Tendinopathy, commonly called tendonitis, is a family of painful conditions of the tendon corresponding to a specific histopathology which involves a mechanism of tissue degeneration. Tendons are the strong, but flexible, bundles of fibrous tissue that connect muscles to your bones. Tendonitis is inflammation that occurs in tendons, typically feel like a dull ache around the affected area and painincreases with movement or touching.
Most of the cases, tendonitis is more common in the heel, knee and shoulder area.
In everyday language, the term tendonitis is misused to designate any tendinopathy (or painful tendon). Indeed, the suffix “-pathy” designating the presence of an inflammatory phenomenon is not suitable, the tendon tissue biopsy having shown an absence of cells (macrophages, lymphocytes or neutrophils) and inflammatory molecules on site.
Tendinopathies actually include: tendinosis (a state of chronic non-inflammatory degeneration) and paratenonitis or tenosynovitis (with inflammatory damage to the synovial sheath causing swelling of the latter and therefore compression of the tendon favoring its deterioration in movement, hypervascularization of tendon sheath and fibrous exudate). In clinical practice, it is not possible to distinguish these three different histopathologies and the term “tendinopathy” is therefore proposed to designate these three conditions of the painful tendon. An ultrasound or an MRI will be necessary to establish a more certain diagnosis. Tendinopathies can be included in musculoskeletal disorders.
pain on palpation of the tendon;
pain when tensioning the tendon muscle;
painful feeling of hooking during movements involving the tendon;
nodules of the tendon (chronic tenosynovitis resulting in fibrosis).
The diagnosis will be confirmed by an MRI or ultrasound.
Location of Tendonitis
Tendinopathies mainly affect the tendons at:
wrist, which can lead to carpal tunnel syndrome;
elbow, causing epicondylitis (more commonly known as “tennis elbow”) or epitrochleitis (golfer’s tendinosis);
the rotator cuff (shoulder), which causes rotator cuff tendinopathy;
sural triceps or calcaneal tendon (Achilles tendon);
tensor fascia lata, causing iliotibial band syndrome or “wiper syndrome” in the knee;
But also :
crow’s feet, linked to rotation, tendonitis generally observed in cyclists;
quadriceps or patellar tendon.
talalgia, inflammation of a weakened heel, in the runner, the footballer and the basketball player, or in general all the sportsmen practicing jumping exercises. In addition, in the event of doping, the simultaneous intake of fluoroquinolone and a corticosteroid may in rare cases lead to rupture of the Achilles tendon.
Tennis Elbow (Lateral Epicondylitis)
Tennis elbow, also called epicondylitis, is a rather particular tendonitis (inflammation of the tendon) insofar as it is an insertion tendonitis. “The tendon is detached from the bone support, the lateral epicondyle”.
Contrary to what its name suggests, tennis elbow is not necessarily due to playing tennis. This tendonitis is even more often linked to professional or domestic activity than to the practice of a sport. Certain movements: tightening a handle (hammer, tool) with force work, rotating the forearm and flexing the wrist and hitting objects are risk factors for epicondylitis.
In addition, certain elements aggravate the lesions of the tendons such as the repetition of harmful gestures, the absence of rest or recovery time, cold work and exposure to vibrations.
intense and / or repeated efforts: assembly line work, or at the athlete’s and the musician’s;
Osteopathic dysfunctions leading to a modification of the work axis of the tendon: frequent cause of unilateral tendinopathies;
smoking, because it causes obstruction of the vessels bringing blood to the tendons;
metabolic diseases, such as diabetes, hypercholesterolemia or dyslipidemia, which also lead to obstruction of the vessels;
certain parasitoses or infectious diseases (example: in Lyme disease due to certain borrelias that can be transmitted by tick bites, at the 2nd or 3rd stage, some patients develop recurrent tendinopathies, synovitis or bursitis).
In all cases, complete healing of tendinopathy can be long (6 months) and requires, in the case of tendinopathy caused by repeated movements, the cessation of the offending movement.
The rest of the tendon remains debated, many studies since 2000 advising a relative rest, by making the tendon work progressively increasing, after having a short period of initial immobilization by compression with splint [ref. desired].
physiotherapy: The most commonly used treatment consists of tendon stimulation using various tools such as: radial shock waves [ref. necessary] derived from extracorporeal lithotripsy, ultrasound, stretching, eccentric strengthening, deep transverse massage. All these techniques generally act in the same way: they offer stimulation of the tendon in the direction of its fibers and promote the creation of type I collagen on the part of the tenocytes, reduce the pathological quantity of fundamental substance within the tendon, promote fibroblast activity and restore a healthy balance between metalloproteases and inhibitors thereof.
Cryotherapy: The use of cryotherapy has shown some benefit in reducing the pain of the patient. As no inflammation takes place on site, its vasoconstrictor effect could only reduce the appearance of the proto-blood vessels mentioned above.
NON-cortisonic infiltrations: The infiltrations of steroidal anti-inflammatory drugs or not in cases of tendinosis tend to limit the quality of healing of the tendon and increase the risk of recurrence or even rupture of the tendon. On the other hand, the infiltrations of PRP (platelet rich-plasma), blood plasma enriched in leukocytes and platelets, obtained after centrifugation of a blood sample from the patient, have shown definite efficacy in the management of tendinosis.
Non-steroidal anti-inflammatory drugs can only be useful in the case of tenosynovitis, with therefore inflammation of the synovial sheath of the said tendon (attested by ultrasound or MRI).
Tendinopathy (kwa Kiingereza tendinitis) ni aina ya ugonjwa wa tendon unaosababishwa na ugonjwa wa tishu. Tendoni ni vifungo vyenye nguvu lakini vyenye kubadilika-badilika vya tishu zenye nyuzi zinazounganisha misuli na mifupa. Tendonitis ni uvimbe unaotokea katika tendons, kawaida kuhisi kama maumivu ya kutisha karibu na eneo lililoathiriwa na maumivu huongezeka na harakati au kugusa. Katika visa vingi, uvimbe wa tendonitis ni wa kawaida zaidi katika sehemu ya kisigino, goti na bega. Katika lugha ya kila siku, neno tendonitis hutumiwa vibaya kurejelea ugonjwa wowote wa tendinopathy (au tendon yenye maumivu). Kwa kweli, suffix <unk>-pathy<unk> inayotambulisha uwepo wa hali ya uchochezi haifai, biopsy ya tishu ya tendon ilionyesha kutokuwepo kwa seli (macrophages, lymphocytes au neutrophils) na molekuli za uchochezi mahali. Tendinopathies ni pamoja na: tendinosis (hali ya degeneration ya muda mrefu isiyo ya uchochezi) na paratenonitis au tenosynovitis (na uharibifu wa uchochezi kwa sheath synovial kusababisha uvimbe wa mwisho na hivyo compression ya tendon favoring uharibifu wake katika harakati, hypervascularization ya sheath tendon na exudate fibrous). Katika mazoezi ya kliniki, haiwezekani kutofautisha histopathologies hizi tatu tofauti na neno <unk>tendinopathy<unk> kwa hivyo linapendekezwa kutaja hali hizi tatu za tendon yenye maumivu. Uchunguzi wa ultrasound au MRI utahitajiwa ili kupata utambuzi wenye uhakika zaidi. Tendinopathies inaweza kuingizwa katika matatizo ya misuli na mifupa. Ugonjwa wa tendon (tenosynovitis ya muda mrefu) Uchunguzi huo utathibitishwa kwa MRI au ultrasound. Tendinopathies huathiri tendons katika: mkono, ambayo inaweza kusababisha carpal tunnel syndrome; kiwiko, kusababisha epicondylitis (kwa kawaida inajulikana kama <unk> tenisi kiwiko<unk>) au epithelial tendinitis (golfer's tendinitis); rotator cuff (mabega), ambayo husababisha rotator cuff tendinopathy; sural triceps au calcaneal tendon (Achilles tendon); tendon tensor fascia lata, kusababisha iliotibial band syndrome au <unk> wiper syndrome <unk> katika goti; lakini pia: <unk>s miguu, kushikamana na mzunguko, tendonitis kwa ujumla kuonekana katika baiskeli; quadriceps au patellar tendon. Talalgia ni ugonjwa wa kuvuja kwa kisigino, ambao huathiri wanariadha, wachezaji wa mpira wa miguu, na wachezaji wa mpira wa kikapu, na pia wanariadha wote wanaofanya mazoezi ya kuruka. Kwa kuongezea, katika hali ya kutumia dawa za kulevya, matumizi ya wakati mmoja ya fluoroquinolone na corticosteroid inaweza katika visa vichache kusababisha kuvunjika kwa tendon ya Achilles. Tennis elbow (Lateral Epicondylitis) ni ugonjwa wa tendonitis ambao ni ugonjwa wa kuambukizwa kwa tendon. <unk> Tendon ni detached kutoka mfupa msaada, lateral epicondyle <unk>. Kinyume na jina lake, kiwiko cha tenisi si lazima kisababishwe na kucheza tenisi. Ugonjwa huu wa tendonitis mara nyingi huhusianishwa na shughuli za kitaaluma au za nyumbani kuliko mazoezi ya michezo. Mageuzi fulani: kukaza kiganja (sanduku, chombo) kwa nguvu, kuzungusha mkono na kugeuza mkono na kugonga vitu ni sababu za hatari ya epicondylitis. Kwa kuongezea, vitu fulani huongeza madhara ya tendon kama vile kurudia ishara zenye madhara, kutokuwa na wakati wa kupumzika au kupona, kazi baridi na kuambukizwa kwa mtetemeko. Ugonjwa wa osteopathic unaosababisha mabadiliko ya axis ya kazi ya tendon: sababu ya mara kwa mara ya tendinopathies ya upande mmoja; kuvuta sigara, kwa sababu husababisha kuziba kwa mishipa inayoleta damu kwa tendons; magonjwa ya kimetaboliki, kama vile kisukari, hypercholesterolemia au dyslipidemia, ambayo pia husababisha kuziba kwa mishipa; baadhi ya parasitosis au magonjwa ya kuambukiza (mfano: ugonjwa wa Lyme kutokana na borosis fulani ambayo inaweza kupitishwa na kuumwa na ticks, katika hatua ya 2 au 3). Katika kesi zote, uponyaji kamili wa tendinopathy inaweza kuwa muda mrefu (miezi sita) na inahitaji, katika kesi ya tendinopathy husababishwa na harakati mara kwa mara, kusimamishwa kwa harakati ya kosa. Utafiti wa miaka ya 2000 unaonyesha kwamba watu wengi wanafikiria kwamba kazi ya tendon inapaswa kuongezeka hatua kwa hatua, baada ya kipindi kifupi cha kutoweka kwa compression na splint. inataka]. Upasuaji wa kawaida ni kuchochea tendon kwa kutumia vifaa mbalimbali kama vile radial shock waves. Kwa mfano, kuna matibabu ya extracorporeal lithotripsy, ultrasound, stretching, na kuimarisha eccentric. Mbinu hizi zote kwa ujumla kutenda kwa njia ile ile: wao kutoa stimulation ya tendon katika mwelekeo wa nyuzi zake na kukuza uundaji wa aina ya I collagen katika sehemu ya tenocytes, kupunguza kiasi pathological ya msingi ndani ya tendon, kukuza shughuli fibroblast na kurudisha usawa wa afya kati ya metalloproteases na inhibitors yao. Cryotherapy: Matumizi ya cryotherapy imeonyesha baadhi ya faida katika kupunguza maumivu ya mgonjwa. Kwa kuwa hakuna uvimbe unaotokea mahali hapo, athari yake ya vasoconstrictor inaweza tu kupunguza kuonekana kwa mishipa ya damu ya proto-iliyosemwa hapo juu. Infiltration ya steroidal anti-inflammatory (SIA) katika kesi ya tendinosis huongeza hatari ya kurudia au kuvunjika kwa tendon. Kwa upande mwingine, infiltrations ya PRP (platelet-rich plasma), plasma ya damu iliyotajwa katika leukocytes na platelets, iliyopatikana baada ya centrifugation ya sampuli ya damu kutoka kwa mgonjwa, imeonyesha ufanisi dhahiri katika usimamizi wa tendinitis. Dawa za kuzuia uvimbe zisizo za steroid zinaweza kuwa na manufaa tu katika kesi ya tenosynovitis, kwa hivyo uvimbe wa kifuniko cha synovial cha tendon iliyotajwa (iliyothibitishwa na ultrasound au MRI).