Tendinopathy Signs and Symptoms

Introduction

• A pathological change in the tendon due to failure in the homeostatic response of the tendon, characterized by tendon thickening, persistent localized tendon pain, swelling, and impaired performance, leading to activity limitation and community participation restriction
• Usually a temporary condition if treated early but may also be recurrent or chronic, with symptoms lasting over 3 months

Definition

• May follow an initial period of inflammation known as tendinitis
• Most commonly seen in persons with activities involving repeated mechanical loading/overuse

• Any acute or chronic painful tendon impairment associated with intratendinous inflammation due to the presence of inflammatory cells

• Refers to the histopathologic finding of chronic midsubstance tendon degeneration caused by accumulation of microtrauma over time without inflammatory impact

• Inflammation of the tendinous sheath, however not categorized as classical tendinopathy in which degeneration is observed within the tendon itself
• Refers to the involvement of the paratendon (paratendinopathy) alone or in combination with tendinosis

• Can lead to spontaneous tendon tears and ruptures without prior symptoms and form the final condition often dinopathies that failed to heal, resulting in loss of the tendon continuum

Signs and Symptoms

• Symptoms:
  • Localized pain
  • Limitation of activities of daily living (ADLs) and instrumental activities of daily living (iADLs)
  • Unable to participate to leisure or recreational activities, play, work or do household chores
• Signs:
  • Redness or erythema
  • Limitation of joint range of motion
  • Tenderness
  • Swelling
  • Warmth

Risk Factors

• Often divided into intrinsic factors which refer to the properties of an individual’s tendon or healing capacity and extrinsic factors which refer to the load placed on the tendon

• Intrinsic factors:
  • Age
    • Tendons become less flexible with age and more prone to damage
    • Increasing age is also associated with increased risk of delayed recovery

• Gender: May be caused by a combination of hormonal influences, biochemical variables and sporting or occupational behaviors

• Obesity: In general, overweight or obese patients have increased risk of developing tendinopathy

• Medical conditions: Preexisting illness such as tendon lesions or injury, anatomic and biomechanical abnormalities and comorbidities (eg arthritis, gout, cardiac disease, lipid disorders, thyroid disease and diabetes)

• Medications
  • Several case reports of tendinopathy and tendon rupture commonly affecting the Achilles tendon in patients receiving fluoroquinolone treatment
  • Corticosteroids can impair local collagen synthesis that can lead to tendon atrophy and reduced tensile strength
  • Statins and aromatase inhibitors
  • Other drugs with potential tendon toxicity include Isotretinoin, anabolic steroids and antiretroviral drugs

• Extrinsic factors
  • Physical or work-related factors:
    • Intense, repeated and sustained exertion, training errors, excessive movement and awkward posture during daily or occupational activities
    • Insufficient recovery time between activities or premature return to sport
    • Starting a new job or returning to work after an extended period of time away
    • Poor environmental conditions (eg cold weather, running surface)
    • Inadequate or poor quality equipment
  • Psychosocial factors (eg monotonous work, time pressure, high work load)