Tendinopathy describes a complex multifaceted pathology of the tendon, characterized by pain, decline in function and reduced exercise tolerance. The most common overuse tendinopathies involve the rotator cuff tendon, medial and lateral elbow epicondyles, patellar tendon, gluteal tendons and the Achilles tendon. The prominent histological and molecular features of tendinopathy include disorganization of collagen fibres, an increase in the microvasculature and sensory nerve innervation, dysregulated extracellular matrix homeostasis, increased immune cells and inflammatory mediators, and enhanced cellular apoptosis. Although diagnosis is mostly achieved based on clinical symptoms, in some cases, additional pain-provoking tests and imaging might be necessary. Management consists of different exercise and loading programmes, therapeutic modalities and surgical interventions; however, their effectiveness remains ambiguous. Future research should focus on elucidating the key functional pathways implicated in clinical disease and on improved rehabilitation protocols.
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The authors declare no competing interests.
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- Rotator cuff impingement
Previously used term to describe rotator cuff tendinopathy, that is, pain and weakness, most commonly experienced with movements of shoulder external rotation and elevation, as a consequence of excessive load on the rotator cuff tissue.
- Subacromial pain syndrome
Pain, weakness and loss of function of the shoulder usually resulting from overhead activities.
- Plantar fascia
Thick, web-like ligament that connects the heel to the front of the foot. This ligament acts as a shock absorber and supports the arch of the foot, facilitating walking.
- Achilles tendon
A strong fibrous cord that connects the muscles in the back of the calf to the calcaneus bone.
- Greater trochanter
The attachment site for five muscles: the gluteus medius, gluteus minimus, piriformis, obturator externus and obturator internus.
- Patellar tendon
The tendon running inferiorly from the patella bone to the tibial tuberosity.
- Tibialis posterior tendon
The tendon on the inner side of the ankle that assists in maintaining the arch of the foot as well as the ability to turn the ankle inwards.
- Tensile load
The ability of a material to withstand a pulling force.
- Interfascicular matrix
The endotenon that facilitates sliding between fascicles
- Fatigue resistance
Resistance to the weakening of a material caused by cyclic loading.
- Resolution pathways
Programmed responses activated during inflammation resulting in a switch of lipid mediators that leads to resolution of inflammation.
Inflammation or irritation of a bursa sac.
- Eccentric training
An eccentric contraction is the motion of an active muscle while it is lengthening under load. Eccentric training is repetitively doing eccentric muscle contractions.
- Pain monitoring model
Physiotherapy model showing that one can safely continue some activity in a patient with Achilles tendinopathy by monitoring patient pain.
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Millar, N.L., Silbernagel, K.G., Thorborg, K. et al. Tendinopathy. Nat Rev Dis Primers 7, 1 (2021). https://doi.org/10.1038/s41572-020-00234-1
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