Corpus: Tendinopathy

Tendinopathies are diseases of the tendons that usually manifest themselves through pain and restricted movement. If the tendon insertion is primarily affected, this is referred to as insertional tendopathy.

The terms "tendopathy", "tendinopathy", "tendinosis" and "tendinitis" are often used synonymously in everyday clinical language. A clear distinction between the terms is not always recognisable. While "tendopathy" can be used for any form of pathological tendon changes, "tendinosis" is primarily a non-inflammatory, degenerative tendon disease. Tendinitis", on the other hand, should be used when inflammatory processes (redness, swelling, etc.) are in the foreground.

Misuse and overloading (tonic and kinetic) lead to so-called microtraumas, particularly in the tendons and tendon insertions of strong muscles. If these cannot heal adequately, this leads to permanent degenerative changes in the form of angiofibroblastic hyperplasia.

Morphologically, tendopathy is characterised by heterotopic ossifications, i.e. ossification of the tendon insertions and calcium deposits in the course of the tendon.

Tendopathies can be further differentiated into:

• Paratendinoses
• Myotendinosis
• Tendinitis
• Tendinosis
• Bursitis
• Enthesiopathies/insertional tendinopathies

Tendovaginitis is present if the tendon sheath is primarily affected.

In a broader sense, tendopathies also include traumatic tendon diseases such as tendon ruptures.

Tendopathy becomes symptomatic primarily due to the secondary inflammation caused by the mechanical irritation, which results in the following symptoms, among others.

• Local pressure pain
• Pain during movement
• Restriction of function of the affected limb sections

The diagnosis of tendopathy is based on clinical examination, sonography and X-ray.

Sonography shows oedematous loosening in the surrounding tissue. X-rays show ossification of the tendon insertions and calcified concretions in the course of the tendon.

The aim of therapy is to eliminate the tendon overload and inhibit the inflammatory reaction, for example by taking the following measures:

• consistent protection of the affected sections
  • If necessary, immobilisation with a plaster cast or functional bandage
• Cooling with ice (only useful in the acute stage)
• Pain treatment with non-steroidal anti-inflammatory drugs (NSAIDs)
• Anti-inflammatory ointments
• Ultrasound therapy
• iontophoresis

In the case of resistance to therapy, surgery (e.g. denervation according to Wilhelm) can bring relief.