From the Guidelines
The approach to diagnose tendinopathy involves a thorough history and physical examination, as most patients can be diagnosed without the need for advanced imaging 1.
Key Components of Diagnosis
- History: The usual presentation of a tendinopathy is an insidious onset of load-related localized pain coinciding with increased activity, with pain gradually increasing in intensity and duration 1.
- Physical Examination: Examination includes inspection for muscle atrophy, asymmetry, swelling, erythema, and joint effusions, as well as palpation for tenderness and range-of-motion testing 1.
- Imaging: Plain radiography, ultrasonography, and magnetic resonance imaging (MRI) can be helpful if the diagnosis remains unclear, with each modality having its own strengths and limitations for different types of tendinopathies 1.
Common Tendinopathies
- Rotator cuff tendinopathy: Often diagnosed with a combination of physical examination and imaging, including ultrasonography and MRI 1.
- Medial and lateral elbow epicondyles tendinopathy: Diagnosed with physical examination and imaging, including plain radiography and ultrasonography 1.
- Patellar tendinopathy: Diagnosed with physical examination and imaging, including ultrasonography and MRI 1.
- Achilles tendinopathy: Diagnosed with physical examination and imaging, including plain radiography, ultrasonography, and MRI 1. By combining a thorough history, physical examination, and judicious use of imaging, clinicians can accurately diagnose tendinopathy and develop an effective treatment plan 1.
From the Research
Diagnosis of Tendinopathy
The diagnosis of tendinopathy is primarily clinical, with imaging only useful in special circumstances 2. A clinical diagnosis is usually combined with imaging, and among all the existing techniques, ultrasound is widely adopted 3. The main parameters considered by ultrasound imaging are:
- Tendon thickness
- Hypoechogenicity of tendon structure
- Neovascularization of the tendon bound tissue
Imaging Techniques
Imaging techniques such as ultrasonography and magnetic resonance imaging (MRI) can refine the diagnosis of tendinopathy 4. Ultrasound imaging has a good reliability in the differentiation between healthy and abnormal tendon tissue, while there are difficulties in the identification of tendinopathy stages 3.
Clinical Presentation
Tendinopathy is characterized by pain in the tendon and impaired performance, sometimes associated with swelling of the tendon 4. The diagnosis of tendinopathy is currently diagnosed as a clinical hypothesis based on the patient symptoms and physical context 5.
Treatment Approaches
The treatment of tendinopathy is highly variable, and there is no consensus on the best approach 2, 4. Eccentric training is currently considered to be the most efficient treatment for tendinopathy, but it requires specific modalities, such as slow speed, low intensity, and gradual intensification 4. Other treatment modalities, such as slowly progressive loading programs, can be used as adjuncts to achieve pain relief 2.