Practice Essentials

Tendonitis is an inflammatory condition characterized by pain at tendinous insertions into bone. The term tendinosis refers to the histopathologic finding of tendon degeneration. The term tendinopathy is a generic term used to describe a common clinical condition affecting the tendons, which causes pain, swelling, or impaired performance. Because of the fact that most pain from tendon conditions is not actually inflammatory in nature, tendinopathy may be a better term than tendonitis.

Common sites of tendinopathy include the following:

Rotator cuff of the shoulder (ie, supraspinatus) and bicipital tendons
Insertion of the wrist extensors (ie, lateral epicondylitis, tennis elbow) and flexors (ie, medial epicondylitis) at the elbow
Patellar and popliteal tendons and iliotibial band at the knee
Insertion of the posterior tibial tendon in the leg (ie, shin splints)
Achilles tendon at the heel

Pathophysiology

Tendons transmit the forces of muscle to the skeleton. As such, they are subjected to repeated mechanical loads, which are felt to be a major causative factor in the development of tendinopathy. Pathologic findings include tendon inflammation, mucoid degeneration, and fibrinoid necrosis in tendons. Microtearing and proliferation of fibroblasts have also been reported. However, the exact pathogenesis of tendinopathy is unclear.

Epidemiology

Middle-aged adults are most susceptible to the development of tendinopathy.

Prognosis

In general, the prognosis is very good with rest and conservative therapy. Chronic tendinopathy can lead to weakening of the tendon and subsequent rupture. Complications of tendonitis may include chronic disability, tendon rupture, and adhesive capsulitis (ie, frozen shoulder).

Patient Education

Quadriceps strengthening exercises is helpful for patellar tendinopathy and change in training routine and/or equipment, if indicated. Runners with Achilles tendinopathy should wear proper footwear, run on softer surfaces, and avoid hills. Patients with tennis elbow should maintain proper backhand technique, use a less tightly strung racket, and play on slower surfaces. Range-of-motion exercises are recommended for patients with rotator cuff tendinopathy to avoid complication of adhesive capsulitis.

For patient education information, see Tendinitis and Tennis Elbow.

Clinical Presentation

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Media Gallery

Hawkins test. The examiner forward flexes the arms to 90° and then forcibly internally rotates the shoulder. This movement pushes the supraspinatus tendon against the anterior surface of the coracoacromial ligament and coracoid process. Pain indicates a positive test result for supraspinatus tendonitis.
Speed test.
Yergason test.
The proximal patellar tendon is most commonly affected in jumper's knee.
Iliotibial band at the lateral femoral condyle, with the posterior fibers denoted.
The Ober test.

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Author

Mark Steele, MD Professor, Department of Emergency Medicine, Chief Medical Officer, Truman Medical Center, University of Missouri-Kansas City School of Medicine

Mark Steele, MD is a member of the following medical societies: American Academy of Emergency Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Jeffrey G Norvell, MD, MBA, RDMS Associate Professor, Program Director, Department of Emergency Medicine, University of Kansas Medical Center

Jeffrey G Norvell, MD, MBA, RDMS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Gino A Farina, MD, FACEP, FAAEM Professor of Emergency Medicine, Hofstra North Shore-LIJ School of Medicine at Hofstra University; Program Director, Department of Emergency Medicine, Long Island Jewish Medical Center

Gino A Farina, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Richard S Krause, MD Senior Clinical Faculty/Clinical Assistant Professor, Department of Emergency Medicine, University of Buffalo State University of New York School of Medicine and Biomedical Sciences

Richard S Krause, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Tendonitis

Practice Essentials

Pathophysiology

Epidemiology

Prognosis

Patient Education

References

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