Tendinosis vs Tendinitis

Tendinosis is intratendinous atrophy and degeneration with a relative absence of inflammation; a palpable nodule may be present over tendon.

Tendinitis is symptomatic degeneration of the tendon with vascular disruption and inflammatory repair response.

TENDINOPATHIES

Tendinopathy is a clinical condition characterized by activity-related pain, focal tendon tenderness, and intratendinous imaging changes. It represents a common and significant problem, with a prevalence of 14% in elite athletes, and requires a recovery time of 3 to 6 months with first-line conservative management. Historically, it was thought to be one of inflammation, and consequently, the condition was labeled tendinitis. However, recent histopathologic studies have shown the underlying pathology to be primarily one of tendon degeneration (tendinosis)

Although the pathologic label tendinosis has been in use for more than 25 years to describe collagen degeneration in tendinopathy, many clinicians still use the term tendinitis to describe painful chronic overuse injury, implying that the fundamental problem is inflammatory. Maffulli and colleagues advocate the use of the term tendinopathy as a generic descriptor of clinical conditions such as pain, swelling, and impaired performance in and around tendons arising from overuse, with the labels tendinosis and tendinitis most appropriately applied after histopathologic examination. This nomenclature separates chronic degeneration of tendons from acute and mainly inflammatory processes, with implications for treatment and management (Table).

Common Tendinopathies 

• Rotator Cuff Tendinopathies
• Lateral Epicondylitis/Tennis Elbow
• Medial Epicondylitis/Golfer's Elbow
• De Quervain’s Syndrome
• Extensor Carpi Ulnaris Tendinitis
• Patellar Tendinopathy
• Achilles Tendon Disorders

Based on the anatomical location of the histopathological changes, it is possible to classify microtraumatic tendon injury into four types (1) tendinitis - tendon strain or tear; (2) tendinosis- intratendinous degeneration; (3) paratenonitis - inflammation of the paratenon only; and (4) paratenonitis with tendinosis.

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Treating Tendon Injury

General Principles

The basic principles governing clinical intervention during tendon healing are outlined in Table 3. The initial clinical assessment of the patient must include a thorough history and physical examination, identifying, in particular, any intrinsic or extrinsic factors that may be contributing to the tendon injury. The exact anatomical site of the disease is located, and an estimate of the stage of healing should be made based on the degree of pain and inflammation. Imaging techniques, such as ultrasound and MRI, may be of help in this process. Establishing the stage of healing will determine the appropriate focus for initial treatment. In general, the treatment protocol should include: 

• the correction of existing intrinsic and extrinsic etiological factors;
• control of pain and inflammation, using drugs, ice, and other modalities; and
• instituting early motion, beginning with passive movement and stretching, then progressing to active exercises.

Principles governing clinical intervention during stages of tendon healing

Physical Therapy Treatment and self-care recommendations for tendinosis include:

• Rest.
• Adjust ergonomics and biomechanics.
• Use appropriate support. Physical therapists can also recommend appropriate support to reduce tensile stress on the tendon, such as bracing or taping
• Stretch and keep moving, though conservatively
• Apply ice. Use ice for 15–20 minutes several times a day (allowing for at least 45 minutes in between icing session), and after engaging in activities that utilize the tendon
• Eccentric strengthening. An eccentric strengthening regimen done 1–2 times daily for 12 weeks has been clinically proven to be a very successful treatment for tendinopathis, especially when the exercises are performed slowly. Eccentric strengthening is “lengthening a muscle while it is loaded and contracting.
• Massage. Massage stimulates circulation and cell activity, especially when done at the appropriate depth. Deep-friction massage applied to the tendon serves to stimulate fibroblast activity and generate new collagen.
• Nutrition. Vitamin C, manganese, and zinc are all important for the synthesis of collagen production. Vitamin B6 and Vitamin E have also been linked to tendon health.

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