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Tendinitis — Clinical Guidelines

Overview

Tendinitis, often a form of tendinopathy, involves inflammation or degeneration of tendons, commonly affecting areas subjected to repetitive stress such as the shoulder, elbow, knee, and Achilles. It manifests as pain, swelling, and impaired function 1 2 3 26 32.

Diagnosis

Clinical Presentation: Pain exacerbated by activity, localized tenderness, and sometimes palpable thickening of the tendon 1 26.

Imaging: Ultrasound and MRI are useful for visualizing tendon abnormalities, including calcifications and tears 1 12 18.

Grading: Various grading systems exist, such as the Patellar Tendinopathy Grading Scale, which categorizes severity based on symptoms and functional impairment 32.

Management

First-Line Treatments:

- Physical Therapy: Focus on eccentric exercises to strengthen the tendon 1 2 3 26 32. - Activity Modification: Reducing repetitive strain and load on the affected tendon 1 2 3 26 32.

Adjunctive Treatments:

- Platelet-Rich Plasma (PRP) Injections: Guided by ultrasound for tendinopathies, showing potential benefits in some studies 1 9 13 14. - Corticosteroid Injections: Can provide short-term relief but may have adverse effects on tendon integrity 14. - Other Therapies: Ultrasound-guided dry needling, percutaneous electrolysis, and transcatheter arterial embolization for refractory cases 2 17 18.

Special Populations

Pediatrics: Limited evidence; conservative management with physical therapy is typically recommended 32.

Elderly: Age-related changes may complicate diagnosis and treatment; focus on conservative measures with close monitoring 1 32.

Comorbidities: Patients with conditions affecting healing (e.g., diabetes) may require extended rehabilitation periods and closer follow-up 32.

Key Recommendations

Initiate Eccentric Strengthening Exercises as first-line therapy to improve tendon resilience and reduce pain (Evidence: Strong 1 2 3 26 32).

Consider PRP Injections under ultrasound guidance for chronic refractory cases, though efficacy varies (Evidence: Moderate 1 9 13 14).

Avoid Frequent Corticosteroid Injections due to potential long-term tendon weakening (Evidence: Moderate 14).

Utilize Imaging Techniques (ultrasound, MRI) for accurate diagnosis and monitoring of tendinopathy progression (Evidence: Moderate 1 12 18).

Tailor Rehabilitation Programs to individual patient needs, especially in special populations like the elderly or those with comorbidities (Evidence: Expert opinion 32).

References

1 Masiello F, Pati I, Veropalumbo E, Pupella S, Cruciani M, De Angelis V. Ultrasound-guided injection of platelet-rich plasma for tendinopathies: a systematic review and meta-analysis. Blood transfusion = Trasfusione del sangue 2023. link 2 Asensio-Olea L, Leirós-Rodríguez R, Marqués-Sánchez MP, de Carvalho FO, Maciel LYS. Efficacy of percutaneous electrolysis for the treatment of tendinopathies: A systematic review and meta-analysis. Clinical rehabilitation 2023. link 3 Chen Q, Shen P, Zhang B, Chen Y, Zheng C. Treatment outcomes of tendinitis of long head of the biceps brachii tendon by different surgeries based on the concept of enhanced recovery after surgery. Joint diseases and related surgery 2023. link 4 Etemadi F, Tabatabaei Naeini A, Aminlari M. Assessment of calcium, phosphorus, magnesium, vitamin D and PTH levels in sera of lame horses. Veterinary medicine and science 2023. link 5 Ji LH, Zhao CL, Wang YQ, Fu ZH. Bisphosphonates-related tendinopathies and ligament disorders: Cases analysis from the U.S. Food and Drug Administration adverse event reporting system. Bone 2023. link 6 Zhang X, Zhang Y, Zhang M, Nakagawa Y, Caballo CB, Szeto HH et al.. Evaluation of SS-31 as a Potential Strategy for Tendinopathy Treatment: An In Vitro Model. The American journal of sports medicine 2022. link 7 Liu Y, Deng XH, Zhang X, Cong T, Chen D, Hall AJ et al.. The Role of Indian Hedgehog Signaling in Tendon Response to Subacromial Impingement: Evaluation Using a Mouse Model. The American journal of sports medicine 2022. link 8 Noriega-González DC, Drobnic F, Caballero-García A, Roche E, Perez-Valdecantos D, Córdova A. Effect of Vitamin C on Tendinopathy Recovery: A Scoping Review. Nutrients 2022. link 9 Van Schaik KD, Lee KS. Orthobiologics: Diagnosis and Treatment of Common Tendinopathies. Seminars in musculoskeletal radiology 2021. link 10 Zampa V, Aringhieri G, Rossi P, Capanna R, Caramella D. Humeral greater tuberosity osteolysis as a complication of intraosseous calcification migration: natural history depicted by imaging. Acta bio-medica : Atenei Parmensis 2021. link 11 Smith RKW, McIlwraith CW. "One Health" in tendinopathy research: Current concepts. Journal of orthopaedic research : official publication of the Orthopaedic Research Society 2021. link 12 Medancic N, Spanic M, Marinic TB, Klobucar H, Cicak N. Arthroscopic removal of arch-shaped rotator cuff calcifying tendinitis without rotator cuff repair and acromioplasty is an excellent treatment regarding pain relief and function. International orthopaedics 2021. link 13 Sheean AJ, Anz AW, Bradley JP. Platelet-Rich Plasma: Fundamentals and Clinical Applications. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2021. link 14 Dadgostar H, Fahimipour F, Pahlevan Sabagh A, Arasteh P, Razi M. Corticosteroids or platelet-rich plasma injections for rotator cuff tendinopathy: a randomized clinical trial study. Journal of orthopaedic surgery and research 2021. link 15 Zhang X, Wada S, Zhang Y, Chen D, Deng XH, Rodeo SA. Assessment of Mitochondrial Dysfunction in a Murine Model of Supraspinatus Tendinopathy. The Journal of bone and joint surgery. American volume 2021. link 16 Kang S, Yoon JS, Lee JY, Kim HJ, Park K, Kim SE. Long-term local PDGF delivery using porous microspheres modified with heparin for tendon healing of rotator cuff tendinitis in a rabbit model. Carbohydrate polymers 2019. link 17 Riggin CN, Chen M, Gordon JA, Schultz SM, Soslowsky LJ, Khoury V. Ultrasound-Guided Dry Needling of the Healthy Rat Supraspinatus Tendon Elicits Early Healing Without Causing Permanent Damage. Journal of orthopaedic research : official publication of the Orthopaedic Research Society 2019. link 18 Hwang JH, Park SW, Kim KH, Lee SJ, Oh KS, Chung SW et al.. Early Results of Transcatheter Arterial Embolization for Relief of Chronic Shoulder or Elbow Pain Associated with Tendinopathy Refractory to Conservative Treatment. Journal of vascular and interventional radiology : JVIR 2018. link 19 Rettig MJ, Leelamankong P, Rungsri P, Lischer CJ. Effect of sedation on fore- and hindlimb lameness evaluation using body-mounted inertial sensors. Equine veterinary journal 2016. link 20 Lubowitz JH. Editorial Commentary: Arthroscopy Is Preferred Over Open Surgery for Patellar Tendonitis. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2015. link 21 Chirba MA, Sweetapple B, Hannon CP, Anderson JA. FDA regulation of adult stem cell therapies as used in sports medicine. The journal of knee surgery 2015. link 22 López-Sanromán FJ, Gómez Cisneros D, Varela del Arco M, Santiago Llorente I, Santos González M. The use of low doses of acepromazine as an aid for lameness diagnosis in horses: An accelerometric evaluation. Veterinary and comparative orthopaedics and traumatology : V.C.O.T 2015. link 23 Osti L, Berardocco M, di Giacomo V, Di Bernardo G, Oliva F, Berardi AC. Hyaluronic acid increases tendon derived cell viability and collagen type I expression in vitro: Comparative study of four different Hyaluronic acid preparations by molecular weight. BMC musculoskeletal disorders 2015. link 24 Cook JL, Purdam CR. The challenge of managing tendinopathy in competing athletes. British journal of sports medicine 2014. link 25 Campbell AL, Smith NC, Reilly JH, Kerr SC, Leach WJ, Fazzi UG et al.. IL-21 receptor expression in human tendinopathy. Mediators of inflammation 2014. link 26 Scott A, Docking S, Vicenzino B, Alfredson H, Murphy RJ, Carr AJ et al.. Sports and exercise-related tendinopathies: a review of selected topical issues by participants of the second International Scientific Tendinopathy Symposium (ISTS) Vancouver 2012. British journal of sports medicine 2013. link 27 Mishra A, Randelli P, Barr C, Talamonti T, Ragone V, Cabitza P. Platelet-rich plasma and the upper extremity. Hand clinics 2012. link 28 Millar NL, Reilly JH, Kerr SC, Campbell AL, Little KJ, Leach WJ et al.. Hypoxia: a critical regulator of early human tendinopathy. Annals of the rheumatic diseases 2012. link 29 Van Vynckt D, Samoy Y, Polis I, Bosmans T, Verschooten F, Van Ryssen B. Evaluation of two sedation protocols for use before diagnostic intra-articular anaesthesia in lame dogs. The Journal of small animal practice 2011. link 30 Finnoff JT, Willick S, Akau CK, Harrast MA, Storm SA. Sports and performing arts medicine: 6. Tendinopathy. PM & R : the journal of injury, function, and rehabilitation 2009. link 31 Millar NL, Wei AQ, Molloy TJ, Bonar F, Murrell GA. Heat shock protein and apoptosis in supraspinatus tendinopathy. Clinical orthopaedics and related research 2008. link 32 Scott A, Ashe MC. Common tendinopathies in the upper and lower extremities. Current sports medicine reports 2006. link 33 Wainstein JL, Nailor TE. Tendinitis and tendinosis of the elbow, wrist, and hands. Clinics in occupational and environmental medicine 2006. link 34 Orchard JW, Cook JL, Halpin N. Stress-shielding as a cause of insertional tendinopathy: the operative technique of limited adductor tenotomy supports this theory. Journal of science and medicine in sport 2004. link80259-7) 35 Cook JL, Purdam CR. Rehabilitation of lower limb tendinopathies. Clinics in sports medicine 2003. link00007-3) 36 Khan K, Cook J. The painful nonruptured tendon: clinical aspects. Clinics in sports medicine 2003. link00035-8) 37 Osbahr DC, Diamond AB, Speer KP. The cosmetic appearance of the biceps muscle after long-head tenotomy versus tenodesis. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2002. link 38 Khan KM, Cook JL, Bonar F, Harcourt P, Astrom M. Histopathology of common tendinopathies. Update and implications for clinical management. Sports medicine (Auckland, N.Z.) 1999. link 39 Uhthoff HK, Sarkar K. Classification and definition of tendinopathies. Clinics in sports medicine 1991. link 40 Seeherman HJ, Morris E, O'Callaghan MW. The use of sports medicine techniques in evaluating the problem equine athlete. The Veterinary clinics of North America. Equine practice 1990. link30565-5) 41 Hoffman GS. Tendinitis and bursitis. American family physician 1981. link 42 Mariani PP, Puddu G, Ferretti A. Jumper's knee. Italian journal of orthopaedics and traumatology 1978. link

Tendinitis