Treatment for Degenerative Tendinopathy
The most effective treatment approach for degenerative tendinopathy includes relative rest, ice therapy, eccentric strengthening exercises, and appropriate pain management, with surgery reserved only for patients who fail 3-6 months of conservative therapy. 1, 2
Understanding Tendinopathy
- Tendinopathy is primarily a degenerative condition rather than an inflammatory one, affecting areas such as the rotator cuff, elbow epicondyles, patellar tendon, and Achilles tendon 1, 2
- It typically presents as gradually increasing load-related localized pain that worsens with activity 1
- Approximately 80% of patients with overuse tendinopathies fully recover within three to six months with appropriate treatment 2
First-Line Treatment Options
Rest and Activity Modification
- Reduce activities that worsen pain to prevent ongoing damage and promote healing 1, 2
- Complete immobilization should be avoided to prevent muscular atrophy and deconditioning 1
- Continue activities that do not exacerbate symptoms to maintain function 2
Cryotherapy (Ice Therapy)
- Apply ice through a wet towel for 10-minute periods to provide optimal short-term pain relief 1, 2
- Cryotherapy is effective for reducing pain and may help limit swelling in acute phases 1
Eccentric Strengthening Exercises
- Eccentric strengthening is an essential component of tendinopathy treatment and may reverse degenerative changes 1, 2
- Has proven particularly beneficial for Achilles tendinosis and patellar tendinosis 1
- Tensile loading of the tendon stimulates collagen production and guides normal alignment of newly formed collagen fibers 1
Pharmacological Management
NSAIDs (Nonsteroidal Anti-inflammatory Drugs)
- Effective for short-term pain relief but have no effect on long-term outcomes 1
- Cannot be recommended over other analgesics for chronic tendinopathy 3, 4
- Topical NSAIDs may provide pain relief with fewer systemic side effects 1, 2
Corticosteroid Injections
- May provide better acute pain relief than oral NSAIDs but do not alter long-term outcomes 1
- Should be used cautiously as they may inhibit healing and reduce tendon strength 2, 3
- Not recommended for long-term management due to potential negative effects on tendon integrity 4
Additional Treatment Options
Supportive Devices
- Orthotics and braces can reinforce, unload, and protect tendons during activity 2
- May help correct biomechanical problems contributing to tendon injury 2
- Selection should be based on the specific tendon affected and patient comfort 2
- No conclusive recommendations can be made for the use of orthotics and braces in patellar tendinopathy or elbow tendinopathy 1
Other Modalities
- Therapeutic ultrasonography, corticosteroid iontophoresis, and phonophoresis are of uncertain benefit 1
- Extracorporeal shock wave therapy (ESWT) appears to be a safe, noninvasive option for pain relief but is expensive 1
- Results with ESWT have been inconsistent across studies 3
Emerging Treatments
- Platelet-rich plasma (PRP) injections show promise for promoting tendon healing but require further research 5, 6
- Sclerotherapy and nitric oxide patches have shown some positive results but need larger trials 3
Surgical Management
- Surgery is an effective treatment option but should be reserved for patients who have failed 3-6 months of conservative therapy 1
- Surgical techniques typically include excision of abnormal tendon tissue and longitudinal tenotomies to release areas of scarring and fibrosis 1
- While effective, surgery carries higher complication rates than conservative options 4
Common Pitfalls and Caveats
- Misdiagnosing tendinopathy as an inflammatory condition ("tendonitis") rather than a degenerative process ("tendinosis") 1, 2
- Relying solely on anti-inflammatory treatments when the condition is primarily degenerative 2, 3
- Returning to full activity too quickly before adequate healing has occurred 1
- Using corticosteroid injections repeatedly, which may weaken tendon structure 2, 4