Question:
What is the difference between tendonitis and tendinopathy and how can they be treated?
Answer:
Tendons attach muscle to bone and help the joints to move fluidly. They are made of different types of collagen. When injured, tendons have difficulty healing because they are poorly vascularized. The tendon will attempt to heal itself by laying down collagen that is not as strong as the original tendon fibers, which can create thickening and pain over time.
An injury to tendons can take up to 10 weeks to heal. In these initial weeks of healing, patients are diagnosed with tendonitis. If pain persists longer than 10 weeks, or the tendon appears thickened on imaging (such as MRI), patients are diagnosed with tendinosis or tendinopathy. Tendinopathy is a mix of tendinitis and tendinosis. Tendinosis typically refers to tendons that have chronic inflammation resulting in tendon thickening.
It Hurts! Now What?
There are many treatment options available. Initially, self-care should focus on icing the area, gentle massage and/or stretching, anti-inflammatories and rest.
A physician may recommend conservative treatment options such as physical therapy or cortisone injections into the tendon to reduce pain. We caution our patients against repeated cortisone injections though, because they may weaken the tendon over time. There is some evidence that supports eccentric-based exercises — stretching a muscle while it is under a load. A biceps curl with a dumbbell is an example. This type of exercise remodels the tendon and can lessen pain. More advanced tendinopathy may be treated surgically, but this is rare and may result in only some improvement.
Another treatment option is platelet-rich plasma and stem cell injections for tendon injuries. This is a procedure in which your own blood platelets or adult stem cells are injected into the injured area. Although both tendonitis and tendinopathy respond well to treatment with these biologic injections, injuries treated early tend to respond faster.
These injections into and around tendons have the benefit of increased ability to heal, decreased healing time and decreased re-injury rate. By injecting your own stem cells into and around the tendon, the body can regrow stronger tendons by increasing normal collagen growth instead of weaker collagen growth. This involves a quick and relatively painless procedure performed by a highly skilled orthopedic specialist, using ultrasound guidance to ensure proper placement.
Dr. Gobezie is an orthopedic surgeon at Regen Orthopedics in Beachwood. Learn more at regenorthopedics.com or call 844-786-2355.
