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Tendonitis, Tendinosis and Calcific Tendonitis

WHAT IS IT?

The tendons connect the muscles with the joint bones and hence transfer muscle power to bones when they move. The term tendinopathy refers to the pathological processes of tendons which may be brought about with or without inflammation.

Tendinopathy is the general term used for both tendonitis and tendinosis. Whereas tendonitis involves swelling of the tendon, the term tendinosis refers to a tendon which is painful or degenerated due to a series of problems affecting the actual tendon tissue.

Calcific tendonitis is a pathology whose origins are unknown and which is characterised by a build up of calcium on the rotator cuff tendons. There is no relationship between this pathology and work or physical activity or a calcium-rich diet. It is more frequent in females between 30 and 50 years of age. 25% of cases are bilateral. Diagnosis is mainly carried out using radiology. Spontaneous cures may occur in 90% of cases but in some cases this can lead to an intense pain crisis (shoulder hyperalgesia).

CAUSES

The shoulder is the joint with the most movement in the human body and tendinopathies are common. The tendon most commonly affected is the supraspinatus tendon.

The (vascular, mechanical and degenerative) factors which lead to rotator cuff injuries are outlined in the section on Subacromial impingement.

There are several possible causes for tendinopathy.  It has been estimated that tendon injuries represent 30-50% of all sports injuries. For instance, Achilles tendon injuries are more common in sports involving running whereas shoulder complaints tend to occur in sports involving throwing objects or requiring overhead movement.

In the realm of Sports Medicine, a frequent cause of tendon injury is excessive muscle workouts. The tendon, as it is resistant and not very elastic, may suffer from repetitive strain, responding to this overwork by swelling. Excessive, badly-managed training can also cause tendon overload. In general, excessive strain and micro-trauma injuries due to repetitive strain can be frequent causes of tendon pathology.

Tendinopathy affects people who carry out repetitive actions in the workplace, or in sporting or other routine activities. Domestic chores such as gardening, cooking or cleaning often require repetitive movements and there exists a risk of developing a tendinopathy over time.

The clinical symptoms may appear gradually or all of a sudden due to the fact that the tendon, once it is weak, may tear.

SYMPTOMS

Symptoms vary from one patient to another. The most common symptoms are pain and sensitivity in the area around the affected tendon. These symptoms may be accompanied by swelling near the injured tendon.

Frequently patients report:

• Increased pain and symptoms during activity.
• A popping sound (crepitus) when the tendon is engaged which on the whole is unpleasant and painful.
• Symptoms getting worse at night and when they get up in the morning.
• A stiff shoulder.
• In the case of calcific tendonitis the pain is more random and there may be different degrees of pain when at rest and during activity and a severe stiff pain may suddenly appear (shoulder hyperalgesia).

Often the symptoms of a shoulder tendinopathy are associated with bursitis, characterised by inflammation of the subacromial bursa.

TREATMENT

As in the case of subacromial impingement, the first step is conservative treatment with physiotherapy, non-steroidal anti-inflammatory medication and with cortico-steroid injections.

After the conservative treatment of a degenerative tendinosis and in those cases where the patient's doctor recommends a conservative treatment with plasma (PRGF®-Endoret®) of the degenerative tendon pathology, the latter will be carried out on an outpatient basis under strict aseptic conditions.

Firstly, the source of the tendinosis is located with an ultrasound scan.

Following this, approximately 4 cc of recently activated PRGF®-Endoret® plasma is injected and this is monitored using an ultrasound scan. In some cases, the volume used may vary in accordance with the size of the injured tendon and the extent of the degeneration. Another ultrasound scan carried out one or two weeks afterwards and analysis of the symptoms will establish the guidelines for the next application. In general 2-3 applications of PRGF®-Endoret® are made at intervals of 1-2 weeks.

As a rule we do not administrate anaesthetic and ice is applied following the injections.

It is essential to, from the start, combine the local application of plasma with a physiotherapy treatment due to the importance of mechanical stimulation to induce cell regeneration.