Citizendia

Tendinitis
Classification and external resources
ICD-10M77.9
ICD-9726.90
eMedicineemerg/570 
MeSHD052256

Tendinitis or tendonitis (from the Greek Τενοντίτις, 'itis' denoting inflammation or swelling) used to be thought of as a painful inflammation of a tendon, however, there is rarely much inflammation associated with the condition, thus 'tendinitis' is a redundant term, 'tendinopathy' being currently used. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings M00-M99 - Diseases of the Musculoskeletal system and Connective tissue (M00-M25 Arthropathies (M00-M03 Infectious arthropathies The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Greek (el ελληνική γλώσσα or simply el ελληνικά — "Hellenic" is an Indo-European language, spoken today by 15-22 million people mainly Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens A tendon (or sinew) is a tough band of Fibrous connective tissue that usually connects Muscle to Bone and is capable of withstanding tension More recent research indicates that tendinopathy is an overuse injury resulting in microtears in the muscle fibres, leading to an increase in tendon repair cells, yet an absence of inflammatory cells. This may lead to reduced tensile strength, thus increasing the chance of tendon rupture. Generally tendinitis is referred to by the body part involved, such as Achilles tendinitis (affecting the Achilles tendon), or patellar tendinitis (jumper's knee, affecting the patellar tendon). Achilles tendinitis is Tendinitis of the Achilles tendon, generally precipitated by overuse of the affected limb and is more common among athletes training under less The Achilles tendon (or occasionally Achilles’ tendon) also known as the calcaneal tendon or the tendocalcaneous, is a Tendon of the posterior Patellar tendinitis ( patellar tendinopathy, also known as jumper's knee) is a relatively common cause of pain in the inferior Patellar region in athletes The patellar ligament ( anterior ligament) is the central portion of the common tendon of the Quadriceps femoris, which is continued from the Patella to Chronic overuse of tendons leads to microscopic tears within the collagen matrix, which gradually weakens the tissue. Collagen is the main Protein of Connective tissue in Animals and the most abundant protein in Mammals making up about 50% of the whole-body protein

Contents

Diagnosis

Swelling in a region of micro damage or partial tear can be detected visually or by touch. Palpation used as part of a Physical examination in which an object is felt (usually with the hands of a Healthcare practitioner to determine its size shape firmness Increased water content and disorganized collagen matrix in tendon lesions may be detected by ultrasonography or magnetic resonance imaging. A lesion is any abnormal tissue found on or in an organism usually damaged by disease or trauma

Symptoms can vary from an ache or pain and stiffness to the local area of the tendon, or a burning that surrounds the whole joint around the inflamed tendon. Stiffness is the resistance of an elastic body to Deformation by an applied Force. A joint is the location at which two or more Bones make contact With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiffer the following day as swelling impinges on the movement of the tendon. Many patients report stressful situations in their life in correlation with the beginnings of pain which may contribute to the symptoms.

Treatment

Due to their highly specialised ultrastructure, low level of vascularization and slow collagen turnover, tendons and ligaments are very slow to heal if injured, and rarely regain their original strength. In Anatomy, the term ligament is used to denote three different types of structures Fibrous tissue that connects Bones to other bones Partial tears heal by the rapid production of disorganized type-III collagen, which is weaker than normal tendon. Collagen type III alpha 1 (Ehlers-Danlos syndrome type IV autosomal dominant, also known as COL3A1, is a human Gene. Recurrence of injury in the damaged region of tendon is common.

Standard treatment of tendon injuries is largely palliative. Palliative care (from Latin palliare to cloak is any form of medical care or treatment that concentrates on reducing the severity of Disease Symptoms Use of non-steroidal anti-inflammatory drugs combined with rest and gradual return to exercise is a common therapy, although there is evidence to suggest that tendinitis is not an inflammatory disorder, and that anti-inflammatory drugs are not an effective treatment[1] and that inflammation does not cause tendon dysfunction. Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAID s or NAID s, are drugs with Analgesic, Antipyretic and in higher [2]

On-going research

Both eccentric loading and extracorporeal shockwave therapy are currently being researched as possible treatments for tendinitis. A muscles contraction (also known as a muscle twitch or simply twitch) occurs when a Muscle fibre generates tension through the action of Actin Extracorporeal Shockwave Therapy or ESWT is a method of treatment of Kidney stones (Extracorporeal Shockwave Lithotripsy shoulder Tendinitis, and other One study found both modalities to be equally effective in treating tendinosis of the Achilles tendon and more effective than a 'wait and see' approach. Tendinosis, sometimes called chronic tendinitis chronic Tendinopathy or chronic tendon injury is damage to a Tendon at a cellular level [3] Other treatments for which research is on-going includes vitamin E, nitric oxide and stem cell injections. Tocopherol, a class of chemical compounds of which many have Vitamin E activity describes a series of Organic compounds consisting of various methylated phenols Nitric oxide or nitrogen monoxide is a Chemical compound with Chemical formula N[[Oxygen O]] Stem cells are cells found in most if not all multi-cellular Organisms.

Eccentric loading

Perhaps the most promising avenue of therapy is indicated in a line of research finding dramatic rates of recovery including complete remodeling of chronically damaged tendon tissue with eccentric loading,[4][5][6][7][8][9][10][11] though eccentric loading may be less effective among non-athletes. A muscles contraction (also known as a muscle twitch or simply twitch) occurs when a Muscle fibre generates tension through the action of Actin [12] However, a 2007 meta-analysis suggested that there is insufficient research to support the use of eccentric loading for the treatment of damage to tendons. In Statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses [13]

Inflatable brace

The use of an inflatable brace (AirHeel) was shown to be as effective as eccentric loading in the treatment of chronic Achilles tendinopathy. Both modalities produced significant reduction in pain scores, but their combination was no more effective than either treatment alone. [14]

Shock-wave therapy

Shock-wave therapy (SWT) may be effective in treating calcific tendinitis in both humans[15] and rats. Extracorporeal Shockwave Therapy or ESWT is a method of treatment of Kidney stones (Extracorporeal Shockwave Lithotripsy shoulder Tendinitis, and other Calcific Tendinitis (also calcific / calcifying / calcified / calcareous tenonitis / tendonitis / tendinopathy, and Rats are various medium sized long-tailed Rodents of the superfamily Muroidea [16] In rat subjects, SWT increased levels of healing hormones and proteins leading to increased cell proliferation and tissue regeneration in tendons. Insulin-like growth factor 1 (IGF-1 that was once called somatomedin C is a Polypeptide Protein Hormone similar in Molecular structure Transforming growth factor beta 1 or TGF-β1 is a polypeptide member of the Transforming growth factor beta superfamily of Cytokines It is a secreted protein Another study found no evidence that SWT was useful in treating chronic pain in the Achilles tendon. Chronic pain is defined as Pain that persists longer than the temporal course of natural healing associated with a particular type of injury or disease process [17]

Vitamin E

Vitamin E has been found to increase the activity of fibroblasts, leading to increased collagen fibrils and synthesis, which seems to speed up the regeneration and increase the regenerative capacity of tendons. Tocopherol, a class of chemical compounds of which many have Vitamin E activity describes a series of Organic compounds consisting of various methylated phenols A fibroblast is a type of cell that synthesizes and maintains the Extracellular matrix of many Animal tissues [18][19]

Nitric oxide

Nitric oxide (NO) also appears to play a role in tendon healing[20] and inhibition of NO synthesis impairs tendon healing. Nitric oxide or nitrogen monoxide is a Chemical compound with Chemical formula N[[Oxygen O]] [21] Supplementing with arginine, the amino acid that the body uses to form NO, may be useful in tendon healing. Arginine (abbreviated as Arg or R) is an α- Amino acid. The L-form is one of the 20 most common natural amino acids In Chemistry, an amino acid is a Molecule containing both Amine and Carboxyl Functional groups In Biochemistry, this [22] The use of a NO delivery system (glyceryl trinitrate patches) applied over the area of maximal tenderness was tested in three clinical trials for the treatment of tendinopathies and was found to significantly reduce pain and increase range of motion and strength. Glyceryl trinitrate (GTN has been used to treat angina and Heart failure since at least 1870 [23]

Common tendonitis injuries

Tendinous injuries are common in the upper and lower limbs (including the rotator cuff attachments), and are less common in the hips and torso. The rotator cuff (rotor cuff is an anatomical term given to the group of Muscles and their Tendons that act to stabilize the Shoulder. Individual variation in frequency and severity of tendinitis will vary depending on the type, frequency and severity of exercise or use; for example, rock climbers tend to develop tendinitis in their fingers, swimmers in their shoulders. Achilles tendinitis is a common injury, particularly in sports that involve lunging and jumping while Patellar tendinitis is a common among basketball and volleyball players owing to the amount of jumping and landing. Achilles tendinitis is Tendinitis of the Achilles tendon, generally precipitated by overuse of the affected limb and is more common among athletes training under less The patella or kneecap is a thick triangular Bone which articulates with the Femur and covers and protects the knee joint Basketball is a team Sport in which two teams of five active players each try to score points against one another by propelling a ball through a 10 feet (3 m Volleyball is an Olympic team sport in which two teams of 6 active players (5 normal players and one 'libero' are separated by a net that is usually four feet [24]

A veterinary equivalent to Achilles tendinitis is bowed tendon, tendinitis of the superficial digital flexor tendon of the horse. Tendinitis /tendonitis is Inflammation of a Tendon. Many times the tendon tissue is torn The horse ( Equus caballus) is a hoofed ( Ungulate) Mammal, one of eight living species of the family Equidae.

See also

References

  1. ^ Khan, K. A repetitive strain injury (RSI also called cumulative trauma disorder ( CTD) occupational overuse syndrome, or work related upper limb disorder Stenosing tenosynovitis is the progressive restriction of the sheath surrounding a Tendon, causing Inflammation ( Tenosynovitis) Tenosynovitis is the Inflammation of the Fluid -filled sheath (called the Synovium) that surrounds a Tendon. Tendinosis, sometimes called chronic tendinitis chronic Tendinopathy or chronic tendon injury is damage to a Tendon at a cellular level Orthopedic surgery or orthopedics (also spelled orthopaedics) is the branch of Surgery concerned with injuries to or conditions involving the Tennis elbow is a condition where the outer part of the elbow becomes painful and tender Tension myositis syndrome ( TMS) is a name M. ; Cook, J. L. , Kannus, P. , Maffulli, N. , Bonar, S. F. (2002-03-16). "Time to abandon the "tendinitis" myth: Painful, overuse tendon conditions have a non-inflammatory pathology". British Medical Journal 324: 626-627. doi:10.1136. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document.  
  2. ^ Marsolais D, Duchesne E, Côté CH, Frenette J. (2007). "Inflammatory cells do not decrease the ultimate tensile strength of intact tendons in vivo and in vitro: protective role of mechanical loading. ". J Appl Physiol 102 (1): 3-4. PMID 16916923.  
  3. ^ Rompe JD, Nafe B, Furia JP, Maffulli N (2007). "Eccentric loading, shock-wave treatment, or a wait-and-see policy for tendinopathy of the main body of tendo Achillis: a randomized controlled trial". Am J Sports Med 3 (35): 374-83. PMID 17244902.  
  4. ^ Alfredson Tom , MD, Håkan; Pietilä, T. , Jonsson, P. & Lorentzon, R. (1998). "Heavy-Load Eccentric Calf Muscle Training For the Treatment of Chronic Achilles Tendinosis". The American Journal of Sports Medicine 26: 360-366. American Orthopaedic Society for Sports Medicine.  
  5. ^ Mafi, N. ; Lorentzon R. & Alfredson H. (2001). "Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis.". Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 9 (1): 42-47. Springer International. 11269583.  
  6. ^ Fahlstrom . , M. ; Jonsson P. , Lorentzon R. & Alfredson H. (2003). "Chronic Achilles tendon pain treated with eccentric calf-muscle training.". Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 11 (5): 327-333. Springer International. 12942235.  
  7. ^ Roos, E. M. ; Engstrom M. , Lagerquist A. & Soderberg B. (2004). "Clinical improvement after 6 weeks of eccentric exercise in patients with mid-portion Achilles tendinopathy -- a randomized trial with 1-year follow-up.". Scandinavian Journal of Medicine & Science in Sports 14 (5): 286-295. Munksgaard International Publishers. 15387802.  
  8. ^ Öhberg, L. ; Lorentzon R. & Alfredson H. (2004). "Eccentric training in patients with chronic Achilles tendinosis: normalised tendon structure and decreased thickness at follow up". British Journal of Sports Medicine 38: 8-11. BMJ Publishing Group Ltd. . doi:10.1136/bjsm.2001.000284. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document.  
  9. ^ >Jonsson, P. ; Alfredson H. (2005). "Superior results with eccentric compared to concentric quadriceps training in patients with jumper's knee: a prospective randomised study.". British journal of sports medicine 39 (11): 847-850. BMJ Publishing Group. 16244196.  
  10. ^ Wilson, J. J. ; Best, T. M. (2005). "Common overuse tendon problems: A review and recommendations for treatment" (PDF). American Family Physician 72 (5): 811-818. American Academy of Family Physicians. .  
  11. ^ Rees, J. D. ; Wilson A. M. & Wolman R. L. (2006). "Current concepts in the management of tendon disorders.". Rheumatology 45 (5): 508-521. Oxford University Press. 16490749.  
  12. ^ Sayana MK, Maffulli N. (2007). "Eccentric calf muscle training in non-athletic patients with Achilles tendinopathy". J Sci Med Sport 1 (10): 52-8. PMID 16828343.  
  13. ^ Woodley BL, Newsham-West RJ, Baxter GD (2007). "Chronic tendinopathy: effectiveness of eccentric exercise". Br J Sports Med 4 (41): 188-98. PMID 17062655.  
  14. ^ Petersen W, Welp R, Rosenbaum D (June 14, 2007). "Chronic Achilles Tendinopathy: A Prospective Randomized Study Comparing the Therapeutic Effect of Eccentric Training, the AirHeel Brace, and a Combination of Both". Am J Sports Med. PMID 17569792.  
  15. ^ Cacchio A, Paoloni M, Barile A, Don R, de Paulis F, Calvisi V, Ranavolo A, Frascarelli M, Santilli V, Spacca G (2006). "Effectiveness of radial shock-wave therapy for calcific tendinitis of the shoulder: single-blind, randomized clinical study". Phys Ther 5 (86): 672-82. PMID 16649891.  
  16. ^ Chen YJ, Wang CJ, Yang KD, Kuo YR, Huang HC, Huang YT, Sun YC, Wang FS (2004). "Extracorporeal shock waves promote healing of collagenase-induced Achilles tendinitis and increase TGF-beta1 and IGF-I expression". J Orthop Res 22 (4): 854-61. doi:10.1016/j.orthres.2003.10.013. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 15183445.  
  17. ^ Costa ML, Shepstone L, Donell ST, Thomas TL (2005). "Shock wave therapy for chronic Achilles tendon pain: a randomized placebo-controlled trial". Clin Orthop Relat Res (440): 199-204. PMID 16239807.  
  18. ^ Gonzalez, Santander R; Plasencia Arriba MA, Martinez Cuadrado G, Gonzalez-Santander Martinez M & Monteagudo de la Rosa M. (1996). "Effects of "in situ" vitamin E on fibroblast differentiation and on collagen fibril development in the regenerating tendon. ". The International Journal of Developmental Biology 1 (Supplemental): 181-182. University Of The Basque Country Press. PMID 9087752.  
  19. ^ Plasencia. , M. A. ; Ortiz C. , Vazquez B. , San Roman J. , Lopez-Bravo A. , Lopez-Alonso A. (1999). "Resorbable polyacrylic hydrogels derived from vitamin E and their application in the healing of tendons. ". Journal of Materials Science. Materials in Medicine 10 (10/11): 641-648. Kluwer Academic Publishers. PMID 15347979.  
  20. ^ Xia, W. ; Szomor Z. , Wang Y. & Murrell G. A. (2006). "Nitric oxide enhances collagen synthesis in cultured human tendon cells.". Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society 24 (2): 159-172. Wiley. 16435353.  
  21. ^ Darmani, H. ; Crossan J. C. & Curtis A. (2004). "Single dose of inducible nitric oxide synthase inhibitor induces prolonged inflammatory cell accumulation and fibrosis around injured tendon and synovium.". Mediators of Inflammation 13 (3): 157-164. Hindawi Pub. Corp. . 15223606.  
  22. ^ Erickson, Laurie (2002-07-01). See also 2002 (disambiguation Year 2002 ( MMII) was a Common year starting on Tuesday of the Gregorian calendar. "July 1st" redirects here For the Ayumi Hamasaki song see H (song. Future Treatments. Retrieved on 2007-04-02. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 68 - Galba, Governor of Hispania, names himself legatus senatus populique Romani, breaking the line of
  23. ^ Murrell GA. (2007). "Using nitric oxide to treat tendinopathy". Br J Sports Med 41 (4): 227-31. doi:10.1136/bjsm.2006.034447. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 17289859.  
  24. ^ Mayo Clinic (2007). Mayo Clinic is a Non-profit medical practice Its headquarters the Mayo Medical School and its research facilities are in Rochester Minnesota in Patellar tendinitis. Retrieved on 2007-06-04. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 781 BC - The first historic Solar eclipse is recorded in China.

External links

Dictionary

tendinitis

-noun

  1. (pathology) Inflammation of a tendon.
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