Tendinitis/Tendinopathy

What is tendinitis or tendinopathy?
Tendons are thick cords that connect muscle to bone. This structure is responsible for allowing the body to move; when muscles contract, it pulls on the tendon connected to the bone being called upon to move. This motion should be smooth and seamless; however, when tendons become inflamed or irritated, this motion becomes painful. Tendinitis, or inflammation of the tendon, is most commonly due to overuse or repetitive actions. Tendinopathy is a clinical syndrome characterized by chronic degenerative changes in the tendon leading to thickening, scarring, and chronic localized tendon pain. The most common areas to develop tendinitis or tendinopathy include the shoulder (rotator cuff tendonitis), elbow (medial or lateral epicondylitis, otherwise known as golfers and tennis elbow, respectively), heel (Achilles tendinitis), and wrist (wrist extensor tendinitis).

Management
A diagnostic ultrasound can be performed in clinic, which will show characteristic changes in tendon appearance including thickening and scarring. Management includes a period of rest from aggravating activities, immobilization, anti-inflammatory medications, physical therapy, and a gradual increase in tendon-loading activities.

Corticosteroid injections, performed under ultrasound guidance, may be considered to reduce pain and inflammation. Repeated injections are not recommended due to risk of tendon rupture.

Platelet rich plasma (PRP) injections may be considered in patients with persisting or chronic symptoms. PRP therapy is a natural process using the bodies own healing factors to stimulate the growth and regeneration of damaged tissue. This procedure is performed under ultrasound-guidance to ensure accuracy and minimize pain.