Is It Really Tendonitis?

The sports pages are usually replete with famous athletes suffering from shoulder, Achilles and elbow tendonitis, etc. There is actually very little evidence that there is an "itis." A tendonitis is associated with an acute edema, hyperemia and infiltration of inflammatory cells. Leadbetter¹ classified tendonitis as a "symptomatic degeneration of tendon with vascular disruption and inflammatory repair response."

The problem with describing injuries as an "itis" is that biopsies of these tendons rarely, if ever, reveal inflammatory cells. Lateral elbow epicondylitis is a perfect example. According to Boyer et al.,² "Signs of either acute or chronic inflammation have not been found in any surgical pathologic specimens in patients with clinically diagnosed lateral tennis elbow syndrome." They state that only one study, which demonstrated tears in the extensor origin with symptoms of more than one year of lateral tennis elbow syndrome, showed "round cell infiltration."

Tendonosis is often the terminology used for the chronic stage of tendonitis, which is characterized as an angioblasitc reaction with random orientation of blood vessels and abnormal appearance of collagen fibers without clinical or histologic signs of intratendinous inflammation.³ Maffulli³ states that "tendonitis" or "tendonosis" should only be used when the microscopic diagnosis of the condition has been confirmed. Maffulli et al.³ feel that the suffix "-dynia" should be used to describe a painful tendon, and the suffix "-opathy" should be used to describe the clinical syndrome characterized by pain, swelling and impaired performance.

Leadbetter¹ used the term paratenonitis to describe an inflammation of the paratenon whether it was lined by synovium or not. He stated that there were inflammatory cells in the paratenon or peritendinous areolar tissue. He used the term paratenonitis to replace the terms tenosynovitis, tenovaginitis and peritendonitis. A study was not mentioned that showed inflammatory cells in paratenonitis.

Now, to be entirely correct, unless there is histopathological microscopic evidence, we are treating tendonopathies of patients complaining of tendodynia.

References

1. Leadbetter WB. Cell-matrix response in tendon injury. Clin Sports Med 1992;11:533-578.
2. Boyer MI, Hastings H. Lateral tennis elbow: is there any science out there? J Shoulder Elbow Surg 1999;8:481-91.
3. Maffulli N, et al. Overuse tendon conditions: time to change a confusing terminology. Arthroscopy 1998;14(8):840-43.