Common Misconceptions about Tendinitis

When Tendinitis is not Tendinitis
On a daily basis, I hear people complaining about their problem with tendinitis. They would go to their physicians, primary care or orthopedics, and leave the office with the term "Tendinitis" and the concept that anti-inflammatory drug (over-the counter, or prescription strength) or muscle relaxants would make them go away. Sadly, these conditions are far too common.

Why the Fuzz?
If the medical professional can't label it properly, how can they treat it correctly?
One factor that may interfere with treatment of these "tendon conditions" may be the mislabeling/misdiagnosing as tendinitis. The classic definition of "tendinitis" is an overuse injury resulting in inflammation of the tendon. There lies the problem, the word inflammation. An increasing body of evidence (BMJ 2002;324:626-627, 16 March ) suggests that these tendon injuries do not involve inflammation! Tendinitis is a bit of a misnomer because most tendon injury (with the exception of complete tendon rupture), there's no inflammation. Hence, the "-itis" in tendinitis does not apply. That is why the traditional allopathic medicinal approach to treating "tendinitis" as an inflammatory condition, with anti-inflammatories is flawed. The one positive note that comes from the definition is the descriptive word overuse.

So, what shall we call it?
Here are the options:

1. Tendinopathy - a general clinical descriptor of tendon injuries. It's a very causal term. It is not leading, in any fashion. It simply identifies that there's a problem with the tendon. How boring... I know.
   
2. Tendinosis - collagen degeneration/degradation with disorganized collagen fiber (ie. scarring about the injured site of the tendon.) We can also depict tendinosis as a connective tissue problem. It involves the production of collagen fibers that are not properly incorporated or remodeled into the normal tendon tissue. (FYI - tendon is made up of organized collagen fibers, just that it's much more organized.) Once again, there's nothing about inflammation.It simply states that the scar tissue impede proper circulation. In other words, poor blood supply ~ little oxygen or nutrients gets into the wounded tissue. The intrinsic healing response of the body has failed - a patch job that's gone wrong.
   
3. Boo-boo on me tendon - you get more attention by your love ones.
   

Now that the tendon condition has a name to go with it, here is a list of tendons that is often aggravated:

• Achilles tendon
  
• Forearm extensors - pain by the outside of the elbow, aka Tennis Elbow
• Forearm flexors - pain by the inside of the elbow, aka Golfer's Elbow
• Patellar tendon
  
• Rotator cuff tendon - pain near the pointy part of the shoulder
  
• Biceps tendon - pain near the front of the shoulder
  

Since, every muscle has a tendon (or two, one at either end of the muscle), it is possible to develop a tendinopathy with any one muscle.

Whatever you do, don't call it tendinitis!