Tendinopathy

Definition

Tendinopathy refers to a spectrum of tendon disorders characterized by pain, swelling, and impaired function, often due to overuse, degeneration, or microtrauma rather than acute inflammation.

Epidemiology

• Common in athletes and individuals engaged in repetitive activities
• Incidence increases with age due to degenerative changes
• Achilles, rotator cuff, patellar, and lateral elbow tendons are commonly affected
• Affects both males and females, with slight male predominance in some sports
• Prevalence varies by activity and occupation
• Significant cause of musculoskeletal pain and disability
• Often leads to chronic pain if not addressed early

Etiology

• Overuse and repetitive microtrauma
• Age-related tendon degeneration (tendinosis)
• Biomechanical abnormalities: poor posture, muscle imbalance, or improper technique
• Previous tendon injury or surgery
• Metabolic disorders: diabetes, hypercholesterolemia
• Certain medications: fluoroquinolones, statins
• Inflammatory or autoimmune conditions (rare)

Pathophysiology

• Degenerative changes in tendon collagen fibers (tendinosis)
• Disruption of tendon matrix and increased ground substance
• Neovascularization and nerve ingrowth leading to pain
• Cellular changes: increased tenocyte proliferation and apoptosis
• Chronic overload leads to failed tendon healing response
• Minimal inflammatory cell infiltration in chronic tendinopathy
• Altered tendon mechanical properties resulting in decreased strength