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Overuse tendon conditions: time to change a confusing terminology
N Maffulli1, K M Khan, G Puddu
1Department of Orthopaedic Surgery, University of Aberdeen Medical School, Foresterhill, Scotland.
Summary
Tendinitis often misdiagnoses tendon degeneration (tendinosis) as acute inflammation. Accurate labeling of overuse tendon injuries as tendinopathy is crucial for proper management and understanding chronicity.
Area of Science:
- Orthopedics
- Sports Medicine
- Pathology
Background:
- Overuse tendon injuries frequently involve degeneration (tendinosis) rather than acute inflammation.
- The term tendinitis is often clinically applied to conditions that are histopathologically tendinoses, masking the chronic nature of the injury.
- Paratenonitis involves acute inflammation of the tendon sheath, distinct from intratendinous degeneration.
Purpose of the Study:
- To clarify the histopathological distinctions between tendinitis, tendinosis, and other peritendinous conditions.
- To advocate for precise terminology in diagnosing and managing overuse tendon injuries.
- To improve athlete and coach understanding of the chronicity of tendon ailments.
Main Methods:
- Review of clinical and histopathological findings in overuse tendon conditions.
- Analysis of the common usage and implications of terms like tendinitis and tendinosis.
- Comparison of descriptions of surgical treatments for 'partial tears' versus actual degenerative tendinopathies.
Main Results:
- Frank inflammation is rare in overuse tendon conditions, primarily associated with ruptures.
- Tendinosis, characterized by degeneration, is often mislabeled as tendinitis, leading to underestimation of chronicity.
- Paratenonitis presents with acute inflammation and exudate, causing crepitus.
- Surgical literature often describes degenerative tendinopathies when referring to 'partial tears'.
Conclusions:
- The combination of pain, swelling, and impaired performance in overuse injuries should be termed tendinopathy.
- Accurate classification into tendinopathy, paratendinopathy, or pantendinopathy based on affected tissues is recommended.
- Correct terminology is essential for appropriate clinical management and patient education regarding chronic tendon conditions.