Tendinosis

Tendinosis: A Comprehensive Guide on Symptoms, Causes, Types, Diagnosis, and Treatments

Tendinosis is a common yet often misunderstood condition that affects tendons, causing pain and functional impairment. Unlike tendinitis, which involves inflammation, tendinosis is characterized by chronic degeneration of the tendon’s collagen fibers due to repetitive strain and poor healing. This article explores tendinosis in depth, covering its symptoms, causes, types, diagnosis, and treatments, providing a thorough understanding for anyone affected or interested in this condition.

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What is Tendinosis?

Tendinosis refers to a chronic, non-inflammatory degeneration of a tendon caused by repetitive microtrauma and failed tendon healing. Tendons are strong, fibrous connective tissues that attach muscles to bones, allowing movement of joints. When tendons undergo repetitive overuse or injury without adequate rest, the normal repair process is disrupted, resulting in structural changes such as collagen disarray, increased ground substance, and neovascularization (new blood vessels), which weaken the tendon.

Unlike tendinitis, where inflammation is the primary problem, tendinosis represents a degenerative process with minimal or no inflammation. This distinction is important because it influences treatment strategies — anti-inflammatory medications alone are usually insufficient for tendinosis.

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Symptoms of Tendinosis

Tendinosis symptoms can vary depending on the tendon involved and the severity of the degeneration. Common symptoms include:

1. Persistent Tendon Pain

• Pain is often localized to the affected tendon and usually worsens with activity.
• The pain is typically dull, aching, and chronic rather than sharp or acute.
• It tends to increase during and after repetitive movements involving the affected tendon.

2. Tenderness and Swelling

• Mild swelling around the tendon site may occur.
• The tendon may be tender to touch or palpation.
• Unlike tendinitis, swelling tends to be less prominent.

3. Stiffness and Reduced Range of Motion

• Movement around the affected joint can be stiff, especially after periods of inactivity.
• Patients may experience difficulty in performing motions that strain the tendon.

4. Weakness

• Weakness or loss of strength in the affected limb or muscle can develop due to tendon degeneration.
• This can impact daily activities and athletic performance.

5. Crepitus (Grating Sensation)

• In some cases, patients feel a crackling or grating sensation when moving the tendon, caused by rough tendon surfaces rubbing.

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Causes of Tendinosis

The primary cause of tendinosis is chronic overuse or repetitive strain on a tendon, which leads to micro-injuries and failed healing. Key causes include:

1. Repetitive Overuse

• Performing repetitive motions without adequate rest causes micro-tears in the tendon fibers.
• Common in athletes (runners, tennis players, swimmers), manual laborers, and musicians.

2. Aging

• Tendons lose elasticity and strength with age, making them more prone to degeneration.
• Blood supply to tendons also decreases with age, slowing healing.

3. Poor Biomechanics and Technique

• Incorrect form during exercise or repetitive tasks can increase stress on tendons.
• Muscle imbalances or tightness can alter tendon loading patterns.

4. Previous Tendon Injuries

• Untreated or poorly healed tendon injuries can predispose to tendinosis.
• Chronic tendinitis can progress into tendinosis if inflammation persists.

5. Medical Conditions

• Conditions like diabetes, rheumatoid arthritis, and gout can affect tendon health.
• Use of certain medications such as fluoroquinolone antibiotics has been linked to tendon degeneration.

6. Lifestyle Factors

• Smoking reduces blood flow and impairs tendon healing.
• Poor nutrition can limit tissue repair.

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Types of Tendinosis

Tendinosis can affect virtually any tendon in the body, but some tendons are more commonly involved:

1. Achilles Tendinosis

• Affects the Achilles tendon at the back of the ankle.
• Common in runners and athletes involved in jumping sports.
• Symptoms include heel pain, stiffness, and swelling.

2. Patellar Tendinosis (Jumper’s Knee)

• Affects the patellar tendon connecting the kneecap to the shinbone.
• Seen in basketball players, volleyball players, and runners.
• Causes anterior knee pain and difficulty jumping.

3. Rotator Cuff Tendinosis

• Involves the tendons of the rotator cuff muscles in the shoulder.
• Common in swimmers, baseball pitchers, and manual laborers.
• Leads to shoulder pain, weakness, and limited range of motion.

4. Lateral Epicondylosis (Tennis Elbow)

• Affects the tendons attaching to the outer elbow.
• Seen in tennis players, painters, and carpenters.
• Results in pain on the outer elbow and grip weakness.

5. Medial Epicondylosis (Golfer’s Elbow)

• Involves tendons on the inner elbow.
• Causes pain on the inside of the elbow and forearm weakness.

6. Wrist Extensor or Flexor Tendinosis

• Common in people with repetitive wrist movements (e.g., typing, factory work).
• Leads to pain, stiffness, and weakness in the wrist and hand.

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Diagnosis of Tendinosis

Diagnosing tendinosis involves clinical evaluation and imaging studies to differentiate it from other tendon disorders and guide treatment.

1. Medical History and Physical Exam

• The doctor takes a detailed history of symptoms, activity level, and risk factors.
• Physical exam includes palpation of the tendon, checking for tenderness, swelling, crepitus, and assessing range of motion and strength.

2. Imaging Studies

• Ultrasound: A cost-effective tool to visualize tendon thickening, fiber disorganization, and neovascularization. Can guide treatment like injections.
• Magnetic Resonance Imaging (MRI): Provides detailed images of tendon structure, showing degeneration, tears, and surrounding tissue status.
• X-rays: Generally used to rule out bone involvement or calcifications but don’t show tendinosis directly.

3. Differential Diagnosis

• Distinguishing tendinosis from tendinitis (inflammation), partial tendon tears, bursitis, or nerve entrapments is essential.
• Blood tests may be done if systemic diseases like rheumatoid arthritis are suspected.

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Treatments for Tendinosis

Because tendinosis involves tendon degeneration rather than inflammation, treatment focuses on promoting tendon healing and restoring function rather than just reducing inflammation.

1. Conservative (Non-Surgical) Treatments

Rest and Activity Modification

• Avoid activities that worsen symptoms, especially repetitive motions.
• Gradually reintroduce activity with modifications to reduce tendon strain.

Physical Therapy

• Eccentric exercises (lengthening contraction of the tendon) are considered the gold standard.
• Stretching and strengthening exercises improve tendon structure and muscle balance.
• Manual therapy, ultrasound therapy, and laser therapy may help.

Medications

• Pain relievers such as acetaminophen or NSAIDs can be used for symptom control but don’t reverse degeneration.
• Topical analgesics or patches may provide localized relief.

Orthotics and Bracing

• Supportive devices like heel lifts for Achilles tendinosis or elbow braces for tennis elbow reduce tendon load during activity.

Shockwave Therapy

• Extracorporeal shockwave therapy (ESWT) uses sound waves to stimulate tendon healing.
• Can reduce pain and improve function, though results vary.

Injections

• Platelet-Rich Plasma (PRP): Uses patient’s own concentrated platelets to promote tissue repair.
• Prolotherapy: Injection of irritant solutions to stimulate healing.
• Corticosteroids: Generally avoided long-term due to potential tendon weakening but sometimes used for short-term pain relief.

2. Surgical Treatment

Surgery is considered if conservative treatments fail after 6 to 12 months or if there is a significant tendon tear.

Surgical Options

• Debridement: Removal of degenerated tendon tissue.
• Tendon repair or reconstruction.
• Tendon release procedures to reduce tension.
• Post-surgery rehabilitation is essential for restoring function.

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Preventing Tendinosis

Prevention focuses on minimizing tendon overuse and promoting healthy tendon maintenance:

• Warm-up and stretch properly before activity.
• Gradually increase exercise intensity and duration.
• Use correct technique and ergonomics.
• Strengthen muscles to support tendons.
• Allow adequate recovery time between activities.
• Maintain a healthy diet rich in protein and vitamins.
• Avoid smoking.

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When to See a Doctor

Seek medical advice if you experience:

• Persistent tendon pain lasting more than a few weeks.
• Severe pain or swelling.
• Significant weakness or loss of function.
• Symptoms interfering with daily activities.

Early diagnosis and treatment can prevent progression and chronic disability.

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Conclusion

Tendinosis is a chronic tendon degeneration resulting from repetitive strain and inadequate healing. It is characterized by pain, stiffness, and weakness in the affected tendon. Proper diagnosis through clinical evaluation and imaging is crucial to distinguish it from inflammatory tendon injuries. Treatment focuses on conservative approaches such as eccentric exercises, activity modification, and advanced therapies like PRP injections. Surgery remains a last resort for refractory cases.

Frequently Asked Questions (FAQs) About Tendinosis

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