What Is Tendinopathy?

A tendon is a strong fibrous connective tissue that connects bones to muscles. Tendonitis usually refers to the degeneration of tendon collagen fibers caused by repeated use of muscle fibers due to excessive use of muscle fibers. In addition to the tendon itself, it can also involve the tendon sheath. In the past, tendinitis was often used for diagnosis, but in fact it is not a single inflammation. In most cases, the affected tendon collagen tissue is often degenerated, so it is now commonly referred to as tendinopathy. The most common chronic diseases related to exercise are Achilles tendinopathy, plantar tendinopathy, quadriceps and hamstring tendinopathy, rotator cuff tendinopathy, "tennis elbow" epicondylitis, and more.

Basic Information

English name: myotenositis
Visiting department: orthopedics

Common locations: Shoulder, elbow, wrist, Achilles tendon
Common causes: Overuse of muscle fibers, caused by repeated intense stretching
Common symptoms: Pain, tenderness, dysfunction, inflammatory response

Causes of tendinitis

It is caused by the excessive use of muscle fibers and repeated strong stretching, which is the result of the interaction of endogenous and exogenous factors. Endogenous factors include physical related factors such as poor alignment and poor muscle strength. Exogenous factors include training errors, poor equipment and skills, and venue changes. The interaction of external factors may also lead to the occurrence of tendinopathy. External factors include: training errors such as distance, intensity, slope movement, technology and fatigue, training venues, etc. These factors play an important role in acute injuries.

Clinical manifestations of tendinitis

Pain, tenderness, dysfunction, and inflammatory response at the lesion. Pain may worsen during repeated stretching activities, and resting pain may also occur. Inflammation of the tendon or tendon sheath causes pain and dysfunction in the lesion. The clinical manifestations vary depending on the site of occurrence.

Disease site

(1) Inflammation of the epicondylitis (golf elbow, baseball elbow) The tendon inflammation attached to the epicondyle of the humerus is caused by repeated weight flexion or rotation of the wrist.

(2) Epicondylitis (tennis elbow) inflammation of the tendon attached to the epicondyle of the humerus, caused by repeated wrist extension or rotation of the wrist.

(3) rotator cuffitis (swimmer's shoulder, tennis shoulder, pitcher's shoulder) A group of tendons that control shoulder movement, including superior ganglia, subganglia, small round muscle, and subscapularis. Caused by repeatedly lifting your shoulders over your head.

(4) Biceps tendinitis connects the part between the biceps brachii and the shoulder due to strain.

(5) The site where patellar tendonitis connects the sacrum and tibia is caused by excessive running and jumping.

(6) Patella tendinitis is located behind the knee joint, caused by excessive running or walking downhill.

(7) Achilles tendinitis is caused by the upper side of the heel, due to excessive downhill running, jumping, or other sports that cause the gastrocnemius pull.

(8) De Quervain tenosynovitis tendon inflammation of the thumb side of the wrist, caused by repeated movements of the hand and wrist.

Clinical symptoms

Tenderness in or near the joints, especially around the shoulder or wrist or Achilles tendinitis, or outside the elbow (tennis elbow), numbness or tingling, stiff joints with pain, limiting movement of affected joints Occasionally, the joints are slightly swollen and the pain persists. The tendons continue to ache after the recurrence of the original injury or recur long after. The pain did not improve for 7 to 10 days. The pain was severe and accompanied by swelling. Tendon rupture may be required and immediate treatment is required. Avoid turning into chronic myositis, or combining other diseases such as bursitis, wrist syndrome, or phlebitis.

Tendonitis examination

X-ray examination can not show the condition of the tendon, but can exclude other bone and joint diseases; ultrasound and magnetic resonance can accurately diagnose.

Tendonitis diagnosis

The diagnosis of this disease is mainly based on its clinical manifestations and physical examination, and tendon palpation is often used:

Epicondylitis

Forearm pronation (with palms facing upwards), fist flexing wrists to resist resistance, at this time palpation of tenderness on the inside of the elbow and the epicondyle of the humerus.

2. Epicondylitis

After the forearm is rotated (with the palms facing down), the forearm remains stationary, the wrist is extended to resist resistance, and the tenderness of the epicondyle of the humerus is palpated.

3. Rotator cuff tendinitis

Superior psoas muscles: flex elbows 90 degrees, rotate shoulders forward 30 degrees, under counter-resistance, abduct shoulders to the thumbs down, you can feel tendon pain or weakness.

Subangina and small round muscles: Flex elbow 90 degrees, resist external rotation of humerus under resistance, and can feel tendon pain.

4. Subscapular myositis

Bend your elbow 90 degrees to resist internal rotation of the humerus, and you can feel tendon pain.

5. Patella tendinitis

Palpate the patellar tendon below the patella.

6. Patella tendinitis

When sitting, place the heel of the affected side on the knee of the healthy side, and you can feel the pain of the knee of the affected side.

7. Achilles tendinitis

Pain in squeezing Achilles tendon with fingers.

8.De Quevain tenosynovitis

Grip the fist and place the thumb in the four fingers. The examiner bends the wrist joint towards the little finger, and the pain is positive.

Differential diagnosis of tendinitis

It should be distinguished from tendon tears, degenerative and infectious arthritis, synovitis, infectious tenosynovitis, myositis, osteomyelitis, phlebitis and so on.

Tendonitis treatment

Routine treatment

In the acute phase, ice pack should be used, and the affected area should be iced for 20 minutes every few hours. The affected limb should be raised and fixed. For tendonitis of the upper limb, it can be fixed in a suitable functional position with braces or plaster. Resting is to relieve muscle tension. The best method; tendinitis in other locations can be reduced with elastic bandages to reduce edema. After the acute phase, develop a suitable rehabilitation plan to increase muscle strength and restore range of activity.

2. Drug treatment

Pain can be relieved with non-steroidal anti-inflammatory drugs. For severe pain, local injection of steroid hormones can control inflammation and reduce pain. However, repeated injections of steroids are not recommended, as multiple injections of steroids can weaken tendons and cause tendon rupture.

3. Surgical treatment

Some patients, especially when adhesions occur; if the above treatments are not effective, surgical treatment can be considered. The narrow tendon sheath is cut open longitudinally, and a small tendon sheath is removed to eliminate the source of pain. Disadvantages: traumatic, painful, and long recovery period.

4.Physiotherapy

Taking a massage bath can help increase body temperature and promote blood circulation. If tendinitis occurs in the knee area, apply warm towels. In recent years, ultrasound therapy has been used to treat tendinitis, especially calcified tendinitis, but its efficacy needs to be further confirmed.