Tendons transmit force from muscle to bone. They have high mechanical strength, good flexibility, and optimal elasticity. They have lower oxygen consumption and operate at a lower metabolic rate, allowing for anaerobic energy-generation capacity essential to carry loads and maintain tension for long periods. Unfortunately, it also results in slower healing after injury.
Chronic tendinitis is an overuse injury. The cause is multifactorial; alignment, biomechanical, repetitive load. A tendon typically goes through 3 phases of healing; inflammatory, proliferative, and remodeling. Chronic tendinitis is a process of disordered healing, wherein there is an imbalance of matrix degeneration and synthesis, leading to degeneration through the deposition of lipid, mucoid or calcific deposition.
Various conservative treatment options exist, including mechanical loading (eccentric strengthening) to stimulate cellular response leading to structural change, cross friction massage, and orthotics/splints. Cortisone injections can provide short term effective, but are often ineffective without load management and rehabilitation. Alternative treatment options include percutaneous tenotomy and platelet rich plasma, where focal area or tendon degeneration are targeted. Ultrasound can be used in the office to diagnose chronic and guide procedures for chronic tendinitis.