REVIEW OF CURRENT KNOWLEDGE OF PATHOLOGY AND TREATMENT OF TENDINOPATHIES

Authors

  • Ronal. P. Olson Duke University, Durham, NC and University of Southern California Los Angeles, CA

Keywords:

Tendinitis, tendinopathy

Abstract

Tendon pain has been considered either an inflammatory result of injury or a degenerative process, (Khan, Cook, Kannus, Maffulli, & Bonar, 2002) but further studies are revealing that it is a complex combination of the two, or a failed healing response. (D'Addona, Maffulli, Formisano, & Rosa, 2017) Some tendon problems are the result of factors external to the tendon, such as excessive demands or mechanical abrasion. At least initially, these are largely inflammatory in nature and may appropriately be termed tendinitis. Reducing inflammation may be an appropriate part of treatment. Other tendon problems occur without obvious injury in inactive individuals. These are mostly degenerative in nature, and have been termed tendinosis to indicate that a non-inflammatory process is at work. If either of these processes is allowed to continue, there will eventually be an arrest of healing. Osti (Osti et al., 2017) (Bhabra et al., 2016) Macroscopic tears may result. By recognizing that there are three general types of tendon pathology ---inflammatory, degenerative, and arrested healing – treatment can be modified to match the defect.

Author Biography

Ronal. P. Olson, Duke University, Durham, NC and University of Southern California Los Angeles, CA

Duke University, Durham, NC and University of Southern California Los Angeles, CA   

References

Abat, F., Alfredson, H., Cucchiarini, M., Madry, H., Marmotti, A., Mouton, C., . . . de Girolamo, L. (2017). Current trends in tendinopathy: consensus of the ESSKA basic science committee. Part I: biology, biomechanics, anatomy and an exercise-based approach. Journal of Experimental Orthopaedics , 4(1), 18. doi:10.1186/s40634-017-0092-6

Alfredson, H., Pietila, T., Jonsson, P., & Lorentzon, R. (1998). Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. American Journal of Sports Medicine, 26(3), 360-366. doi:10.1177/03635465980260030301

Almekinders, L. C., Vellema, J. H., & Weinhold, P. S. (2002). Strain patterns in the patellar tendon and the implications for patellar tendinopathy. Knee Surgery, Sports Traumatology, Arthroscopy, 10(1), 2-5. doi:10.1007/s00167010022

Bhabra, G., Wang, A., Ebert, J., Edwards, P., Zheng, M., & Zheng, M.-H. (2016). Lateral Elbow Tendinopathy: Development of a Pathophysiology-Based Treatment Algorithm (Vol. 4).

Bleakley, C., McDonough, S., & MacAuley, D. (2004). The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. American Journal of Sports Medicine, 32(1), 251-261. doi:10.1177/0363546503260757

Boesen, A. P., Hansen, R., Boesen, M. I., Malliaras, P., & Langberg, H. (2017). Effect of High-Volume Injection, Platelet-Rich Plasma, and Sham Treatment in Chronic Midportion Achilles Tendinopathy: A Randomized Double-Blinded Prospective Study. American Journal of Sports Medicine 45(9), 2034-2043. doi:10.1177/0363546517702862

Chaudhry, F. A. (2017). Effectiveness of dry needling and high-volume image-guided injection in the management of chronic mid-portion Achilles tendinopathy in adult population: a literature review. Eur J Orthop Surg Traumatol, 27(4), 441-448. doi:10.1007/s00590-017-1957-1

Cheatham, S. W., Lee, M., Cain, M., & Baker, R. (2016). The efficacy of instrument assisted soft tissue mobilization: a systematic review. J Can Chiropr Assoc, 60(3), 200-211.

Chiavaras, M. M., & Jacobson, J. A. (2013). Ultrasound-guided tendon fenestration. Semin Musculoskelet Radiol, 17(1), 85-90. doi:10.1055/s-0033-1333942

Coombes, B. K., Bisset, L., & Vicenzino, B. (2010). Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet, 376(9754), 1751-1767. doi:10.1016/s0140-6736(10)61160-9

Coombes, B. K., Connelly, L., Bisset, L., & Vicenzino, B. (2016). Economic evaluation favours physiotherapy but not corticosteroid injection as a first-line intervention for chronic lateral epicondylalgia: evidence from a randomised clinical trial. British Journal of Sports Medicine, 50(22), 1400-1405. doi:10.1136/bjsports-2015-094729

D'Addona, A., Maffulli, N., Formisano, S., & Rosa, D. (2017). Inflammation in tendinopathy. The Surgeon, 15(5), 297-302. doi:10.1016/j.surge.2017.04.004

Dakin, S. G., Martinez, F. O., Yapp, C., Wells, G., Oppermann, U., Dean, B. J., . . . Carr, A. J. (2015). Inflammation activation and resolution in human tendon disease. Science Translational Medicine, 7(311), 311ra173. doi:10.1126/scitranslmed.aac4269

Dejaco, B., Habets, B., van Loon, C., van Grinsven, S., & van Cingel, R. (2017). Eccentric versus conventional exercise therapy in patients with rotator cuff tendinopathy: a randomized, single blinded, clinical trial. Knee Surg Sports Traumatol Arthrosc, 25(7), 2051-2059. doi:10.1007/s00167-016-4223-x

Dorsher, P. T. (2008). Can classical acupuncture points and trigger points be compared in the treatment of pain disorders? Birch's analysis revisited. Journal of Alternative and Complementary Medicine, 14(4), 353-359. doi:10.1089/acm.2007.0810

Gattie, E., Cleland, J. A., & Snodgrass, S. (2017). The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 47(3), 133-149. doi:10.2519/jospt.2017.7096

Herod, T. W., & Veres, S. P. (2017). Development of overuse tendinopathy: A new descriptive model for the initiation of tendon damage during cyclic loading. Journal of Orthopaedic Research doi:10.1002/jor.23629

Hubbard, T. J., & Denegar, C. R. (2004). Does Cryotherapy Improve Outcomes With Soft Tissue Injury? Journal of Athletic Training, 39(3), 278-279.

Jacobson, J. A., Yablon, C. M., Henning, P. T., Kazmers, I. S., Urquhart, A., Hallstrom, B., . . . Parameswaran, A. (2016). Greater Trochanteric Pain Syndrome: Percutaneous Tendon Fenestration Versus Platelet-Rich Plasma Injection for Treatment of Gluteal Tendinosis. Journal of Ultrasound in Medicine35(11), 2413-2420. doi:10.7863/ultra.15.11046

James, S. L., Ali, K., Pocock, C., Robertson, C., Walter, J., Bell, J., & Connell, D. (2007). Ultrasound guided dry needling and autologous blood injection for patellar tendinosis. British Journal of Sports Medicine 41(8), 518-521; discussion 522. doi:10.1136/bjsm.2006.034686

Khan, K. M., Cook, J. L., Kannus, P., Maffulli, N., & Bonar, S. F. (2002). Time to abandon the “tendinitis†myth : Painful, overuse tendon conditions have a non-inflammatory pathology. BMJ : British Medical Journal, 324(7338), 626-627.

Kubo, K., Yajima, H., Takayama, M., Ikebukuro, T., Mizoguchi, H., & Takakura, N. (2010). Effects of acupuncture and heating on blood volume and oxygen saturation of human Achilles tendon in vivo. European Journal of Applied Physiology, 109(3), 545-550. doi:10.1007/s00421-010-1368-z

McAlindon, T. E., LaValley, M. P., Harvey, W. F., Price, L. L., Driban, J. B., Zhang, M., & Ward, R. J. (2017). Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. Jama, 317(19), 1967-1975. doi:10.1001/jama.2017.5283

Mohamadi, A., Chan, J. J., Claessen, F. M., Ring, D., & Chen, N. C. (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

Morton, S., Chan, O., King, J., Perry, D., Crisp, T., Maffulli, N., & Morrissey, D. (2014). High volume image-guided Injections for patellar tendinopathy: a combined retrospective and prospective case series. Muscles Ligaments Tendons Journal, 4(2), 214-219.

Olaussen, M., Holmedal, O., Mdala, I., Brage, S., & Lindbaek, M. (2015). Corticosteroid or placebo injection combined with deep transverse friction massage, Mills manipulation, stretching and eccentric exercise for acute lateral epicondylitis: a randomised, controlled trial. BMC Musculoskelet Disord, 16, 122. doi:10.1186/s12891-015-0582-6

O'Neill, S., Watson, P. J., & Barry, S. (2015). Why Are Eccentric Exercises Effective For Achilles Tendinopathy? International Journal of Sports Physical Therapy, 10(4), 552-562.

Osti, L., Buda, M., Del Buono, A., Osti, R., Massari, L., & Maffulli, N. (2017). Apoptosis and rotator cuff tears: scientific evidence from basic science to clinical findings. British Medical Bulletin, 122(1), 123-133. doi:10.1093/bmb/ldx008

Spang, C., & Alfredson, H. (2017). Richly innervated soft tissues covering the superficial aspect of the extensor origin in patients with chronic painful tennis elbow - Implication for treatment? Journal of Musculoskeletal & Neuronal Interactions, 17(2), 97-103.

Spang, C., Chen, J., & Backman, L. J. (2016). The tenocyte phenotype of human primary tendon cells in vitro is reduced by glucocorticoids. BMC Musculoskeletal Disorders, 17(1), 467. doi:10.1186/s12891-016-1328-9

Urso, M. L. (2013). Anti-inflammatory interventions and skeletal muscle injury: benefit or detriment? Journal of Applied Physiology , 115(6), 920-928. doi:10.1152/japplphysiol.00036.2013

van den Bekerom, M. P., Struijs, P. A., Blankevoort, L., Welling, L., van Dijk, C. N., & Kerkhoffs, G. M. (2012). What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults? Journal of Athletic Training, 47(4), 435-443. doi:10.4085/1062-6050-47.4.14

Vella, L., Markworth, J. F., Paulsen, G., Raastad, T., Peake, J. M., Snow, R. J., . . . Russell, A. P. (2016). Ibuprofen Ingestion Does Not Affect Markers of Post-exercise Muscle Inflammation. Frontiers in Physiology, 7, 86. doi:10.3389/fphys.2016.00086

Vieira R, G., Pinheiro, C. M., Messa, S. P., Delfino, G. B., Marqueti Rde, C., Salvini Tde, F., & Durigan, J. L. (2016). Cryotherapy Reduces Inflammatory Response Without Altering Muscle Regeneration Process and Extracellular Matrix Remodeling of Rat Muscle. Scientific Reports, 6, 18525. doi:10.1038/srep18525

Downloads

Issue

Section

Articles