RheumatologyTier 2Disease (DEADMAN)

Tendinopathy

Description

Tendinopathy - a degenerative, overuse-related tendon disorder causing pain and dysfunction - is now understood as predominantly a degenerative (tendinosis) process rather than a primarily inflammatory one, a shift from older terminology ("tendinitis") that still persists in common usage

Extremely common, particularly in overuse-prone sites (rotator cuff, lateral epicondyle "tennis elbow," Achilles tendon, patellar tendon) and increasing with age and repetitive occupational/sporting activity

Repetitive microtrauma exceeds the tendon's capacity for repair, producing disorganised collagen structure, increased ground substance, and neovascularisation with only mild/absent classic inflammatory cell infiltrate on histology - the "-osis" (degenerative) rather than "-itis" (inflammatory) pattern, explaining the generally limited/inconsistent efficacy of anti-inflammatory treatment alone

Clinical diagnosis based on localised tendon pain, worse with specific loading activities, and focal tenderness at the affected tendon
Ultrasound or MRI can confirm and characterise the degree of tendon degeneration/thickening and identify partial tears, though clinical diagnosis is often sufficient without imaging for straightforward presentations

Eccentric loading exercise programs have the strongest evidence base for tendinopathy rehabilitation (particularly Achilles and patellar tendinopathy), promoting tendon remodelling/collagen realignment - a fundamentally different approach from simple rest
Corticosteroid injection can provide short-term pain relief but has limited/inconsistent long-term benefit and some evidence of a negative effect on tendon structure/healing with repeated use - used cautiously and sparingly given this concern
NSAIDs provide symptomatic relief but do not address the underlying degenerative process, consistent with the shift away from viewing tendinopathy as primarily inflammatory

Rotator cuff tendinopathy, lateral/medial epicondylitis, Achilles tendinopathy, patellar tendinopathy, tendon rupture (a recognised complication of severe/neglected tendinopathy, or associated with fluoroquinolone use)

The shift from "tendinitis" to "tendinopathy/tendinosis" reflects a genuine change in understanding the underlying pathology (degenerative, not primarily inflammatory) - this directly explains why rest and anti-inflammatories alone are often insufficient, and why active, structured loading-based rehabilitation is now the evidence-based cornerstone of treatment

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