Contents
Definition
- Tendinopathy is thought to be an adaptive response of the tendon to repetitive stress and/or trauma and may progress through stages of increasing severity. It can be considered in 3 stages1
- Reactive tendinopathy
- Response to rapid increase in loading or from direct trauma
- Leads to thickening of the tendon and increases stiffness
- Tendon disrepair
- A result of prolonged excessive loading
- May lead to increase in vascularity and neuronal ingrowth
- Degenerative tendinopathy
- Chronic overloading leading to collagen tissue becoming disorganized which may lead to partial tears and ruptures (typically in elderly)
- The mechanism of injury may vary between inflammation of the fluid-filled sheath surrounding the tendon (tenosynovitis), tendinopathy, tendon disruption and tendon instability2
- Reactive tendinopathy
Causes
- Overuse as a result of repetitive loading of the muscle like that of sporting activity
- Irritation caused by repetitive flexion and extension of the wrist, particularly in supination
- Fall on the hand or lateral force applied to the wrist when the muscle is engaged in strong isometric contraction
Localization
- Tenoperiost of the posterior aspect of lateral epicondyle of the humerus
Risk factors
- If the patient is not prone to repetitive chronic overloading activities, inflammatory conditions such as rheumatoid arthritis can be considered
Examination
- Resisted extension of the wrist with elbow extended – painful and weak
- Resisted ulnar deviation – painful and weak
- Palpation can be used to pinpoint the location of the lesion