Tendonitis

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Tendonitis
Classification & external resources
ICD-9 726.90
eMedicine emerg/570 
MeSH D052256

Tendonitis (also spelled tendinitis) is an inflammation of a tendon. Generally tendonitis is referred to by the body part involved, such as Achillies tendonitis (inflammation of the Achilles tendon), or patellar tendonitis (jumper's knee; inflammation of the patellar tendon). Chronic overuse of tendons leads to microscopic tears within the collagen matrix, which gradually weakens the tissue. Tendonitis can also be associated with systemic inflammatory diseases such as rheumatoid arthritis.[citation needed]

Contents

[edit] Diagnosis

Swelling in a region of micro damage or partial tear can be detected visually or by touch. Increased water content and disorganized collagen matrix in tendon lesions may be detected by ultrasonography or magnetic resonance imaging.

Symptoms can vary from an ache or pain and stiffness to the local area of the tendon, or a burning that surrounds the whole joint around the inflamed tendon. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiffer the following day as swelling impinges on the movement of the tendon.

[edit] Treatment

Due to their highly specialised ultrastructure, low level of vascularization and slow collagen turnover, tendons and ligaments are very slow to heal if injured, and rarely regain their original strength. Partial tears heal by the rapid production of disorganized type-III collagen, which is weaker than normal tendon. Recurrence of injury in the damaged region of tendon is common.

Standard treatment of tendon injuries is largely palliative. Non-steroidal anti-inflammatory drugs combined with rest and gradual return to exercise is a common therapy, but there is evidence to suggest that tendonitis is not an inflammatory disorder and that anti-inflammatory drugs are not effective.[1] Perhaps the most promising avenue of therapy is indicated in a line of research finding dramatic rates of recovery including complete remodeling of chronically damaged tendon tissue with eccentric loading.[2][3][4][5][6][7][8][9]

[edit] Medical research

Vitamin E may speed up the regeneration of tendons through action on fibroblasts.[10][11] Research also suggests that nitric oxide plays an important role in tendon healing[12] and inhibition of NO synthesis impairs tendon healing.[13] A potential implication is the supplementing with arginine, the amino acid that the body uses to form NO.[14] Other preliminary research suggests that the injection of stem cells might promote tendon-injury healingCompletely ruptured tendons may be sutured together with or without grafted material.[14]

[edit] Common areas of tendonitis

Tendinous injuries are common in the upper and lower limbs (including the rotator cuff attachments), and are less common in the hips and torso. Individual variation in frequency and severity of tendonitis will vary depending on the type, frequency and severity of exercise or use. In example, rock climbers tend to develop tendonitis in their fingers, swimmers in their shoulders.

Achilles tendonitis is a common injury, particularly in sports that involve lunging and jumping.

A veterinary equivalent to Achilles tendonitis is bowed tendon, tendonitis of the superficial digital flexor tendon of the horse.

[edit] See also

[edit] Footnotes

  1. ^ Khan, K.M.; Cook, J.L., Kannus, P., Maffulli, N., Bonar, S.F. (2002-03-16). "Time to abandon the "tendinitis" myth: Painful, overuse tendon conditions have a non-inflammatory pathology". British Medical Journal 324: 626-627. DOI:10.1136. Retrieved on 2007-04-02. 
  2. ^ Alfredson Tom , MD, Håkan; Pietilä, T., Jonsson, P. & Lorentzon, R. (1998). "Heavy-Load Eccentric Calf Muscle Training For the Treatment of Chronic Achilles Tendinosis". The American Journal of Sports Medicine 26: 360-366. Retrieved on 2007-04-02. 
  3. ^ Mafi, N.; Lorentzon R. & Alfredson H. (2001). "Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis.". Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 9 (1): 42-47. 11269583. Retrieved on 2007-04-02. 
  4. ^ Fahlstrom ., M.; Jonsson P., Lorentzon R. & Alfredson H. (2003). "Chronic Achilles tendon pain treated with eccentric calf-muscle training.". Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 11 (5): 327-333. 12942235. Retrieved on 2007-04-02. 
  5. ^ Roos, E.M.; Engstrom M., Lagerquist A. & Soderberg B. (2004). "Clinical improvement after 6 weeks of eccentric exercise in patients with mid-portion Achilles tendinopathy -- a randomized trial with 1-year follow-up.". Scandinavian Journal of Medicine & Science in Sports 14 (5): 286-295. 15387802. Retrieved on 2007-04-02. 
  6. ^ Öhberg, L.; Lorentzon R. & Alfredson H. (2004). "Eccentric training in patients with chronic Achilles tendinosis: normalised tendon structure and decreased thickness at follow up". British Journal of Sports Medicine 38: 8-11. Retrieved on 2007-04-02. 
  7. ^ >Jonsson, P.; Alfredson H. (2005). "Superior results with eccentric compared to concentric quadriceps training in patients with jumper's knee: a prospective randomised study.". British journal of sports medicine 39 (11): 847-850. 16244196. Retrieved on 2007-04-02. 
  8. ^ Wilson, J.J.; Best, T.M. (2005). "Common overuse tendon problems: A review and recommendations for treatment" (PDF). American Family Physician 72 (5): 811-818. Retrieved on 2007-04-02. 
  9. ^ Rees, J.D.; Wilson A.M. & Wolman R.L. (2006). "Current concepts in the management of tendon disorders.". Rheumatology 45 (5): 508-521. 16490749. Retrieved on 2007-04-02. 
  10. ^ Gonzalez, Santander R; Plasencia Arriba MA, Martinez Cuadrado G, Gonzalez-Santander Martinez M & Monteagudo de la Rosa M. (1996). "Effects of "in situ" vitamin E on fibroblast differentiation and on collagen fibril development in the regenerating tendon.". The International Journal of Developmental Biology 1 (Supplemental): 181-182. 9087752. Retrieved on 2007-04-02. 
  11. ^ Plasencia., M.A.; Ortiz C., Vazquez B., San Roman J., Lopez-Bravo A., Lopez-Alonso A. (1999). "Resorbable polyacrylic hydrogels derived from vitamin E and their application in the healing of tendons.". Journal of Materials Science. Materials in Medicine 10 (10/11): 641-648. 15347979. Retrieved on 2007-04-02. 
  12. ^ Xia, W.; Szomor Z., Wang Y. & Murrell G.A. (2006). "Nitric oxide enhances collagen synthesis in cultured human tendon cells.". Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society 24 (2): 159-172. 16435353. Retrieved on 2007-04-02. 
  13. ^ Darmani, H.; Crossan J.C. & Curtis A. (2004). "Single dose of inducible nitric oxide synthase inhibitor induces prolonged inflammatory cell accumulation and fibrosis around injured tendon and synovium.". Mediators of Inflammation 13 (3): 157-164. 15223606. 
  14. ^ a b Erickson, Laurie (2002-07-01). Future Treatments. Retrieved on April 2, 2007.

[edit] External links

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