Insertion tendinopathies are pain conditions in the transition from the tendon to the bone caused by irritation of the tendon attachments. Athletes in particular are affected by insertion tendinopathies.
What is insertional tendopathy?
If pressure pain, muscle tension or stress pain is noticed at the tendon attachment, a doctor or sports medicine specialist should be consulted promptly. A medical examination is necessary if the symptoms persist for more than a few days or rapidly increase in intensity. See AbbreviationFinder for abbreviations related to Insertion Tendopathy.
Inflammation or irritation in the tendon insertion area, ie in the transition zone from the tendon to the bone, is collectively referred to as insertion tendinopathy.
Depending on the clinical symptoms, a distinction is made between chronic and acute insertion tendinopathies. While in acute insertion tendinopathies the pain symptoms as a result of trauma are in the foreground, chronic irritation of the tendon attachments in many cases result in structural-degenerative changes such as calcium deposits, bone spur formation or ossification in the affected areas.
Pronounced pain in the area of the tendon insertion, which increases with passive stretching and active contraction under resistance, are characteristic symptoms of insertion tendinopathy. In general, insertion tendinopathy can manifest itself in all tendon attachments; the Achilles tendon (achillodynia), the patellar tendon (patellar tendon syndrome), the supraspinatus tendon (supraspinatus tendon syndrome) and the tendon attachments of the elbow (tennis elbow) are predestined.
Causes
In general, a distinction is made between primary insertion tendopathy, which is directly caused by sport-specific overload, and secondary insertion tendopathy, which can occur in connection with muscular tension as a result of arthrosis or vertebral diseases (originating from the spine).
In the case of athletes and untrained people in particular, the tendon insertions are heavily strained during peak loads. One-sided loads, incorrect movements and external factors (such as a very hard floor covering, exposure to cold) can cause incorrect loading of the insertion areas, which on the one hand ensure the transmission of force from the tendon to the bone and on the other hand cushion excessive loads.
In addition, misalignments affecting the joints or bone axes can lead to permanent mechanical irritation of the tendons (microtraumas). As a result of pain-related permanent relief of the affected area, the adjacent muscles can also atrophy. Inflammatory (including rheumatism, Bechterew’s disease) or metabolic diseases can also favor the development of an insertion tendinopathy.
Symptoms, Ailments & Signs
An insertion tendinopathy manifests itself primarily through increasing pain in the affected part of the body. The symptoms occur mainly during physical exercise and cause tension and muscle hardening as they progress. The pain can also lead to permanent muscle weakness.
Atrophy can also occur. Externally, insertion tendinopathy can be recognized by the noticeable swelling or thickening of the tendon. The affected body region may be red and overheated. The complaints mainly occur in the tendon attachments of the elbow and in the area of the Achilles tendon and patellar tendon.
After a sports injury, painful inflammation or irritation can also occur in the pelvic area. The pain itself can occur during exertion and at rest. The inflammation typically becomes noticeable at night. Then there is severe pain, which leads to sleep problems, depression and other complications for those affected.
As a result, those affected are often irritable and occasionally suffer from depressive moods. As a result of the relieving posture, joint wear and tear, permanent misalignments, circulatory disorders and a number of other symptoms and complaints can occur. Children may even develop developmental disorders or permanent muscle weakness.
Diagnosis & History
In many cases, the suspicion of an insertion tendinopathy results from the clinical symptoms and the sports-specific stresses described in the anamnesis of the person concerned.
The loosened areas in the bony area of the insertion sites, which are characteristic of chronic insertion tendinopathy, as well as the structural changes can be made visible by means of a radiological examination, whereby in some cases a comparative assessment with the opposite side can be useful. Bone changes and the typical thickening and swelling of the tendons in the insertion area (oedematous and fatty degeneration) can be assessed with the help of magnetic resonance imaging (MRI).
In addition, the end points of the tendons usually show fibrous roughening. In the case of insertion tendinopathies, the prognosis and course depend to a large extent on the specifically affected tendon attachment and the compliance (cooperation with regard to therapy) of the person concerned, but can generally be rated as good.
Complications
In most cases, insertion tendinopathy occurs primarily in athletes. This leads to pain and inflammation of the tendons, which usually also leads to severe restrictions in movement. The quality of life of the patient is reduced by this disease. It is not uncommon for pain to occur in the muscles, which leads to a reduced resilience of the person concerned.
Likewise, the movement restrictions can be so pronounced that the person concerned is dependent on the help of other people in everyday life. Without treatment, insertional tendinopathy leads to muscle weakness. The everyday life of those affected is significantly restricted by this disease. It is not uncommon for the affected regions to swell. If there is pain at rest, this pain at rest can also lead to sleep disorders or depression.
Treatment is carried out with the help of medication or therapy. There are no particular complications. However, the pain and discomfort may not be completely relieved. Life expectancy is usually not reduced or affected by insertional tendinopathy. As a rule, certain sports can no longer be carried out without further ado.
When should you go to the doctor?
If pressure pain, muscle tension or stress pain is noticed at the tendon attachment, a doctor or sports medicine specialist should be consulted promptly. A medical examination is necessary if the symptoms persist for more than a few days or rapidly increase in intensity. If the symptoms occur in connection with an injury, you should go to the doctor immediately. Medical advice is required, especially in the case of externally visible symptoms, such as redness or even bleeding. If a hardening of the muscles is noticed, the disease may have progressed further.
A doctor must diagnose insertion tendinopathy before tendon thickening or other serious complications develop.athleteand people who subject their feet to great stress at work are particularly susceptible to the disease and should see a doctor if they experience the symptoms mentioned. The correct contact person is your general practitioner, a sports doctor or an orthopedist. If the affected foot can no longer be moved at all, it is best to use the nearest one pediatrician for signs of tendon disease. hospitalvisited. Ideally, insertion tendinopathy is treated in a specialist clinic. If there are signs of tendon disease, children should go to a
Treatment & Therapy
The therapeutic measures depend significantly on the severity of the pain symptoms and whether there is acute or chronic inflammation of the tendon attachment. In the case of an acute insertion tendinopathy, for example, the treatment measures initially aim to immobilize the affected area.
Cryotherapeutic measures (eg with CO2 or ice) as well as orally or locally applied anti-inflammatory drugs (inflammation inhibitors) can be used as support. After the acute pain symptoms have subsided, electrotherapeutic and physical measures (including TENS, ultrasound therapy, iontophoresis) are usually indicated. In the case of chronic insertion tendinopathies, initially isometric contraction exercises are usually recommended to strengthen the muscles, which are subsequently substituted by dynamic exercises below the pain threshold in the course of therapy.
If necessary, corticosteroid infiltrates, local heat applications and extracorporeal shock wave therapy (ESWT) can also be used to relieve pain and ensure elasticity. In addition, the underlying cause of the insertion tendinopathy should be treated or eliminated. If, for example, the Achilles tendon insertion (achillodynia) is affected, shoes with slightly higher heels can help in some cases.
Furthermore, therapy with ACP (autologous conditioned plasma) can be considered in chronic insertion tendinopathies, especially in the Achilles tendon, elbow or shoulder area, to stimulate regenerative growth and accelerate healing. Surgical removal of the affected portion of the tendon is seen as the last resort in the case of insertion tendinopathies and, due to the risk of functional impairment, is only considered if the conservative measures are unsuccessful.
Outlook & Forecast
As a rule, insertion tendinopathy must always be treated by a doctor. If the disease is not treated, the pain will not go away on its own and in most cases the symptoms will worsen significantly.
As a rule, the severe pain of insertion tendinopathy can be treated well with the help of painkillers. There are no further complications or other complaints. Furthermore, the pain can be alleviated with the help of various therapies and exercises. This also alleviates the further course of the disease and limits the symptoms. Proper treatment of the insertion tendinopathy leads to a positive course of the disease in most cases, although complete healing cannot always be achieved.
If the insertion tendinopathy is not treated, there will be considerable complications and limitations in the everyday life of the person concerned. The patient suffers from severe limitations in movement and is usually no longer able to cope with everyday life on his own. He is dependent on the help of other people and suffers from a significantly reduced quality of life. Life expectancy is usually not negatively affected by insertional tendinopathy.
Prevention
Sport-specific overloads and thus also insertion tendinopathies can be avoided with adequate training programs adapted to individual needs. Untrained people should also avoid overloading during sporting activities. In addition, a well-developed musculature protects against overstraining the tendons and reduces the risk of insertion tendinopathies.
Aftercare
As a rule, patients with insertion tendinopathy have very few or even no special aftercare measures at their disposal. In the case of this disease, the person affected is primarily dependent on a quick diagnosis and also on a quick and, above all, on an early treatment of the disease, so that further complications can be prevented.
Self-healing cannot occur with insertion tendinopathy, so those affected are always dependent on treatment by a doctor. As a rule, the treatment is carried out by taking medication. Those affected should always ensure that they are taken regularly and that the medication is dosed correctly in order to permanently relieve the symptoms.
In many cases, concentration exercises are also necessary to control the symptoms of the insertion tendinopathy. Many of the exercises can also be performed at home, which may speed up healing. Most patients with this disease are also dependent on the help and support of their own family and friends, whereby loving and intensive conversations may also be necessary, above all to prevent psychological upsets or depression.
You can do that yourself
The treatment of insertion tendinopathy usually always depends on the exact cause. However, the affected person must in any case immobilize the affected region and protect it and no longer move it. Athletes in particular should no longer pursue their sport if they have insertion tendinopathy.
Various exercises are available to the patient to strengthen the muscles, which can be carried out in physiotherapy or at home. Above all, contraction exercises have a positive effect on the course of the disease. This can also restore mobility in the region so that there are no restrictions in everyday life. Heat applications are also very helpful in the case of an insertion tendopathy. These include hot baths or a visit to a sauna.
If the problems occur in the Achilles tendon, special shoes can be helpful here. These should have a slight heel and be slightly wider than normal shoes to support the leg when walking. The affected person should also regularly apply the prescribed medication to the respective area to relieve pain, as this also prevents further inflammation and treats the current one.