Rheumatology Advance Access originally published online on February 20, 2006
Rheumatology 2006 45(5):508-521; doi:10.1093/rheumatology/kel046
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
REVIEW |
Current concepts in the management of tendon disorders
1 Institute of Orthopaedics and Musculo-Skeletal Science, Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP and 2 Defence Medical Rehabilitation Centre, Headley Court, Surrey KT18 6JN, UK.
Correspondence to: J. D. Rees. E-mail: j.rees{at}doctors.org.uk
Primary disorders of tendons are common and constitute a high proportion of referrals to rheumatologists. Certain tendons are particularly vulnerable to degenerative pathology; these include the Achilles, patella, elements of the rotator cuff, forearm extensors, biceps brachi and tibialis posterior tendons. Disorders of these tendons are often chronic and can be difficult to manage successfully in the long term.
Significant advances have been made in understanding the pathophysiology of these conditions. Histopathological evidence, together with advances in imaging techniques, has made us more appreciative of the degenerative (rather that inflammatory) nature of these conditions. Additionally the presence of neovascularization is now well-recognized in long-standing tendinopathy.
We review the mechanical, vascular and developing neural theories that attempt to explain the aetiology of degenerative tendinopathy. We also explore theories of why specific tendons (such as the Achilles and supraspinatus tendons) are particularly prone to degenerative pathology.
Traditionally, treatments have placed a heavy emphasis on anti-inflammatory strategies, which are often inappropriate. Recently, however, significant advances in the practical management of tendon disorders have been made. In particular the advent of ‘eccentric loading’ training programmes has revolutionized the treatment of Achilles tendinopathy in some patients. This concept is currently being extended to include other commonly injured tendons. Other current treatments are reviewed, as are potential future treatments.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  T. P. C. Kane, M. Ismail, and J. D. F. Calder Topical Glyceryl Trinitrate and Noninsertional Achilles Tendinopathy: A Clinical and Cellular Investigation Am. J. Sports Med., June 1, 2008; 36(6): 1160 - 1163. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Knobloch, M. Spies, K. H Busch, and P. M Vogt Sclerosing therapy and eccentric training in flexor carpi radialis tendinopathy in a tennis player Br. J. Sports Med., December 1, 2007; 41(12): 920 - 921. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. M. Askling, M. Tengvar, T. Saartok, and A. Thorstensson Acute First-Time Hamstring Strains During Slow-Speed Stretching: Clinical, Magnetic Resonance Imaging, and Recovery Characteristics Am. J. Sports Med., October 1, 2007; 35(10): 1716 - 1724. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. M. Ahrens and P. Boileau The long head of biceps and associated tendinopathy J Bone Joint Surg Br, August 1, 2007; 89-B(8): 1001 - 1009. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S J Warden Animal models for the study of tendinopathy Br. J. Sports Med., April 1, 2007; 41(4): 232 - 240. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-L. Croisier, M. Foidart-Dessalle, F. Tinant, J.-M. Crielaard, and B. Forthomme An isokinetic eccentric programme for the management of chronic lateral epicondylar tendinopathy Br. J. Sports Med., April 1, 2007; 41(4): 269 - 275. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. V September, M. P Schwellnus, M. Collins, and W. Gibson Tendon and ligament injuries: the genetic component * COMMENTARY Br. J. Sports Med., April 1, 2007; 41(4): 241 - 246. [Full Text] [PDF]
|
|