What is Tendonitis?

Tendons attach muscle to bone. They consist of white fibrous tissue with a relatively poor blood supply. The sites of weakness are at the connections of red muscle tissue to the tendon, and at the tendon attachment to the bone, which when injured is also called an enthesopathy. Both sites can be injured with trauma and are actually fatigued and injured daily. Fortunately, the body has an innate healing ability, and each night while sleeping deeply, healing takes place. Hormones and nutrition play a significant role in the process of healing.

Tendinitis may be present in the first few weeks or months after injury to a tendon. Most cases of chronic tendon pain after 3-6 months are actually "tendinosis". Tendinosis is the microscopic degeneration of connective tissue fibers, which leads to breakdown at the attachment points, and strain of the remaining connections, leading to pain. Many now prefer to label these processes "Tendinopathy".

Common locations for tendinopathy include the following:

▪ Outer Shoulder (Rotator Cuff tendinopathy)
▪ Lateral Elbow (Lateral Epicondylitis - Tennis Elbow)
▪ Inner Elbow (Medial Epicondylitis - Golfer's Elbow)
▪ Wrist and thumb (DeQuervain's Tenosynovitis)
▪ Outer Hip (Gluteal or Piriformis tendinopathy)
▪ Top Front of the Knee (Quadriceps tendinopathy)
▪ Bottom Front of the Knee (Patellar tendinopathy)
▪ Ankle (Posterior tibialis tendinopathy)

When healing is insufficient due to excessive trauma, poor nutrition, hormone insufficiency, excessive use of anti-inflammatories, or other factors, tendinosis may result. The poor healing can result in pain when the tissues are stressed, and the muscles may guard the affected part, leading to "trigger points" in the muscle itself. Patients often present with pronounced, tender points diffusely throughout one or another body region, or the points may remain very localized to one extremity or spine region. Pain medications, anti-inflammatories, and muscle relaxant medications are often prescribed with limited long-term benefit because the underlying pain generator is unresolved.

Connective tissue injuries can be stimulated to heal with regenerative medicine injection techniques if they fail more conservative approaches, such as physical therapy, eccentric muscle strengthening, massage, manipulation, and other approaches. Tendon attachments can be healed using Prolotherapy or Platelet-Rich Plasma injection techniques. Larger tendon, disk, and ligament tears may require Mesenchymal Stem Cell injections to provide a scaffold to build connective tissue upon. A truly severe and relatively rare completely transected tendon or ligament tear may likely require surgery, but the great majority of tendon injuries may be repaired using regenerative medicine procedures.