Tendinosis
Tendinosis is the gradual stiffening of a tendon due to collagen loss. It is a condition that causes pain and joint stiffness.
Symptoms and causes
Tendinosis is a chronic condition characterized by the degeneration of tendon collagen, which is the fibrous tissue that connects muscles to bones. As a result, the tendon becomes stiffer and causes limited movement accompanied by pain. Although it is often confused with tendinitis because many of the symptoms are similar, tendinosis does not involve tissue inflammation.
Tendinosis can affect any tendon in the body, but it is more common in areas prone to repetitive movement, such as the shoulder, knee, elbow, or heel.
The prognosis of tendinosis is generally favorable, as full functionality is often restored with appropriate therapy. However, the recovery process is usually long and requires consistency in treatment.
Symptoms
The most common symptoms of tendinosis are:
- Chronic and persistent pain.
- Tenderness to touch.
- Weakness.
- Stiffness.
- Limited range of motion.
Causes
Tendinosis is caused by degeneration of the collagen fibers that make up the tendons, which may result from:
- Repetitive and continuous use of the tendon.
- Genetic predisposition.
- Autoimmune diseases affecting connective tissue:
- Systemic lupus erythematosus: the body attacks tissues that make up the joints, skin, kidneys, and brain.
- Scleroderma: causes excessive collagen production, leading to hardening and thickening of the skin, ligaments, and tendons.
- Rheumatoid arthritis: causes pain, inflammation, stiffness, and joint deformity.
- Polymyositis: a chronic inflammatory condition that causes severe muscle weakness, usually in muscles closest to the trunk.
- Overlap syndrome: combines features of several autoimmune diseases simultaneously, such as lupus and rheumatoid arthritis.
Risk factors
The risk of tendinosis increases in the presence of the following factors:
- Age: more common in older individuals, as tendons naturally lose elasticity over time.
- Living in areas with extreme temperatures or high humidity.
- Sports or occupations requiring repetitive joint movement.
- Poor nutrition: lack of vitamin C and amino acids impairs collagen synthesis.
- Sedentary lifestyle: lack of exercise can weaken tendons and reduce elasticity.
- Obesity: joint overload due to excess weight, systemic inflammation, and metabolic alterations contribute to tendon damage.
- Smoking: reduced blood flow makes tissue repair more difficult. Additionally, nicotine decreases collagen production, weakening tendons.
- Alcoholism: alcohol interferes with processes necessary to maintain collagen, weakening tendon structure.
- Family history: there is a genetic predisposition to tendinosis, so multiple cases may occur within the same family.
Complications
The most common complications of tendinosis are:
- Tendon rupture.
- Chronic pain.
- Limited joint movement.
- Muscle weakness.
- Fibrosis, thickening, or calcification of the tendon.
- Inability to perform daily activities.
Prevention
To prevent tendinosis, it is recommended to:
- Perform exercises to strengthen muscles.
- Warm up properly before physical activity.
- Respect recovery time between periods of intense activity.
- Maintain proper posture during sports or repetitive physical work.
- Stay adequately hydrated.
- Follow a healthy diet.
Which specialist treats tendinosis?
Tendinosis is diagnosed and treated within the specialty of Traumatology and Orthopedic surgery.
Diagnosis
The diagnosis of tendinosis is primarily clinical and is usually established through the following procedures:
- Medical history: analysis of the patient’s medical and family history, lifestyle, general health status, and reported symptoms.
- Physical examination:
- Inspection of the joint to detect swelling, skin color changes, or deformity.
- Palpation to identify pain points, inflammation, or areas of increased warmth.
- Range of motion assessment:
§ Passive: the specialist moves the joint without force to detect possible stiffness.
§ Active: the patient performs a forceful movement to elicit pain.
Additional tests may be requested to assess structural integrity and rule out other conditions:
- Ultrasound: provides real-time images of the tendon. Useful for detecting tissue degeneration or tears.
- X-ray: allows visualization of bone structures and identification of fractures, calcifications, or arthritis.
- Magnetic resonance imaging (MRI): provides more detailed images and is used in complex cases.
Treatment of tendinosis is tailored to the needs and characteristics of each patient. The most effective approaches include:
- Rest: avoiding activity to allow the damaged tendon to recover.
- Heat application to reduce chronic pain.
- Cold application to relieve acute pain.
- Rehabilitation: specific exercises help strengthen muscles and stretch tendons to improve joint biomechanics.
- Medication: analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) relieve acute pain and reduce inflammation (although minimal in chronic cases).
- Corticosteroid injection: medication is injected directly into the affected area to achieve a more potent effect.
- Platelet-rich plasma (PRP) injection: a sample of the patient’s blood is processed to obtain a serum with a high platelet concentration. When injected into the injured tendon, it stimulates collagen production to promote tissue regeneration and reduce pain.
- Shock wave therapy: high-energy acoustic waves are directed at the affected area to stimulate tissue regeneration and relieve pain.
- Surgery: surgical intervention is only performed when previous treatments have not achieved the desired results. Whenever possible, a minimally invasive approach is used to repair damage, remove scar tissue, or excise the injured area to reconnect the healthy portion at a new bony insertion point.
- TENEX ultrasonic tenotomy: a fast, minimally invasive technique that promotes patient recovery and can be performed on an outpatient basis. With ultrasound guidance, a very small incision is made to remove damaged tissue.
