the collagen fascicles in the tendon extracellular matrix, and buckling of the tenocyte cells and their nuclei.[32]

Diagnosis

 
Diagram illustrating tendonitis and tendon rupture

Symptoms can vary from aches or pains and local joint stiffness, to a burning that surrounds the whole joint around the inflamed tendon. In some cases, swelling occurs along with heat and redness, and there may be visible knots surrounding the joint. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiff the following day as muscles tighten from the movement of the tendon. Many patients report stressful situations in their life in correlation with the beginnings of pain which may contribute to the symptoms.[citation needed]

Medical imaging

Ultrasound imaging can be used to evaluate tissue strain, as well as other mechanical properties.[33] Ultrasound-based techniques are becoming more popular because of its affordability, safety, and speed. Ultrasound can be used for imaging tissues, and the sound waves can also provide information about the mechanical state of the tissue.[34]

Treatment

Treatment of tendon injuries is largely conservative. Use of non-steroidal anti-inflammatory drugs (NSAIDs), rest, and gradual return to exercise is a common therapy. Resting assists in the prevention of further damage to the tendon. Ice, compression and elevation are also frequently recommended. Physical therapy, occupational therapy, orthotics or braces may also be useful. Initial recovery is typically within two to three days and full recovery is within three to six months.[2] Tendinosis occurs as the acute phase of healing has ended (six to eight weeks) but has left the area insufficiently healed. Treatment of tendinitis helps reduce some of the risks of developing tendinosis, which takes longer to heal.[citation needed]

There is tentative evidence that low-level laser therapy may also be beneficial in treating tendinopathy.[35] The effects of deep transverse friction massage for treating tennis elbow and lateral knee tendinitis is unclear.[36]

NSAIDs

NSAIDs may be used to help with pain.[2] They however do not alter long term outcomes.[2] Other types of pain medication, like paracetamol, may be just as useful.[2]

Steroids

Steroid injections have not been shown to have long term benefits but have been shown to be more effective than NSAIDs in the short term.[37] They appear to have little benefit in tendinitis of the rotator cuff.[38] There are some concerns that they may have negative effects.[39]

Other injections

There is insufficient evidence on the routine use of injection therapies (autologous blood, platelet-rich plasma, deproteinised haemodialysate, aprotinin, polysulphated glycosaminoglycan, skin derived fibroblasts etc.) for treating Achilles tendinopathy.[40] As of 2014 there was insufficient evidence to support the use of platelet-rich therapies for treating musculoskeletal soft tissue injuries such as ligament, muscle and tendon tears and tendinopathies.[41]

Prognosis

Initial recovery is usually within two to three months, and full recovery usually within three to six months. About 80% of people will fully recover within 12 months.[2]

Epidemiology

Tendon injury and resulting tendinopathy are responsible for up to 30% of consultations to sports doctors and other musculoskeletal health providers.[42] Tendinopathy is most often seen in tendons of athletes either before or after an injury but is becoming more common in non-athletes and sedentary populations. For example, the majority of patients with Achilles tendinopathy in a general population-based study did not associate their condition with a sporting activity.[43] In another study the population incidence of Achilles tendinopathy increased sixfold from 1979–1986 to 1987–1994.[44] The incidence of rotator cuff tendinopathy ranges from 0.3% to 5.5% and annual prevalence from 0.5% to 7.4%.[45]

Terminology

Tendinitis is a very common, but misleading term. By definition, the suffix "-itis" means "inflammation of". Inflammation[46] is the body's local response to tissue damage which involves red blood cells, white blood cells, blood proteins with dilation of blood vessels around the site of injury. Tendons are relatively avascular.[47] Corticosteroids are drugs that reduce inflammation. Corticosteroids can be useful to relieve chronic tendinopathy pain, improve function, and reduce swelling in the short term. However, there is a greater risk of long-term recurrence.[48] They are typically injected along with a small amount of a numbing drug called lidocaine. Research shows that tendons are weaker following corticosteroid injections.

Tendinitis is still a very common diagnosis, though research increasingly documents that what is thought to be tendinitis is usually tendinosis.[49]

Anatomically close but separate conditions are:

Research

The use of a nitric oxide delivery system (glyceryl trinitrate patches) applied over the area of maximal tenderness was found to reduce pain and increase range of motion and strength.[57]

A promising therapy involves eccentric loading exercises involving lengthening muscular contractions.[58]

Other animals

Bowed tendon is a horseman's term for tendinitis (inflammation) and tendinosis (degeneration), most commonly seen in the superficial digital flexor tendon in the front leg of horses.

Mesenchymal stem cells, derived from a horse's bone marrow or fat, are currently being used for tendon repair in horses.[59]

References

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External links

  • Questions and Answers about Bursitis and Tendinitis - US National Institute of Arthritis and Musculoskeletal and Skin Diseases


January 26, 2023
tendinopathy, confused, with, tenonitis, type, tendon, disorder, that, results, pain, swelling, impaired, function, pain, typically, worse, with, movement, most, commonly, occurs, around, shoulder, rotator, cuff, tendinitis, biceps, tendinitis, elbow, tennis, . Not to be confused with Tenonitis Tendinopathy is a type of tendon disorder that results in pain swelling and impaired function 3 1 The pain is typically worse with movement 6 It most commonly occurs around the shoulder rotator cuff tendinitis biceps tendinitis elbow tennis elbow golfer s elbow wrist hip knee jumper s knee popliteus tendinopathy or ankle Achilles tendinitis 3 7 2 TendinopathyOther names 1 tendinosus 2 Achilles tendon a commonly affected tendon SpecialtyPrimary careSymptomsPain swelling 3 CausesInjury repetitive activities 3 Diagnostic methodBased on symptoms examination medical imaging 4 TreatmentRest NSAIDs splinting physiotherapy 5 Prognosis80 better within 6 months 2 FrequencyCommon 3 2 Causes may include an injury or repetitive activities 3 Less common causes include infection arthritis gout thyroid disease diabetes and the use of quinolone antibiotic medicines 8 9 Groups at risk include people who do manual labor musicians and athletes 10 Diagnosis is typically based on symptoms examination and occasionally medical imaging 4 A few weeks following an injury little inflammation remains with the underlying problem related to weak or disrupted tendon fibrils 11 Treatment may include rest NSAIDs splinting and physiotherapy 5 Less commonly steroid injections or surgery may be done 5 About 80 of patients recover completely within six months 2 Tendinopathy is relatively common 3 Older people are more commonly affected 10 It results in a large amount of missed work 2 Contents 1 Signs and symptoms 2 Cause 2 1 Types 3 Pathophysiology 4 Diagnosis 4 1 Medical imaging 5 Treatment 5 1 NSAIDs 5 2 Steroids 5 3 Other injections 6 Prognosis 7 Epidemiology 8 Terminology 9 Research 10 Other animals 11 References 12 External linksSigns and symptoms EditSymptoms include tenderness on palpation swelling and pain often when exercising or with a specific movement 12 Cause EditCauses may include an injury or repetitive activities 3 Groups at risk include people who do manual labor musicians and athletes 10 Less common causes include infection arthritis gout thyroid disease and diabetes 9 Despite the injury of the tendon there are roads to healing which includes rehabilitation therapy and or surgery 13 Obesity or more specifically adiposity or fatness has also been linked to an increasing incidence of tendinopathy 14 Quinolone antibiotics are associated with increased risk of tendinitis and tendon rupture 15 A 2013 review found the incidence of tendon injury among those taking fluoroquinolones to be between 0 08 and 0 2 16 Fluoroquinolones most frequently affect large load bearing tendons in the lower limb especially the Achilles tendon which ruptures in approximately 30 to 40 of cases 17 Types Edit Achilles tendinitis Calcific tendinitis Patellar tendinitis jumper s knee Pathophysiology EditAs of 2016 the pathophysiology of tendinopathy is poorly understood While inflammation appears to play a role the relationships among changes to the structure of tissue the function of tendons and pain are not understood and there are several competing models none of which have been fully validated or falsified 18 19 Molecular mechanisms involved in inflammation includes release of inflammatory cytokines like IL 1b which reduces the expression of type I collagen mRNA in human tenocytes and causes extracellular matrix degradation in the tendon 20 However in a recent systematic review signs of chronic inflammation including either the presence of inflammatory cells or an increase in inflammatory markers were observed in the majority of tendons with tendinopathy 21 There are multifactorial theories that could include tensile overload tenocyte related collagen synthesis disruption load induced ischemia neural sprouting thermal damage and adaptive compressive responses The intratendinous sliding motion of fascicles and shear force at interfaces of fascicles could be an important mechanical factor for the development of tendinopathy and predispose tendons to rupture 22 The most commonly accepted cause for this condition is seen to be an overuse syndrome in combination with intrinsic and extrinsic factors leading to what may be seen as a progressive interference or the failing of the innate healing response Tendinopathy involves cellular apoptosis matrix disorganization and neovascularization 23 Classic characteristics of tendinosis include degenerative changes in the collagenous matrix hypercellularity hypervascularity and a lack of inflammatory cells which has challenged the original misnomer tendinitis 24 25 Histological findings include granulation tissue microrupture degenerative changes and there is no traditional inflammation As a consequence lateral elbow tendinopathy or tendinosis is used instead of lateral epicondylitis 26 Examination of tennis elbow tissue reveals noninflammatory tissue so the term angiofibroblastic tendinosis is used 27 Cultures from tendinopathic tendons contain an increased production of type III collagen 28 29 Longitudinal sonogram of the lateral elbow displays thickening and heterogeneity of the common extensor tendon that is consistent with tendinosis as the ultrasound reveals calcifications intrasubstance tears and marked irregularity of the lateral epicondyle Although the term epicondylitis is frequently used to describe this disorder most histopathologic findings of studies have displayed no evidence of an acute or a chronic inflammatory process Histologic studies have demonstrated that this condition is the result of tendon degeneration which causes normal tissue to be replaced by a disorganized arrangement of collagen Therefore the disorder is more appropriately referred to as tendinosis or tendinopathy rather than tendinitis 30 Colour Doppler ultrasound reveals structural tendon changes with vascularity and hypo echoic areas that correspond to the areas of pain in the extensor origin 31 Load induced non rupture tendinopathy in humans is associated with an increase in the ratio of collagen III I proteins a shift from large to small diameter collagen fibrils buckling of the collagen fascicles in the tendon extracellular matrix and buckling of the tenocyte cells and their nuclei 32 Diagnosis Edit Diagram illustrating tendonitis and tendon rupture Symptoms can vary from aches or pains and local joint stiffness to a burning that surrounds the whole joint around the inflamed tendon In some cases swelling occurs along with heat and redness and there may be visible knots surrounding the joint With this condition the pain is usually worse during and after activity and the tendon and joint area can become stiff the following day as muscles tighten from the movement of the tendon Many patients report stressful situations in their life in correlation with the beginnings of pain which may contribute to the symptoms citation needed Medical imaging Edit Ultrasound imaging can be used to evaluate tissue strain as well as other mechanical properties 33 Ultrasound based techniques are becoming more popular because of its affordability safety and speed Ultrasound can be used for imaging tissues and the sound waves can also provide information about the mechanical state of the tissue 34 Treatment EditTreatment of tendon injuries is largely conservative Use of non steroidal anti inflammatory drugs NSAIDs rest and gradual return to exercise is a common therapy Resting assists in the prevention of further damage to the tendon Ice compression and elevation are also frequently recommended Physical therapy occupational therapy orthotics or braces may also be useful Initial recovery is typically within two to three days and full recovery is within three to six months 2 Tendinosis occurs as the acute phase of healing has ended six to eight weeks but has left the area insufficiently healed Treatment of tendinitis helps reduce some of the risks of developing tendinosis which takes longer to heal citation needed There is tentative evidence that low level laser therapy may also be beneficial in treating tendinopathy 35 The effects of deep transverse friction massage for treating tennis elbow and lateral knee tendinitis is unclear 36 NSAIDs Edit NSAIDs may be used to help with pain 2 They however do not alter long term outcomes 2 Other types of pain medication like paracetamol may be just as useful 2 Steroids Edit Steroid injections have not been shown to have long term benefits but have been shown to be more effective than NSAIDs in the short term 37 They appear to have little benefit in tendinitis of the rotator cuff 38 There are some concerns that they may have negative effects 39 Other injections Edit There is insufficient evidence on the routine use of injection therapies autologous blood platelet rich plasma deproteinised haemodialysate aprotinin polysulphated glycosaminoglycan skin derived fibroblasts etc for treating Achilles tendinopathy 40 As of 2014 there was insufficient evidence to support the use of platelet rich therapies for treating musculoskeletal soft tissue injuries such as ligament muscle and tendon tears and tendinopathies 41 Prognosis EditInitial recovery is usually within two to three months and full recovery usually within three to six months About 80 of people will fully recover within 12 months 2 Epidemiology EditTendon injury and resulting tendinopathy are responsible for up to 30 of consultations to sports doctors and other musculoskeletal health providers 42 Tendinopathy is most often seen in tendons of athletes either before or after an injury but is becoming more common in non athletes and sedentary populations For example the majority of patients with Achilles tendinopathy in a general population based study did not associate their condition with a sporting activity 43 In another study the population incidence of Achilles tendinopathy increased sixfold from 1979 1986 to 1987 1994 44 The incidence of rotator cuff tendinopathy ranges from 0 3 to 5 5 and annual prevalence from 0 5 to 7 4 45 Terminology EditTendinitis is a very common but misleading term By definition the suffix itis means inflammation of Inflammation 46 is the body s local response to tissue damage which involves red blood cells white blood cells blood proteins with dilation of blood vessels around the site of injury Tendons are relatively avascular 47 Corticosteroids are drugs that reduce inflammation Corticosteroids can be useful to relieve chronic tendinopathy pain improve function and reduce swelling in the short term However there is a greater risk of long term recurrence 48 They are typically injected along with a small amount of a numbing drug called lidocaine Research shows that tendons are weaker following corticosteroid injections Tendinitis is still a very common diagnosis though research increasingly documents that what is thought to be tendinitis is usually tendinosis 49 Anatomically close but separate conditions are Enthesitis wherein there is inflammation of the entheses the sites where tendons or ligaments insert into the bone 50 51 It is associated with HLA B27 arthropathies such as ankylosing spondylitis psoriatic arthritis and reactive arthritis 52 53 Apophysitis inflammation of the bony attachment generally associated with overuse among growing children 54 55 56 Research EditThe use of a nitric oxide delivery system glyceryl trinitrate patches applied over the area of maximal tenderness was found to reduce pain and increase range of motion and strength 57 A promising therapy involves eccentric loading exercises involving lengthening muscular contractions 58 Other animals EditBowed tendon is a horseman s term for tendinitis inflammation and tendinosis degeneration most commonly seen in the superficial digital flexor tendon in the front leg of horses Mesenchymal stem cells derived from a horse s bone marrow or fat are currently being used for tendon repair in horses 59 References Edit a b Tendinopathy MeSH Browser US National Library of Medicine Retrieved 18 November 2018 a b c d e f g h i j k Wilson JJ Best TM Sep 2005 Common overuse tendon problems A review and recommendations for treatment PDF American Family Physician 72 5 811 8 PMID 16156339 a b c d e f g h Tendinitis National Institute of Arthritis and Musculoskeletal and Skin Diseases 12 April 2017 Retrieved 18 November 2018 a b Tendinitis National Institute of Arthritis and Musculoskeletal and Skin Diseases 12 April 2017 Retrieved 18 November 2018 a b c Tendinitis National Institute of Arthritis and Musculoskeletal and Skin Diseases 12 April 2017 Retrieved 18 November 2018 Tendinitis National Institute of Arthritis and Musculoskeletal and Skin Diseases 12 April 2017 Retrieved 18 November 2018 Tendinitis National Institute of Arthritis and Musculoskeletal and Skin Diseases 12 April 2017 Retrieved 18 November 2018 Fluoroquinolones and risk of Achilles tendon disorders case control study British Medical Journal 1 June 2002 Retrieved 21 September 2022 a b Tendinitis National Institute of Arthritis and Musculoskeletal and Skin Diseases 12 April 2017 Retrieved 18 November 2018 a b c Tendinitis National Institute of Arthritis and Musculoskeletal and Skin Diseases 12 April 2017 Retrieved 18 November 2018 Khan KM Cook JL Kannus P Maffulli N Bonar SF 2002 03 16 Time to abandon the tendinitis myth Painful overuse tendon conditions have a non inflammatory pathology BMJ 324 7338 626 7 doi 10 1136 bmj 324 7338 626 PMC 1122566 PMID 11895810 Rees JD Maffulli N Cook J Sep 2009 Management of tendinopathy Am J Sports Med 37 9 1855 67 doi 10 1177 0363546508324283 PMID 19188560 S2CID 1810473 Nirschl RP Ashman ES 2004 Tennis elbow tendinosis epicondylitis Instr Course Lect 53 587 98 PMID 15116648 Gaida JE Ashe MC Bass SL Cook JL 2009 Is adiposity an under recognized risk factor for tendinopathy A systematic review Arthritis Rheum 61 6 840 9 doi 10 1002 art 24518 PMID 19479698 FDA May 12 2016 FDA Drug Safety Communication FDA advises restricting fluoroquinolone antibiotic use for certain uncomplicated infections warns about disabling side effects that can occur Stephenson AL Wu W Cortes D Rochon PA September 2013 Tendon Injury and Fluoroquinolone Use A Systematic Review Drug Safety 36 9 709 21 doi 10 1007 s40264 013 0089 8 PMID 23888427 S2CID 24948660 Bolon Brad 2017 01 01 Mini Review Toxic Tendinopathy Toxicologic Pathology 45 7 834 837 doi 10 1177 0192623317711614 ISSN 1533 1601 PMID 28553748 Millar NL Murrell GA McInnes IB 25 January 2017 Inflammatory mechanisms in tendinopathy towards translation Nature Reviews Rheumatology 13 2 110 122 doi 10 1038 nrrheum 2016 213 PMID 28119539 S2CID 10794196 Cook JL Rio E Purdam CR Docking SI October 2016 Revisiting the continuum model of tendon pathology what is its merit in clinical practice and research British Journal of Sports Medicine 50 19 1187 91 doi 10 1136 bjsports 2015 095422 PMC 5118437 PMID 27127294 Millar Neal L Murrell George A C McInnes Iain B 2017 01 25 Inflammatory mechanisms in tendinopathy towards translation Nature Reviews Rheumatology 13 2 110 122 doi 10 1038 nrrheum 2016 213 ISSN 1759 4804 PMID 28119539 S2CID 10794196 Jomaa G et al 2020 A systematic review of inflammatory cells and markers in human tendinopathy BMC Musculoskelet Disord 21 1 78 doi 10 1186 s12891 020 3094 y PMC 7006114 PMID 32028937 Sun YL et al 2015 Lubricin in Human Achilles Tendon The Evidence of Intratendinous Sliding Motion and Shear Force in Achilles Tendon J Orthop Res 33 6 932 7 doi 10 1002 jor 22897 PMID 25864860 S2CID 20575820 Charnoff Jesse Naqvi Usker 2017 Tendinosis Tendinitis StatPearls Treasure Island FL StatPearls Publishing PMID 28846334 Fu SC Rolf C Cheuk YC Lui PP Chan KM 2010 Deciphering the pathogenesis of tendinopathy a three stages process Sports Med Arthrosc Rehabil Ther Technol 2 30 doi 10 1186 1758 2555 2 30 PMC 3006368 PMID 21144004 Abate M Silbernagel KG Siljeholm C Di Iorio A De Amicis D Salini V Werner S Paganelli R 2009 Pathogenesis of tendinopathies inflammation or degeneration Arthritis Research amp Therapy 11 3 235 doi 10 1186 ar2723 PMC 2714139 PMID 19591655 du Toit C Stieler M Saunders R Bisset L Vicenzino B 2008 Diagnostic accuracy of power Doppler ultrasound in patients with chronic tennis elbow British Journal of Sports Medicine 42 11 572 576 doi 10 1136 bjsm 2007 043901 hdl 10072 22142 ISSN 0306 3674 PMID 18308874 S2CID 3274396 Nirschl RP October 1992 Elbow tendinosis tennis elbow Clin Sports Med 11 4 851 70 doi 10 1016 S0278 5919 20 30489 0 PMID 1423702 Maffulli N Ewen SW Waterston SW Reaper J Barrass V 2000 Tenocytes from ruptured and tendinopathic achilles tendons produce greater quantities of type III collagen than tenocytes from normal achilles tendons An in vitro model of human tendon healing Am J Sports Med 28 4 499 505 doi 10 1177 03635465000280040901 PMID 10921640 S2CID 13511471 Ho JO Sawadkar P Mudera V 2014 A review on the use of cell therapy in the treatment of tendon disease and injuries J Tissue Eng 5 2041731414549678 doi 10 1177 2041731414549678 PMC 4221986 PMID 25383170 McShane JM Nazarian LN Harwood MI October 2006 Sonographically guided percutaneous needle tenotomy for treatment of common extensor tendinosis in the elbow J Ultrasound Med 25 10 1281 9 doi 10 7863 jum 2006 25 10 1281 PMID 16998100 S2CID 22963436 Zeisig Eva Ohberg Lars Alfredson Hakan 2006 Sclerosing polidocanol injections in chronic painful tennis elbow promising results in a pilot study Knee Surgery Sports Traumatology Arthroscopy 14 11 1218 1224 doi 10 1007 s00167 006 0156 0 ISSN 0942 2056 PMID 16960741 S2CID 23469092 Pingel J Lu Y Starborg T Fredberg U Langberg H Nedergaard A et al 2014 3 D ultrastructure and collagen composition of healthy and overloaded human tendon evidence of tenocyte and matrix buckling J Anat 224 5 548 55 doi 10 1111 joa 12164 PMC 3981497 PMID 24571576 Duenwald S Kobayashi H Frisch K Lakes R Vanderby R February 2011 Ultrasound echo is related to stress and strain in tendon J Biomech 44 3 424 9 doi 10 1016 j jbiomech 2010 09 033 PMC 3022962 PMID 21030024 Duenwald Kuehl S Lakes R Vanderby R June 2012 Strain induced damage reduces echo intensity changes in tendon during loading J Biomech 45 9 1607 11 doi 10 1016 j jbiomech 2012 04 004 PMC 3358489 PMID 22542220 Tumilty S Munn J McDonough S Hurley DA Basford JR Baxter GD February 2010 Low level laser treatment of tendinopathy a systematic review with meta analysis Photomedicine and Laser Surgery 28 1 3 16 doi 10 1089 pho 2008 2470 PMID 19708800 S2CID 10634480 Loew Laurianne M Brosseau Lucie Tugwell Peter Wells George A Welch Vivian Shea Beverley Poitras Stephane De Angelis Gino Rahman Prinon 2014 11 08 Deep transverse friction massage for treating lateral elbow or lateral knee tendinitis Cochrane Database of Systematic Reviews 2014 11 CD003528 doi 10 1002 14651858 cd003528 pub2 ISSN 1465 1858 PMC 7154576 PMID 25380079 Gaujoux Viala C Dougados M Gossec L December 2009 Efficacy and safety of steroid injections for shoulder and elbow tendonitis a meta analysis of randomised controlled trials Ann Rheum Dis 68 12 1843 9 doi 10 1136 ard 2008 099572 PMC 2770107 PMID 19054817 Mohamadi A Chan JJ Claessen FM Ring D Chen NC January 2017 Corticosteroid Injections Give Small and Transient Pain Relief in Rotator Cuff Tendinosis A Meta analysis Clinical Orthopaedics and Related Research 475 1 232 243 doi 10 1007 s11999 016 5002 1 PMC 5174041 PMID 27469590 Dean BJ Lostis E Oakley T Rombach I Morrey ME Carr AJ February 2014 The risks and benefits of glucocorticoid treatment for tendinopathy a systematic review of the effects of local glucocorticoid on tendon Seminars in Arthritis and Rheumatism 43 4 570 6 doi 10 1016 j semarthrit 2013 08 006 PMID 24074644 Kearney RS Parsons N Metcalfe D Costa ML 26 May 2015 Injection therapies for Achilles tendinopathy PDF The Cochrane Database of Systematic Reviews 5 CD010960 doi 10 1002 14651858 CD010960 pub2 PMID 26009861 Moraes Vinicius Y Lenza Mario Tamaoki Marcel Jun Faloppa Flavio Belloti Joao Carlos 2014 04 29 Cochrane Database of Systematic Reviews Cochrane Database Syst Rev 2014 4 CD010071 doi 10 1002 14651858 cd010071 pub3 PMC 6464921 PMID 24782334 McCormick A Charlton J Fleming D Jun 1995 Assessing health needs in primary care Morbidity study from general practice provides another source of information BMJ 310 6993 1534 doi 10 1136 bmj 310 6993 1534d PMC 2549904 PMID 7787617 de Jonge S et al 2011 Incidence of midportion Achilles tendinopathy in the general population Br J Sports Med 45 13 1026 8 doi 10 1136 bjsports 2011 090342 hdl 1765 30870 PMID 21926076 S2CID 206879020 Leppilahti J Puranen J Orava S Incidence of Achilles tendon rupture Acta Orthop Scand 1996 67 277 9 Littlewood Chris May Stephen Walters Stephen 2013 10 01 Epidemiology of rotator cuff tendinopathy a systematic review Shoulder amp Elbow 5 4 256 265 doi 10 1111 sae 12028 ISSN 1758 5740 S2CID 74208378 Inflammation The Free Dictionary avascular The Free Dictionary Rees J D Stride M Scott A 2013 Tendons time to revisit inflammation British Journal of Sports Medicine 48 21 1553 1557 doi 10 1136 bjsports 2012 091957 ISSN 0306 3674 PMC 4215290 PMID 23476034 Bass Lmt 2012 Tendinopathy Why the Difference Between Tendinitis and Tendinosis Matters International Journal of Therapeutic Massage amp Bodywork Research Education amp Practice 5 1 14 7 doi 10 3822 ijtmb v5i1 153 PMC 3312643 PMID 22553479 D Agostino MA Olivieri I June 2006 Enthesitis Best Practice amp Research Clinical Rheumatology Clinical Rheumatology 20 3 473 86 doi 10 1016 j berh 2006 03 007 PMID 16777577 Enthesitis Enthesitis The Free Dictionary 2009 Retrieved 2010 11 27 Schett G Lories RJ D Agostino MA Elewaut D Kirkham B Soriano ER McGonagle D November 2017 Enthesitis from pathophysiology to treatment Nature Reviews Rheumatology Review 13 12 731 741 doi 10 1038 nrrheum 2017 188 PMID 29158573 S2CID 24724763 Schmitt SK June 2017 Reactive Arthritis Infectious Disease Clinics of North America Review 31 2 265 277 doi 10 1016 j idc 2017 01 002 PMID 28292540 OrthoKids Osgood Schlatter s Disease Sever s Disease Kidshealth org Retrieved 2014 04 29 Hendrix CL 2005 Calcaneal apophysitis Sever disease Clinics in Podiatric Medicine and Surgery 22 1 55 62 vi doi 10 1016 j cpm 2004 08 011 PMID 15555843 Murrell GA 2007 Using nitric oxide to treat tendinopathy Br J Sports Med 41 4 227 31 doi 10 1136 bjsm 2006 034447 PMC 2658939 PMID 17289859 Rowe V Hemmings S Barton C Malliaras P Maffulli N Morrissey D November 2012 Conservative management of midportion Achilles tendinopathy a mixed methods study integrating systematic review and clinical reasoning Sports Med 42 11 941 67 doi 10 2165 11635410 000000000 00000 PMID 23006143 Koch TG Berg LC Betts DH 2009 Current and future regenerative medicine principles concepts and therapeutic use of stem cell therapy and tissue engineering in equine medicine Can Vet J 50 2 155 65 PMC 2629419 PMID 19412395 External links EditQuestions and Answers about Bursitis and Tendinitis US National Institute of Arthritis and Musculoskeletal and Skin Diseases Retrieved from https en wikipedia org w index php title Tendinopathy amp oldid 1135095208, wikipedia, wiki, book, books, library,

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