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 type of tendon injury is known 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, including the elbow and shoulder, as well as the lower limb, such as the Achilles or patellar tendons. Dr Masci is a tendon specialist with extensive experience in managing tendon issues. Having published 20 peer-reviewed papers and been invited to present at international conferences on tendonitis, he is renowned as an authority on managing complex tendon cases.
What is tendinopathy?
Tendinopathy is a term to describe a breakdown of collagen proteins within a tendon. This breakdown can occur suddenly or develop gradually over time due to tendon overload. Additionally, certain medical conditions, such as obesity or diabetes, can lead to collagen breakdown.
Tendinopathy presents with pain in the tendon that arises after activity. Everyday activities that cause pain include running for Achilles tendinopathy and jumping for Patellar tendinopathy. Essentially, a tendon specialist can detect and diagnose these conditions early, thereby enhancing the potential for recovery and improved performance.
How do we diagnose tendinopathy?
We recognise most cases by a description of typical inflammatory pain. However, an examination is essential 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 reveals typical changes associated with collagen breakdown and increased blood flow.
How is tendinopathy managed?
We know that most tendons that show collagen breakdown do not respond to rest. Additionally, previous treatments, such as anti-inflammatory tablets, which were once thought to help alleviate tendon pain, may delay healing. We now know that patients with tendinopathy respond to an exercise programme. How and why patients respond to exercise is unknown, but it 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 for tendonitis suggests that the benefits are short-term. Surgery has a limited role in the treatment of tendonitis, reserved for select cases.
There is no one-size-fits-all approach for tendonitis in different parts of the body. Each tendon requires a specialised approach using one or more available options. Click on the common tendonitis conditions to learn about how we manage these cases differently.
