Highlights & Basics
- Tendinopathy is a general term that describes tendon degeneration characterized by a combination of pain, swelling, and impaired performance.
- Common sites include the rotator cuff (supraspinatus tendon), wrist extensors (lateral epicondyle) and pronators (medial epicondyle), patellar and quadriceps tendons, and Achilles tendon.
- The exact etiology is unclear. Studies suggest it is an overuse condition leading to inadequate tendon repair that predisposes the tendon to microtears and degeneration.
- Treatment consists of activity modification, relative rest, ice, stretching, and strengthening. Stretching and strengthening are best guided by a physical therapist.
- Extracorporeal shockwave therapy or ultrasound-guided injection of platelet-rich plasma may be considered in recalcitrant tendinopathy, but their use remains controversial.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
MRI demonstrating calcific tendinopathy involving the distal central supraspinatus
MRI demonstrating mild to moderate tendinopathy of the proximal centimeter of the patellar tendon, characterized by thickening and abnormal signal within the tendon
Impingement test: with hand in full pronation, passively raise shoulder in line of movement of scapula. Pain = positive test
Impingement test: with shoulder in 90º forward flexion, elbow in 90º flexion, apply downward pressure on the hand while stabilizing at the elbow. Pain = positive test
Test for lateral epicondylitis: resisted wrist extension with elbow in full extension stresses the origin of the extensor carpi radialis brevis tendon and elicits pain at the lateral epicondyle
Test for medial epicondylitis: resisted forearm pronation and palmar flexion elicits pain at the medial epicondyle
Medial and lateral pressure applied anterior and superior to the Achilles insertion elicits pain
Eccentric calf exercise. To start: rise up on bilateral toes over the edge of a step
Then cross the unaffected ankle behind the affected ankle. Finally, lower the heel down over the step
Citations
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