Tendinopathy - Wikipedia

Tendinitis is a very common, but misleading term. By definition, the suffix "-itis" means "inflammation of". Inflammation is the body's local response to tissue ... Tendinopathy FromWikipedia,thefreeencyclopedia Jumptonavigation Jumptosearch NottobeconfusedwithTenonitis. MedicalconditionTendinopathyOthernames[1]tendinosus[2]Achillestendon(acommonlyaffectedtendon)SpecialtyPrimarycareSymptomsPain,swelling[3]CausesInjury,repetitiveactivities[3]DiagnosticmethodBasedonsymptoms,examination,medicalimaging[4]TreatmentRest,NSAIDs,splinting,physiotherapy[5]Prognosis80%betterwithin6months[2]FrequencyCommon[3][2] Tendinopathy,atypeoftendondisorderthatresultsinpain,swelling,andimpairedfunction.[3][1]Thepainistypicallyworsewithmovement.[6]Itmostcommonlyoccursaroundtheshoulder(rotatorcufftendinitis,bicepstendinitis),elbow(tenniselbow,golfer'selbow),wrist,hip,knee(jumper'sknee,popliteustendinopathy),orankle(Achillestendinitis).[3][7][2] Causesmayincludeaninjuryorrepetitiveactivities.[3]Groupsatriskincludepeoplewhodomanuallabor,musicians,andathletes.[8]Lesscommoncausesincludeinfection,arthritis,gout,thyroiddisease,anddiabetes.[9]Diagnosisistypicallybasedonsymptoms,examination,andoccasionallymedicalimaging.[4]Afewweeksfollowinganinjurylittleinflammationremains,withtheunderlyingproblemrelatedtoweakordisruptedtendonfibrils.[10] Treatmentmayincluderest,NSAIDs,splinting,andphysiotherapy.[5]Lesscommonlysteroidinjectionsorsurgerymaybedone.[5]About80%ofpatientsrecovercompletelywithinsixmonths.[2]Tendinopathyisrelativelycommon.[3]Olderpeoplearemorecommonlyaffected.[8]Itresultsinalargeamountofmissedwork.[2] Contents 1Signsandsymptoms 2Cause 2.1Types 3Pathophysiology 4Diagnosis 4.1Medicalimaging 5Treatment 5.1NSAIDs 5.2Steroids 5.3Otherinjections 6Prognosis 7Epidemiology 8Terminology 9Research 10Otheranimals 11References 12Externallinks Signsandsymptoms[edit] Symptomsincludestendernessonpalpation,swelling,andpain,oftenwhenexercisingorwithaspecificmovement.[11] Cause[edit] Causesmayincludeaninjuryorrepetitiveactivities.[3]Groupsatriskincludepeoplewhodomanuallabor,musicians,andathletes.[8]Lesscommoncausesincludeinfection,arthritis,gout,thyroiddisease,anddiabetes.[9]Despitetheinjuryofthetendonthereispoorhealing.[12] Quinoloneantibioticsareassociatedwithincreasedriskoftendinitisandtendonrupture.[13]A2013reviewfoundtheincidenceoftendoninjuryamongthosetakingfluoroquinolonestobebetween0.08and0.2%.[14]Fluoroquinolonesmostfrequentlyaffectlargeload-bearingtendonsinthelowerlimb,especiallytheAchillestendonwhichrupturesinapproximately30to40%ofcases.[15] Types[edit] Achillestendinitis Calcifictendinitis Patellartendinitis(jumper'sknee) Pathophysiology[edit] Asof2016thepathophysiologyoftendinopathyispoorlyunderstood.Whileinflammationappearstoplayarole,therelationshipsamongchangestothestructureoftissue,thefunctionoftendons,andpainarenotunderstoodandthereareseveralcompetingmodels,noneofwhichhavebeenfullyvalidatedorfalsified.[16][17]MolecularmechanismsinvolvedininflammationincludesreleaseofinflammatorycytokineslikeIL-1βwhichreducestheexpressionoftypeIcollagenmRNAinhumantenocytesandcausesextracellularmatrixdegradationinthetendon.[18] Therearemultifactorialtheoriesthatcouldinclude:tensileoverload,tenocyterelatedcollagensynthesisdisruption,load-inducedischemia,neuralsprouting,thermaldamage,andadaptivecompressiveresponses.Theintratendinousslidingmotionoffasciclesandshearforceatinterfacesoffasciclescouldbeanimportantmechanicalfactorforthedevelopmentoftendinopathyandpredisposetendonstorupture.[19]Obesity,ormorespecifically,adiposityorfatness,hasalsobeenlinkedtoanincreasingincidenceoftendinopathy.[20] Themostcommonlyacceptedcauseforthisconditionhoweverisseentobeanoverusesyndromeincombinationwithintrinsicandextrinsicfactorsleadingtowhatmaybeseenasaprogressiveinterferenceorthefailingoftheinnatehealingresponse.Tendinopathyinvolvescellularapoptosis,matrixdisorganizationandneovascularization.[21] Classiccharacteristicsof"tendinosis"includedegenerativechangesinthecollagenousmatrix,hypercellularity,hypervascularity,andalackofinflammatorycellswhichhaschallengedtheoriginalmisnomer"tendinitis".[22][23] Histologicalfindingsincludegranulationtissue,microrupture,degenerativechanges,andthereisnotraditionalinflammation.Asaconsequence,"lateralelbowtendinopathyortendinosis"isusedinsteadof"lateralepicondylitis".[24] Examinationoftenniselbowtissuerevealsnoninflammatorytissue,sotheterm"angiofibroblastictendinosis"isused.[25] CulturesfromtendinopathictendonscontainanincreasedproductionoftypeIIIcollagen.[26][27] Longitudinalsonogramofthelateralelbowdisplaysthickeningandheterogeneityofthecommonextensortendonthatisconsistentwithtendinosis,astheultrasoundrevealscalcifications,intrasubstancetears,andmarkedirregularityofthelateralepicondyle.Althoughtheterm"epicondylitis"isfrequentlyusedtodescribethisdisorder,mosthistopathologicfindingsofstudieshavedisplayednoevidenceofanacute,orachronicinflammatoryprocess.Histologicstudieshavedemonstratedthatthisconditionistheresultoftendondegeneration,whichcausesnormaltissuetobereplacedbyadisorganizedarrangementofcollagen.Therefore,thedisorderismoreappropriatelyreferredtoas"tendinosis"or"tendinopathy"ratherthan"tendinitis".[28] ColourDopplerultrasoundrevealsstructuraltendonchanges,withvascularityandhypo-echoicareasthatcorrespondtotheareasofpainintheextensororigin.[29] Load-inducednon-rupturetendinopathyinhumansisassociatedwithanincreaseintheratioofcollagenIII:Iproteins,ashiftfromlargetosmalldiametercollagenfibrils,bucklingofthecollagenfasciclesinthetendonextracellularmatrix,andbucklingofthetenocytecellsandtheirnuclei.[30] Diagnosis[edit] Diagramillustratingtendonitisandtendonrupture Symptomscanvaryfromachesorpainsandlocaljointstiffness,toaburningthatsurroundsthewholejointaroundtheinflamedtendon.Insomecases,swellingoccursalongwithheatandredness,andtheremaybevisibleknotssurroundingthejoint.Withthiscondition,thepainisusuallyworseduringandafteractivity,andthetendonandjointareacanbecomestiffthefollowingdayasmusclestightenfromthemovementofthetendon.Manypatientsreportstressfulsituationsintheirlifeincorrelationwiththebeginningsofpainwhichmaycontributetothesymptoms.[citationneeded] Medicalimaging[edit] Ultrasoundimagingcanbeusedtoevaluatetissuestrain,aswellasothermechanicalproperties.[31] Ultrasound-basedtechniquesarebecomingmorepopularbecauseofitsaffordability,safety,andspeed.Ultrasoundcanbeusedforimagingtissues,andthesoundwavescanalsoprovideinformationaboutthemechanicalstateofthetissue.[32] Treatment[edit] Treatmentoftendoninjuriesislargelyconservative.Useofnon-steroidalanti-inflammatorydrugs(NSAIDs),rest,andgradualreturntoexerciseisacommontherapy.Restingassistsinthepreventionoffurtherdamagetothetendon.Ice,compressionandelevationarealsofrequentlyrecommended.Physicaltherapy,occupationaltherapy,orthoticsorbracesmayalsobeuseful.Initialrecoveryistypicallywithin2to3daysandfullrecoveryiswithin3to6months.[2]Tendinosisoccursastheacutephaseofhealinghasended(6–8weeks)buthaslefttheareainsufficientlyhealed.Treatmentoftendinitishelpsreducesomeoftherisksofdevelopingtendinosis,whichtakeslongertoheal.[citationneeded] Thereistentativeevidencethatlow-levellasertherapymayalsobebeneficialintreatingtendinopathy.[33]Theeffectsofdeeptransversefrictionmassagefortreatingtenniselbowandlateralkneetendinitisisunclear.[34] NSAIDs[edit] NSAIDsmaybeusedtohelpwithpain.[2]Theyhoweverdonotalterlongtermoutcomes.[2]Othertypesofpainmedication,likeparacetamol,maybejustasuseful.[2] Steroids[edit] SteroidinjectionshavenotbeenshowntohavelongtermbenefitsbuthavebeenshowntobemoreeffectivethanNSAIDsintheshortterm.[35]Theyappeartohavelittlebenefitintendinitisoftherotatorcuff.[36]Therearesomeconcernsthattheymayhavenegativeeffects.[37] Otherinjections[edit] Thereisinsufficientevidenceontheroutineuseofinjectiontherapies(autologousblood,platelet-richplasma,deproteinisedhaemodialysate,aprotinin,polysulphatedglycosaminoglycan,skinderivedfibroblastsetc.)fortreatingAchillestendinopathy.[38]Asof2014therewasinsufficientevidencetosupporttheuseofplatelet-richtherapiesfortreatingmusculoskeletalsofttissueinjuriessuchasligament,muscleandtendontearsandtendinopathies.[39] Prognosis[edit] Initialrecoveryisusuallywithin2to3months,andfullrecoveryusuallywithin3to6months.About80%ofpeoplewillfullyrecoverwithin12months.[2] Epidemiology[edit] Tendoninjuryandresultingtendinopathyareresponsibleforupto30%ofconsultationstosportsdoctorsandothermusculoskeletalhealthproviders.[40]Tendinopathyismostoftenseenintendonsofathleteseitherbeforeorafteraninjurybutisbecomingmorecommoninnon-athletesandsedentarypopulations.Forexample,themajorityofpatientswithAchillestendinopathyinageneralpopulation-basedstudydidnotassociatetheirconditionwithasportingactivity.[41]InanotherstudythepopulationincidenceofAchillestendinopathyincreasedsixfoldfrom1979-1986to1987-1994.[42]Theincidenceofrotatorcufftendinopathyrangesfrom0.3%to5.5%andannualprevalencefrom0.5%to7.4%.[43] Terminology[edit] Tendinitisisaverycommon,butmisleadingterm.Bydefinition,thesuffix"-itis"means"inflammationof".Inflammation[44]isthebody'slocalresponsetotissuedamagewhichinvolvesredbloodcells,whitebloodcells,bloodproteinswithdilationofbloodvesselsaroundthesiteofinjury.Tendonsarerelativelyavascular.[45] Corticosteroidsaredrugsthatreduceinflammation.Corticosteroidscanbeusefultorelievechronictendinopathypain,improvefunction,andreduceswellingintheshortterm.However,thereisagreaterriskoflong-termrecurrence.[46]Theyaretypicallyinjectedalongwithasmallamountofanumbingdrugcalledlidocaine.Researchshowsthattendonsareweakerfollowingcorticosteroidinjections.Tendinitisisstillaverycommondiagnosis,thoughresearchincreasinglydocumentsthatwhatisthoughttobetendinitisisusuallytendinosis.[47] Anatomicallyclosebutseparateconditionsare: Enthesitis,whereinthereisinflammationoftheentheses,thesiteswheretendonsorligamentsinsertintothebone.[48][49]ItisassociatedwithHLAB27arthropathiessuchasankylosingspondylitis,psoriaticarthritis,andreactivearthritis.[50][51] Apophysitis,inflammationofthebonyattachment,generallyassociatedwithoveruseamonggrowingchildren.[52][53][54] Research[edit] Theuseofanitricoxidedeliverysystem(glyceryltrinitratepatches)appliedovertheareaofmaximaltendernesswasfoundtoreducepainandincreaserangeofmotionandstrength.[55] Apromisingtherapyinvolveseccentricloadingexercisesinvolvinglengtheningmuscularcontractions.[56] Otheranimals[edit] Bowedtendonisahorseman'stermfortendinitis(inflammation)andtendinosis(degeneration),mostcommonlyseeninthesuperficialdigitalflexortendoninthefrontlegofhorses. Mesenchymalstemcells,derivedfromahorse'sbonemarroworfat,arecurrentlybeingusedfortendonrepairinhorses.[57] References[edit] ^ab"TendinopathyMeSHBrowser".USNationalLibraryofMedicine.Retrieved18November2018. ^abcdefghijkWilson,JJ;BestTM(Sep2005)."Commonoverusetendonproblems:Areviewandrecommendationsfortreatment"(PDF).AmericanFamilyPhysician.72(5):811–8.PMID 16156339. ^abcdefgh"Tendinitis".NationalInstituteofArthritisandMusculoskeletalandSkinDiseases.12April2017.Retrieved18November2018. ^ab"Tendinitis".NationalInstituteofArthritisandMusculoskeletalandSkinDiseases.12April2017.Retrieved18November2018. ^abc"Tendinitis".NationalInstituteofArthritisandMusculoskeletalandSkinDiseases.12April2017.Retrieved18November2018. ^"Tendinitis".NationalInstituteofArthritisandMusculoskeletalandSkinDiseases.12April2017.Retrieved18November2018. ^"Tendinitis".NationalInstituteofArthritisandMusculoskeletalandSkinDiseases.12April2017.Retrieved18November2018. 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Externallinks[edit] QuestionsandAnswersaboutBursitisandTendinitis -USNationalInstituteofArthritisandMusculoskeletalandSkinDiseases ClassificationDICD-10:M77.9ICD-9-CM:726.90MeSH:D052256DiseasesDB:31624SNOMEDCT:68172002ExternalresourcesMedlinePlus:001229eMedicine:emerg/570 vteSofttissuedisordersCapsularjointSynoviopathy Synovitis/Tenosynovitis Calcifictendinitis Stenosingtenosynovitis Triggerfinger DeQuervainsyndrome Transientsynovitis Ganglioncyst osteochondromatosis Synovialosteochondromatosis Plicasyndrome villonodularsynovitis Giant-celltumorofthetendonsheath Bursopathy Bursitis Olecranon Prepatellar Trochanteric Subacromial Achilles Retrocalcaneal Ischial Iliopsoas Synovialcyst Baker'scyst Calcificbursitis NoncapsularjointSymptoms Ligamentouslaxity Hypermobility Enthesopathy/Enthesitis/Tendinopathyupperlimb Adhesivecapsulitisofshoulder Impingementsyndrome Rotatorcufftear Golfer'selbow Tenniselbow lowerlimb Iliotibialbandsyndrome Patellartendinitis Achillestendinitis Calcanealspur Metatarsalgia Bonespur other/general: Tendinitis/Tendinosis NonjointFasciopathy Fasciitis:Plantar Nodular Necrotizing Eosinophilic Fibromatosis/contracture Dupuytren'scontracture Plantarfibromatosis Aggressivefibromatosis Knucklepads Retrievedfrom"https://en.wikipedia.org/w/index.php?title=Tendinopathy&oldid=1071534941" Categories:DisordersoffasciaInflammationsOveruseinjuriesPainHiddencategories:CS1maint:multiplenames:authorslistArticleswithshortdescriptionShortdescriptionisdifferentfromWikidataAllarticleswithunsourcedstatementsArticleswithunsourcedstatementsfromOctober2020ACwith0elementsWikipediamedicinearticlesreadytotranslate Navigationmenu Personaltools NotloggedinTalkContributionsCreateaccountLogin Namespaces ArticleTalk English Views ReadEditViewhistory More Search Navigation MainpageContentsCurrenteventsRandomarticleAboutWikipediaContactusDonate Contribute HelpLearntoeditCommunityportalRecentchangesUploadfile Tools WhatlinkshereRelatedchangesUploadfileSpecialpagesPermanentlinkPageinformationCitethispageWikidataitem Print/export DownloadasPDFPrintableversion Inotherprojects WikimediaCommons Languages العربيةDeutschEspañolItalianoעברית日本語ଓଡ଼ିଆPortuguêsРусскийSvenska中文 Editlinks