Practice Essentials
Tendonitis is an inflammatory condition characterized by pain at tendinous insertions into bone. The term tendinosis refers to the histopathologic finding of tendon degeneration. The term tendinopathy is a generic term used to describe a common clinical condition that affects the tendons, causing pain, swelling, or impaired performance. Because of the fact that most pain from tendon conditions is not actually inflammatory in nature, tendinopathy may be a better term than tendonitis.
Common sites of tendinopathy include the following:
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Rotator cuff of the shoulder (ie, supraspinatus) and bicipital tendons
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Insertion of the wrist extensors (ie, lateral epicondylitis, tennis elbow) and flexors (ie, medial epicondylitis) at the elbow
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Patellar and popliteal tendons and iliotibial band at the knee
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Insertion of the posterior tibial tendon in the leg (ie, shin splints)
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Achilles tendon at the heel
Diagnosis of tendinopathy is based on history and physical examination findings (see Presentation). The role of imaging studies is as follows (see Workup):
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Radiographs may be indicated if a history of trauma is present, but findings usually are negative with tendinopathy.
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Further imaging studies, such as ultrasonography and MRI, are usually reserved for cases in which the diagnosis is unclear or conservative management treatment fails.
For all forms of tendinopathy, treatment centers on nonpharmacologic measures, including the following:
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Rest
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Cooling
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Splinting and/or immobilization
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Strengthening and stretching exercises once the pain has subsided
Additional therapeutic measures include the following:
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For pain relief, analgesics or oral or topical nonsteroidal anti-inflammatory drugs (although the vast majority of tendinopathies are not inflammatory)
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In calcific tendonitis of the shoulder, ultrasound-guided needling and lavage
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In cases unresponsive to conservative therapy, corticosteroid injections can be considered, although the short-term pain relief they may provide might come at the expense of long-term recovery, and they are contraindicated in Achilles tendinopathy
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In casess unresponsive to conservative therapy, arthroscopic or open surgical tendon decompression and tenodesis
See Treatment for more detail.
Pathophysiology
Tendons transmit the forces of muscle to the skeleton. As such, they are subjected to repeated mechanical loads, which are felt to be a major causative factor in the development of tendinopathy. Pathologic findings include tendon inflammation, mucoid degeneration, and fibrinoid necrosis in tendons. Microtearing and proliferation of fibroblasts have also been reported. However, the exact pathogenesis of tendinopathy is unclear.
Epidemiology
Middle-aged adults are most susceptible to the development of tendinopathy.
Prognosis
In general, the prognosis is very good with rest and conservative therapy. Chronic tendinopathy can lead to weakening of the tendon and subsequent rupture. Complications of tendonitis may include chronic disability, tendon rupture, and adhesive capsulitis (ie, frozen shoulder).
Patient Education
Quadriceps strengthening exercises is helpful for patellar tendinopathy and change in training routine and/or equipment, if indicated. Runners with Achilles tendinopathy should wear proper footwear, run on softer surfaces, and avoid hills. Patients with tennis elbow should maintain proper backhand technique, use a less tightly strung racket, and play on slower surfaces. Range-of-motion exercises are recommended for patients with rotator cuff tendinopathy to avoid complication of adhesive capsulitis.
For patient education information, see Tendinitis and Tennis Elbow.
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Hawkins test. The examiner forward flexes the arms to 90° and then forcibly internally rotates the shoulder. This movement pushes the supraspinatus tendon against the anterior surface of the coracoacromial ligament and coracoid process. Pain indicates a positive test result for supraspinatus tendonitis.
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Speed test.
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Yergason test.
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The proximal patellar tendon is most commonly affected in jumper's knee.
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Iliotibial band at the lateral femoral condyle, with the posterior fibers denoted.
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The Ober test.
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