What is upper limb tendinopathy?
Tendons attach muscles to bones and are situated all over the body. Some tendons are sheet-like in shape, for example, the rotator cuff and others are more like cords, in the case of the biceps tendon. Tendinopathy is a condition that occurs following repetitive eccentric overload. It can also be part of a degenerative picture in which there are micro-tears. It can affect any tendon in the body. Within the shoulder and elbow common sites are the rotator cuff tendons, long head of biceps, triceps distal biceps and in the common extensor and flexor origins, leading to tennis and golfer’s elbow.”
What are the symptoms of upper limb tendinopathy?
Symptoms are usually pain and in some cases pain-related weakness. Pain is most commonly felt when that tendon is used for exercise or daily activities. There can be generalised aching following activities and in some patients, this may be felt lower down the arm than the tendon. In some cases, these micro-tears can become more substantial and can even lead to tendon rupture.
How is it diagnosed?
It is diagnosed by taking a careful history and performing a detailed examination. It is important to exclude other potential causes and exclude any significant tears. USS and MRI scan be used to assess for these and further delineate the extent of tendinopathy.
How is it treated?
Treatment can begin with symptomatic management with pain killers and physiotherapy to work on strengthening and range of eccentric exercises. Activity modification is extremely important in treating these tendinopathies. Bracing can be used to offload the tendon. Injections can be useful as a diagnostic and therapeutic measure and can allow the patient to engage thoroughly with their physiotherapy regime. However, in some circumstances, these have been shown to prolong symptoms and other measures have been shown to be more beneficial in the long run.
For more prolonged cases failing to respond to these measures, a careful discussion with the patient regarding the options will be undertaken. Arthroscopic assessment can help to assess for significant tears where imaging has been inconclusive. In some cases release of the tendon for symptomatic relief and promote inflammation and potential healing is required. Management of acute tendon ruptures is determined based on symptoms and function of the patient. The repair can be performed by both an arthroscopic or open approach.