1. Figure 1 Pathological and clinical features of tendinopathy
Figure 1 | Pathological and clinical features of tendinopathy. Schematic representation of the microstructure of normal tendon showing collagen fibril structure and tenocytes in homeostatic tendon. The main pathological features of tendinopathy include mucoid degeneration, loss of parallel collagen fibril structure, increased neovessels, changes in type III to type I collagen ratio and cell death (apoptosis). Importantly, there is a 'switch' in collagen production from the predominant type I collagen (95% in normal tendon) to the biomechanically inferior type III collagen (5% in normal tendon), which is increased by ∼30% in tendinopathic tissues. Cardinal clinical signs include pain, fusiform swelling and loss of function, particularly in sporting individuals. Treatments range from physiotherapy (isometric and eccentric exercises) aiming to reduce pain by loading the tendon back to a homeostatic state, to pain relief with NSAIDs and local corticosteroid injections. Surgery (tendon release and debridement, microcautery) remains possible for recalcitrant situations with more-recent therapies including shockwave therapy and platelet-rich plasma injections whose evidence base remains limited.
Millar, N. L. et al. (2017) Inflammatory mechanisms in tendinopathy – towards translation
Nat. Rev. Rheumatol. doi: /nrrheum