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TENDINOPATHY/TENDONITIS
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What is it?
“Tendinopathy” is a catch-all term used to describe the conditions of tendonitis (or “tendinitis”) and tendonosis. Tendinopathies are injuries that occur in tendons, which are structures that attach muscle to bone. Tendonitis refers to an acute inflammation of the tendon, which usually lasts for a period of 10 days or less. Tendinosis is a chronic condition in which the tendon begins to break down and grow irregularly. It  can be a source of prolonged pain and dysfunction. Commonly involved tendons are in the shoulder, elbow, wrist, hip, knee and ankle.

Causes
Most tendon injuries are caused by overuse of the specific muscle group. These injuries are common in athletes who do the same activity over and over again. Running and jumping, overhead hitting and throwing, commonly lead to overuse injuries. The injury can be made worse by poor conditioning, technique, and nutrition. External factors such as poor coaching, improper equipment, and sport environment can also contribute to tendinopathy.

Risk Factors
• Overuse activities (running, jumping, throwing, and hitting, for example)
• Inappropriate athletic movement techniques
• Lack of flexibility
• Inappropriate equipment and footwear
• Age
• Genetic predisposition

Symptoms
• Pain and swelling at the site of dysfunction
• Thickening of the tendon 

Diagnosis
Most tendon injuries can be accurately detected by a history and exam performed by a medical professional experienced in sports-related injuries. Numerous maneuvers to locate the pain and test the range of motion and strength of the affected area will be performed. Imaging studies such as x-ray, ultrasound, and magnetic resonance imaging (MRI) are often used to evaluate patients with tendinopathies.

Treatment
Initial treatment of tendinopathies includes relative rest, ice, compression, and pain medications. A structured rehabilitation program is critical for recovery. The focus of rehabilitation is typically on range of motion and eccentric strengthening (strengthening the muscle while it is lengthening). Correction of training errors and biomechanics need to be addressed. Braces, manual therapy, injection therapies, and shockwave therapy may be prescribed. In severe situations, surgery may be considered.

Injury Prevention
There is little information on the prevention of tendonitis and tendinosis. Focus should be placed on proper functional technique in sport, and balanced training of the entire body. Athletes with a propensity for tendon problems should also be aware that prolonged time off and rapid changes in training programs may predispose them to future injury.

Return To Play
Return to play is dictated by an athlete’s ability to perform the activity necessary to compete in the sport.

AMSSM Member Authors: Kyle Goerl, MD, Robert Dimeff, MD

References
Scott A, Docking S, Vicenzino B, et al. Sports and exercise-related tendinopathies: a review of selected topical issues by participants of the second International Scientific Tendinopathy Symposium (ISTS) Vancouver 2012. Br J Sports Med. 2013;47(9):536–44. doi:10.1136/bjsports-2013-092329.  Gallo R a, Plakke M, Silvis ML. Common Leg Injuries of Long-Distance Runners: Anatomical and Biomechanical Approach. Sports Health. 2012;4(6):485–495. doi:10.1177/1941738112445871.

Littlewood C. Contractile dysfunction of the shoulder (rotator cuff tendinopathy): an overview. J Man Manip Ther. 2012;20(4):209–213. doi:10.117 9/2042618612Y.0000000005.

Yuan T, Zhang C-Q, Wang JH-C. Augmenting tendon and ligament repair with platelet-rich plasma (PRP). Muscles Ligaments Tendons J. 2013;3(3):139– 149. Available at: http://www.pubmedcentral.nih.gov/articlerender. fcgi?artid=3838322&tool=pmcentrez&rendertype=abstract.

Category: Overuse Injuries,

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