Many patients have been diagnosed with tendon problems, usually being told they have 'tendinitis'. This is often related to overuse syndromes and can be seen in multiple areas of the body.
Common areas of tendon problems include the Achilles tendon (heel), rotator cuff tendons (shouler), patellar tendon (knee), and the elbow tendons (golfers and tennis elbow).
Historically, this has been thought to be an inflammatory condition and treated as such. However, newer research has changed the way that we diagnose and treat this condition.
First, some definitions:
· Tendons are rope like structures which connect muscle to bone. Ligaments connect bone to bone.
· Tendinitis: The suffix "itis" means inflammation.
· Tendinosis: The suffix "osis" implies chronic degeneration without inflammation.
· Tendinopathy: Clinical syndrome describing overuse tendon injuries characterized by pain, swelling, and impaired performance.
Interestingly, studies have shown that there is very little, if any, inflammation with most overuse tendon injuries. Therefore, the term tendin'itis' is being used less. Along those same lines, without inflammation, the use of ongoing anti-inflamatories for chronic tendon injuries are being limited.
The most appropriate term is usually "tendinosis" indicating chronic degenerative changes of the tendon. But don't lose faith - the word degenerative does not mean doomed. Think of it as a disorganization of the tendon structure which can simply be re-organized with the proper treatment.
The use of musculoskeletal ultrasound is key in making the diagnosis of tendinosis as it evaluates the state of the tendon and can differentiate between tendinosis versus a partial or complete tear.
Initial treatments consist of modified activities/rest, ice, ergonomic assessments and physical therapy. The goal of physical therapy with most tendinosis injuries is an eccentric strengthening program. Eccentric indicates strengthening while the muscle is lengthening as opposed to concentric (muscle shortening) strengthening. Think of lifting a load of bricks (against gravity) vs. lowering a load of bricks (with gravity).This form of a strengthening program has shown to be superior in treating chronic tendon injuries.
Other treatment options include various injection therapies. These can be corticosteroid injections or platelet rich plasma injections (PRP), along with other options. Surgery is typically a last resort and is usually only indicated when other conservative treatment options have failed.
Written By: Dr. John Tobey