Unlike muscle injuries which heal quickly, tendon injuries are slower to repair.

Often, tendon injuries require expert assessment and management to permit a return to previous activity.  The most common tendon injury is referred to as tendonitis.  However, we now use the term tendinopathy as a more suitable description covering the spectrum of tendon injuries.  Tendinopathy affects the upper limb such as the elbow and shoulder and the lower limb such as the Achilles or Patellar tendon.  Dr Masci is a tendon specialist with broad experience in management of tendon issues.  Having published 20 peer-reviewed papers and invited to present at international conferences on tendonitis, he is renowned as an authority on managing difficult tendon cases.

tendonitis

What is tendinopathy?

Tendinopathy is a term to describe a breakdown of collagen proteins within a tendon. This breakdown can occur suddenly or over time due to gradual tendon overload. Also, certain medical diseases such as obesity or diabetes can lead to collagen breakdown.

Tendinopathy presents with pain arising from the tendon after activity. Common activities that cause pain include running for Achilles tendinopathy and jumping for Patellar tendinopathy.  Essentially, a tendon specialist is able to detect and diagnose these conditions early, enhancing the potential for recovery and performance. 

How do we diagnose tendinopathy?

We recognise most cases by a description of typical inflammatory pain. However, an examination is important to rule out other causes of pain. For example, pain close to the Achilles could be due to swelling in the ankle joint. Likewise imaging of the tendon is helpful in complex cases. Ultrasound shows typical changes of collagen breakdown and increased blood flow.

jumpers knee on ultrasound
patellar tendonitis

How is tendinopathy managed?

We know that most tendons that show collagen breakdown do not respond to rest. In addition, previous treatments such as anti-inflammatory tablets, once thought to help tendon pain, may in fact delay healing. We now know that patients with tendinopathy respond to an exercise programme. How and why patients respond to exercise is unknown but might be due to the stimulatory effects of exercise on collagen.

In addition to exercise, Dr Masci uses other treatments such as shockwave therapy, GTN patches and injections. A recent review of injections in tendonitis suggests that the benefits are short term. Surgery has little role in the treatment of tendonitis only reserved for selective cases.

There is not a one size fits all approach for tendonitis in different parts of the body. Each tendon requires a specialised approach using one of more available options. Click on the common tendonitis conditions  to learn about how we manage these cases differently.