Tendinosis

Tendinosis is also known as chronic tendinitis, chronic tendinopathy, and tendinosus.

Tendinosis is sometimes called chronic tendinitis and describes a tendon injury that continues to cause pain due to its slow healing properties. In the musculoskeletal system, the tendon is a connective tissue that connects bone to muscle. The tendons in our body are built for strength and some flexibility, though they may strained or possibly rupture when enough pressure has been put on it due to repetitive strain or a trauma. While the condition of tendonitis literally means inflammation of the tendon, the repetitive strain or trauma that results in tendinosis results in damage to the structure at the cellular level.

As a result of the trauma, the tendon suffers from micro-tears within the tendon structure and along the tendon sheath which supports it. As a result of the micro-tears within and around the tendon, there is an increase in the activity of the tendon repair cells. The resulting tears and regeneration cell activity may result in a reduction of the tensile strength of the overall structure, making it vulnerable to rupture. This condition is sometimes classified as tendinitis despite the fact that there is often no inflammation involved with a tendinosis injury. Inflammation is a symptom of tendinitis but not tendinosis.

An examination of the cellular structure of the tendon cells may help to confirm the diagnosis of Tendinosis. Upon diagnostic testing using Magnetic Resonance Magnetic Resonance Imaging (MRI) or Ultrasound, an expert may observe degenerative changes in the collagenous matrix, hypercellularity, and little evidence of inflammatory cell activity.



Symptoms: A person will typically seek medical help due to pain, swelling, or stiffness in the structures supported by that muscle and supporting tendon. Upon physical examination, the doctor may observe swelling or tearing of the tendon through touch or visual examination.

Diagnostic imaging modalities such as MRI and Ultrasound may show an increased water content and disorganized collagen matrix in tendon lesions.

The symptoms of pain and stiffness may be localized around the affected tendon, or there may be a greater area of burning pain around the entire joint that tendon supports.

The severity of symptoms usually increases during and following exercise activity and extended use of that body part. Following exercises and activities that aggravate affected tendon, the tendon and joint may be more swollen and stiff the following morning.

Diagnosis: Though tests such as the MRI may help doctors to confirm the soft tissue damage, tears or partial tears of the tendon may be detected through touch upon physical examination. The pain, swelling, and stiffness associated with this injury may be experienced during and after exercise or activities that put added stress on the involved soft tissues. These symptoms may be heightened the next day after the activity.

There seems to be a psychological component to this condition as well, as many patients with this condition report increased symptoms following stressful life events.

Treatment: Because tendons have a poor blood supply, they are slow to heal when they sustain micro-tears or changes at the cellular level. Even when the tendons to repair themselves, the healed structures are often not as strong as before the injury. When these tendons do sustain major injury, they immediately begin replacing the damaged tissue through the production of disorganized type-III collagen. This replacement tissue is not as strong, and the patient will be more vulnerable to the recurrence of the original injury.

Rest and the avoidance of the activity that caused the injury in the first place are two important factors in the healing process. Physical therapy may accelerate the healing process. Anti-inflammatories are not considered to be effective in treating this condition.

Some innovative treatments for this condition that have shown a lot of promise include:
  • Eccentric Loading
  • Inflatable Braces
  • Nitric Oxide
  • Shock-wave Therapy
  • Soft Tissue Mobilization
  • Tendon Bioengineering
  • Vitamin B6
  • Vitamin E