Tendon Injury – Tendinopathies
What is Tendinopathy?
Tendinopathy is a failure of the normal healing response of a tendon and develops after the tendon and surrounding structures have been overused. This is commonly seen in patients who have recently altered their daily activities or suddenly increased their training load, for example when preparing for a long-distance race. The tendon fibres become disrupted and some cells die. There is then a disorganised structure of tendon cells (tenocytes) and a process known as neovascularisation (New blood vessels develop in the tendon) resulting in pain and stiffness. This can become so severe that it prevents exercise or even normal activities of daily life. If left untreated overtime these tendons become weaker and more susceptible to tearing/rupture.
Symptoms of Tendinopathy
Patients classically report pain at the site of the tendinopathy. This is severe at first but usually fades to an ache after a few weeks. It is worse after exercise and eases a bit with rest. Interestingly patients may well be able to complete their exercise in the early stages of tendinopathy as the pain reduces during, only to return after cessation. Another classic symptom is a feeling of pain and stiffness at the site in the mornings. When examined by a clinician, patients will often have tenderness around the area and a reduced range of movement of the affected joint. The tendon may be thickened, and the surrounding muscles may have lost bulk.
It is crucial the correct diagnosis is made as there are many conditions that present like a tendinopathy but have different pathologies. This will obviously alter the clinician’s treatment plan. Correct diagnosis is made through careful history taking (try to elicit a cause) and focussed examination. A functional screen should be performed to look for factors that pre-dispose the patient to develop a tendinopathy at that site. The tendon should be appropriately loaded during the examination and all possible alternative diagnoses should be excluded.
Investigations
A diagnosis of tendinopathy may be made solely from the clinical history and examination findings. Other modalities may include…
Investigations
Treatment Priniciples
Treatment Options
Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)
A short course may be prescribed in the first instance when pain is very severe. Long term use of anti-inflammatory drugs is generally to be avoided.
Extracorporeal Shockwave Therapy (ECST)
This is a mechanical therapy that helps to reduce pain at the site of the tendinopathy by affecting the pain receptors and promoting tissue healing. It is delivered by a clinician in courses of 3-6 sessions (1 per week) each lasting a couple of minutes each.
Dry Needling
In this procedure a needle is inserted into the tendon multiple times in order to encourage bleeding and promote tendon healing. It is done under local anaesthetic.
Steroid Injections
These are used to reduce inflammation and pain. While they show good short-term benefit, they have negative consequences for the tendon in the mid to long term and so are not widely advised or used now.
Hydrodissection injection
This procedure disrupts the new blood vessels and nerves that have grown into the tendon during the tendinopathic process. The clinician injects normal saline into the sheath that surrounds the tendon stripping these structures. This results in reduced pain.
Platelet Rich Plasma Injections
This is a procedure in which 20ml of blood is drawn from the patient and spun down in a centrifuge. The platelet rich plasma floating at the top of the sample is then harvested and injected into and around the tendon. The aim is to promote tendon healing. Usually, two treatments are required.
Tendinopathy Surgery at Sozo
A surgical opinion may be considered in cases that fail other treatment options. It is viewed as a last resort and does not guarantee resolution. Symptoms may recur with both non-surgical and surgical approaches. The surgery aims to remove the damaged abnormal tendon, and stimulate healing by freshening up the tendon insertion.
