Tendinopathy

Orthopaedic surgeons come across tendinopathy frequently. It was and is still often referred to as tendinitis, but this implied that the tendon is inflamed and this is not the case. This is also why tendinopathy doesn’t respond to steroid injections, in the way that we have thought in the past.

Just like other tissues in the body, our tendons are always in a cycle of repairing themselves. If the loads and use on the tendon exceeds its ability to undertake repair, the tendon can develop tendinopathy and you can experience pain. This can sometimes settle on its own, but on other occasions it can require treatment. Treatments come under the same categories for all tendinopathies, but the thresholds vary depending on which tendon is affected. Treatments include activity modification or splintage, physiotherapy, injection therapy, or in some cases surgery.

    Steroid injections have become less widely used, now that there is more understanding of the process of tendinopathy. In certain situations, they can still be useful though. More recently, the use of platelet rich plasma (PRP) injections have become widespread, and the indications for use have become clearer. A sample of your blood is taken and then it is placed into a centrifuge. This separates the blood into its layers and allows the PRP to be drawn off and used as an injection. This injection contains the growth factors that encourage your body to speed up the repair process within the tendon.

      Patella tendinopathy is a common complaint amongst sportspeople. It is sometimes referred to as jumper’s knee, but the condition is widespread and certainly not confined to jumpers. There are many famous sportspeople who have been afflicted and, in some cases, it has ended careers prematurely. Rafael Nadal would be a commonly sited individual, and the legendary tennis player has had to have spells away from tennis to manage the problem. It shows that even the very best athletes can be affected and some rest and rehabilitation can be required. The principles of treatment are the same as for the other tendinopathies, with physiotherapy often being employed to facilitate rehab and begin an eccentric loading regime. PRP injections can be useful and also arthroscopic tendon debridement (a relatively short keyhole procedure).

        Gluteus medius is a muscle originating from the outside of the pelvis and its tendon attaches to the side of the hip (greater trochanter). This gluteus medius tendon can develop tendinopathy and can present with pain on the side of the hip. This brings it into a group of diagnoses that a grouped together to be known as lateral hip pain conditions. Trochanteric bursitis would be the other common lateral hip pain condition. Lateral hip pain conditions are experienced as pain on the side of your hip, and this distinguishes them from osteoarthritis of the hip or hip impingement, which tend to produce groin pain.

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