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Overview of the management of overuse (chronic) tendinopathy

Karim Khan, MD
Alex Scott, PhD, RPT
Section Editor
Karl B Fields, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Overuse tendinopathy is a clinical syndrome characterized by chronic pain and tendon thickening. It commonly results from overuse and occurs in workers and recreational athletes. The majority of tendinopathies present in the chronic stage, with symptoms over three months in duration.

Normally, tendon consists of tightly-packed collagen fibers. In tendinopathies, the collagen is in a state of disrepair, with proliferation and chronic irritation of neurovascular repair tissue in the tendon and its linings (paratendon and endotendon). This pattern is similar in most tendinopathies of the upper and lower extremity. Although complete or partial tendon ruptures may result from overuse, the treatment principles differ markedly from overuse tendinopathies and are therefore discussed separately. Paratendinopathies (eg, de Quervain's tenosynovitis) are also distinct in that the primary pathology is the paratendon rather than the tendon proper and are not discussed here.

The general treatment of chronic tendinopathy will be discussed here. The pathophysiology of tendinopathy and the management of specific tendinopathies are reviewed elsewhere. (See "Achilles tendinopathy and tendon rupture" and "Epicondylitis (tennis and golf elbow)" and "Rotator cuff tendinopathy".)


The patient's history should elucidate what type of training or activity led to the tendinopathy and determine the level of function to which the patient aims to return.

Validated, reliable, and simple functional assessment scores, such as the Victoria Institute of Sport Assessment (VISA) for patellar tendinopathy or VISA-A for Achilles tendinopathy, can help the clinician to grade symptoms and determine patient function (figure 1 and figure 2) [1,2]. Such scores also provide a useful means of monitoring recovery during rehabilitation. The VISA and VISA-A questionnaires can be completed in five minutes or less.

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Literature review current through: Nov 2017. | This topic last updated: Mar 02, 2017.
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