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
Tendinitis
Any acute or chronic painful tendon impairment associated with intratendinous inflammation due to the presence of inflammatory cells
Tendinosis
Refers to the histopathologic finding of chronic midsubstance tendon degeneration caused by accumulation of microtrauma over time without inflammatory impact
Tenosynovitis (Paratendinitis/Peritendinitis)
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
Tendon Injuries
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
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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
