- Foot Surgery
- Fracture Care
- General Orthopaedics
- Hand Surgery
- Joint Replacement
- Pediatric Orthopaedics
- Physical Medicine
- Spine Care
- Sports Medicine
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OUR PHYSICIANS:
- Kirk D. Clifford, MD
- Mary Beth Deering, MD
- Michael P. Dohm, MD
- Michael Dolecki, MD
- David P. Fisher, MD
- Robert L. Frazho, MD
- James S. Gebhard, MD
- Steven J. Heil, MD
- Michael J. Huang, MD
- Waqqar Khan-Farooqi, MD
- Mark G. Luker, MD
- Jeffrey M. Nakano, MD
- Richard J. Price, MD
- Michael T. Reeder, DO
- Michael D. Rooks, MD
- James K. Weaver, MD
- Thea A. Wojtkowski, MD
Tendinitis vs. Tendinopathy vs. Tendinosis
Tendinitis is a familiar term used in reference to painful tendons. Our upper extremities have rotator cuff tendonitis, tennis elbow and various tendonitis around the wrist and hand. The lower extremities include patellar tendonitis and Achilles tendonitis.
Unfortunately, the word tendonitis is often used incorrectly. The suffix "itis" implies inflammation, but that is not the major component of tendon pain. Over the last ten years, the terms tendinopathy and tendinosis have been used to describe the pathological changes in the tendon as it inserts into the bone. Tendonitis is chronic degeneration in the tendon as it inserts into the bone and the failed healing response of the tendon.
As we age, our tendons become chronically injured secondary to excessive mechanical load. Eventually, the tendon becomes weakened and does not respond to load as before. The inability to respond results in disorganization and breakdown of the tendon matrix. As the tendon disorder progresses there is further damage to the tendon cells and loss of collagen. There are many proposed factors to this: increased age, less flexibility, training or exercise errors, improper equipment or footwear and the inability to respond to overuse. Basically, we lose the ability to respond to repetitive mechanical load – we overdo it and pay for it!
Management of Tendonopathy
Non-operative management is the mainstay for treatment of chronic tendinopathy but response is unpredictable. Treatment of tendinopathy can be frustrating and prolonged for all patients.
Start with relative rest – absolute rest may contribute to prolongation of symptoms. Tendon loading is necessary for collagen repair and tendon remodeling. Relative rest, which allows for motion and low level strengthening, is the first step to healing.
Exercise begins with eccentric exercise for the specific tendon. These exercises, or "negative lifts," involve using the muscle while it lengthens. These exercises involve pre-stretching, progressively increasing the load applied to the tendon and avoiding explosive motions. Consult your sports medicine physician, athletic trainer or physical therapist when attempting these exercises.
Application of ice (cryotherapy) for pain control may be helpful. NSAID (Anti-inflammatory medications) treatment has fallen out of favor as there is not a large component of inflammation involved in the tendon and chronic use can lead to many side effects.
Corticosteroid injections have been used for many decades with varying effects at different locations. Frequently, they give fairly quick pain relief. Better studies have only showed limited or short-term benefit. As for Achilles tendonopathy, there is agreement that cortisone injections should be avoided at the Achilles. Discuss all your options with your physician when you are considering corticosteroids and your tendons.
Topical nitroglycerin has been used at low doses to attempt to improve healing by increased exposure to nitric oxide (NO). Studies have shown modest improvement with Achilles tendonopathy associated with eccentric exercise. The most common side effect is headache.
Biological healing is looking at ways to improve our ability to heal ourselves. Examples include injections of platelets, stem cells and prolotherapy. PRP or Platelet-rich-Plasma injections involve injection of the patients own platelets into the tendon. The platelets have multiple growth factors to theoretically stimulate healing. The best studies have involved tennis elbow. Prolotherapy involves the injection of sclerosing agents into the tendon to stimulate healing. Using the patient's own stem cells for injecting into the tendon is fairly new and exciting and is involved in many ongoing studies.
Surgery is dependent on many factors: joint and tendon involved, age of the patient, other medical problems and surgeon preference.
Conclusion: As we age, our tendons have accumulated "wear and tear" and frequently we present with sore and stiff joints. To be proactive, keep yourself conditioned and flexible; slowly advance any exercise program; maintain a healthy weight; follow an "anti-inflammatory diet"; use common sense and remain active and healthy.
Dr. Mike Reeder
Rocky Mountain Orthopaedic Associates