Tendonitis

Tendonitis is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • The term “tendinitis” has been used to describe chronic painful tendon injuries before the underlying pathology was fully understood. The terms “tendinosis” or “tendinopathy” should be used instead to describe most chronic tendon disorders lasting >3 mo. This confusion has led to false belief that inflammation is the central etiology, when in reality most tendinopathies are not caused by inflammation but by a failed healing response to trauma or overuse
  • Overuse syndrome:
    • Clinical Syndrome of chronic pain and tendon thickening
    • Synovial cells increase in thickness
    • Excess synovial fluid collection
    • Constant irritation
  • If no further injury occurs, the acute process may last from 48 hr to 2 wk

Etiology

  • Mechanical overload or repetitive microtrauma to the musculotendinous unit:
    • Intrinsic factors:
      • Inflexibility
      • Muscle weakness or imbalance
    • Extrinsic factors:
      • Excessive deviation, frequency, or activity
  • In tendinopathies the collagen is in a state of disrepair with proliferation and chronic irritation of neurovascular repair tissue in the tendon and its linings
  • Chemotactic and vasoactive chemical mediators are released leading to vasodilatation and cellular edema, increasing the number and activity of PMNs in the tissue

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Basics

Description

  • The term “tendinitis” has been used to describe chronic painful tendon injuries before the underlying pathology was fully understood. The terms “tendinosis” or “tendinopathy” should be used instead to describe most chronic tendon disorders lasting >3 mo. This confusion has led to false belief that inflammation is the central etiology, when in reality most tendinopathies are not caused by inflammation but by a failed healing response to trauma or overuse
  • Overuse syndrome:
    • Clinical Syndrome of chronic pain and tendon thickening
    • Synovial cells increase in thickness
    • Excess synovial fluid collection
    • Constant irritation
  • If no further injury occurs, the acute process may last from 48 hr to 2 wk

Etiology

  • Mechanical overload or repetitive microtrauma to the musculotendinous unit:
    • Intrinsic factors:
      • Inflexibility
      • Muscle weakness or imbalance
    • Extrinsic factors:
      • Excessive deviation, frequency, or activity
  • In tendinopathies the collagen is in a state of disrepair with proliferation and chronic irritation of neurovascular repair tissue in the tendon and its linings
  • Chemotactic and vasoactive chemical mediators are released leading to vasodilatation and cellular edema, increasing the number and activity of PMNs in the tissue

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