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Rheumatology Advance Access published online on February 20, 2006
Rheumatology, doi:10.1093/rheumatology/kel046
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received October 13, 2005
Accepted January 13, 2006

Review

Current concepts in the management of tendon disorders

J. D. Rees 1 *, A. M. Wilson 2, and R. L. Wolman 2

1 Institute of Orthopaedics and Musculo-Skeletal Science, Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP, UK; Defence Medical Rehabilitation Centre, Headley Court, Surrey KT18 6JN, UK
2 Institute of Orthopaedics and Musculo-Skeletal Science, Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP, UK

* To whom correspondence should be addressed.
J. D. Rees, E-mail: j.rees{at}doctors.org.uk


  Abstract

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.


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