Tendinopathy Clinic

Tendinopathy is the general term for a range of medical conditions in and around tendons, usually arising from overuse injuries, that are often accompanied by pain, weakness, inflammation or stiffness.

Patellar tendinopathy (jumper’s knee)

Patellar tendinopathy (jumper’s knee) is pain in the patellar tendon – a band of tissue connecting the kneecap (patella) to the shin bone (tibia). It is usually caused by repetitive activities such as running based sports, basketball and volleyball.

Common symptoms

Patients experience pain just beneath the kneecap during activities such as jumping, running, kicking and squatting. 

Diagnosis

A medical history, focused on common risk factors, and an examination is usually followed by an ultrasound or MRI scan to confirm the diagnosis, and to look for any associated problems such as a tear within the tendon, cartilage damage behind the kneecap or inflammation in the fat pad below the kneecap.

Treatment

Your OrthTeam consultant will look for any risk factors for tendinopathy (usually overuse or a spike in training load) and will advise you on how to modify your training. Management will involve advice on progressive strengthening exercises for the tendon, as well as referring you for a course of physiotherapy to oversee the exercise prescription and how to progress this over time. They may also advise you regarding nutritional aspects including optimal protein intake and collagen supplementation if needed.

In some cases, where there is an intrasubstance tendon tear within the tendon or associated fat pad inflammation, an ultrasound guided injection of platelet-rich plasma (PRP) or corticosteroid respectively may be considered in addition to the progressive strengthening exercises. If this does not relieve your symptoms, effective treatment can be more difficult and may include further injection therapy, shockwave therapy or surgery in certain selected cases.

Elbow tendinopathy

Elbow tendinopathy is a common injury associated with activities requiring repetitive use of the wrist and hand and results from overuse of the tendons on the outside or inside of the elbow. Lateral elbow tendinopathy or ‘tennis elbow’ and medial elbow tendinopathy (golfer’s elbow) affect many people, not just athletes.

Common symptoms

The primary sensation with elbow tendinopathy is pain felt on the outer or inner aspect of the elbow. Lateral elbow tendinopathy (tennis elbow) involves the common extensor tendon origin and is felt on the outside of the elbow. Medial elbow tendinopathy (golfer’s elbow) involves the common flexor tendon origin and is felt on the inside of the elbow. Pain typically develops gradually. Initially, it may only be painful following exercise but later there may be pain also at rest. Along with pain, stiffness or tightness in the elbow and forearm region may also be experienced.

Diagnosis 

Your OrthTeam consultant will take a medical history and perform an examination of your elbow. They may arrange an ultrasound scan or an MRI scan to help confirm the diagnosis and to rule out other problems such as a tear within the tendon or co-existing arthritis.

Treatment

Your OrthTeam consultant will advise you regarding any existing risk factors for your elbow tendinopathy and how to address these. They will advise you about appropriate exercises, the use of an elbow clasp to help offload the tendon, and will refer you for physiotherapy to oversee progression of these exercises over time. Other treatments including shockwave therapy (ESWT), GTN patches and injections such as PRP (platelet rich plasma) or corticosteroid injection may be considered. Minimally invasive surgeries such as percutaneous tenotomy may be needed if conservative management has failed.

Achilles tendinopathy 

Achilles tendinopathy is a painful condition affecting the Achilles tendon. In most cases, Achilles tendinopathy is an overuse injury. Professional and weekend athletes can suffer from the condition, however it is also a common injury in people not involved in sport. Sometimes it can be related to certain types of arthritis.

Common symptoms

Pain at the back of the heel and in the middle of the tendon causing pain with running and jumping activities and sometimes pain with walking, swelling and tenderness of the Achilles tendon.

Diagnosis

Your OrthTeam consultant will take your medical history, including your exercise habits and checking for risk factors such as a recent spike in training load, inflammatory arthritis, certain medications (Ciprofloxacin can cause tendinopathy), being overweight and other metabolic factors (raised lipids, gout and diabetes). They will perform a physical examination, checking for thickness and tenderness of the Achilles tendon and will examine your ankle, leg and back to look for any other factors that may be contributing. They may refer you for a diagnostic ultrasound scan and occasionally blood tests (to test for an inflammatory condition or to check for raised cholesterol, uric acid or diabetes), or an MRI scan of the tendon. 

Treatment

Your OrthTeam consultant will advise you regarding how to modify any identified risk factors. Initially you may need to modify activities that aggravate the tendon such as running and jumping. They will advise you regarding appropriate alternative exercise which is unlikely to cause pain such as swimming and cycling and how to start exercises to load (strengthen) the tendon and calf region. You are likely to be referred for a course of physiotherapy to oversee the exercise prescription and to advise on how to progress this over time. Your consultant may also advise you regarding nutritional aspects including optimal protein intake and collagen supplementation if needed, weight loss and if relevant how to lower your cholesterol, uric acid and how to optimise diabetic control. In some cases, where there is an intrasubstance tendon tear within the tendon, an ultrasound guided injection of platelet rich plasma (PRP) may be considered in addition to the progressive strengthening exercises.

In cases of inflammation in the paratenon (sheath around the tendon), topical anti-inflammatory treatment in a night wrap may be considered. Sometimes heel raise inserts are advised to take pressure off the tendon insertion. In cases of flat or excessively pronated foot posture, your doctor may recommend podiatry input for consideration of orthotic prescription. Other treatment considerations include a course of oral anti-inflammatory medication (for acute reactive tendinopathy in younger athletes or where there is associated inflammation around the tendon), shockwave therapy and GTN patches. If the tendinopathy is at the tendon insertion (Enthesitis), and there is suspected background arthritis, then you may be referred for a Rheumatology opinion. If conservative treatment has failed, then surgery may be considered.

Other common tendon problems

Other common tendon problems seen by OrthTeam consultants include:

  • Rotator cuff tendinopathy in the shoulder
  • Wrist extensor tendinopathy including De Quervain’s tenosynovitis, intersection syndrome and ECU tendinopathy
  • Hamstring tendinopathy
  • Adductor tendinopathy in the groin
  • Iliopsoas tendinopathy (hip flexor)
  • Gluteal tendinopathy on the outer aspect of the hip
  • Tibialis posterior tendinopathy on the inside of the ankle
  • Plantar fasciitis (fasciopathy) under the heel

Tendinopathy is estimated to affect more than 150,000 people in the UK every year. It's more common in athletes, with research showing that around 10% of runners develop Achilles tendinopathy annually.

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