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Where is the pain coming from in tendinopathy? It may be biochemical, not only structural, in origin

K M Khan¹, J L Cook², N Maffulli³, P Kannus⁴

¹ School of Human Kinetics and Allan McGavin Sports Medicine Centre University of British Columbia Vancouver, Canada
² Victorian Institute of Sport Tendon Study Group and Alphington Sports Medicine Clinic, Melbourne, Australia
³ Department of Orthopaedics University of Aberdeen Aberdeen, Scotland
⁴ UKK Institute, Tampere, Finland

Traditional dogma would have it that pain in tendinopathy arises through one of two mechanisms. Firstly, it may result from inflammation in "tendinitis". Secondly, it may be due to separation of collagen fibres in more severe forms of tendinopathy. The latter situation parallels the mechanism of pain with collagen separation after an acute grade I or II ligament injury (fig 1).

View larger version (18K): [in this window] [in a new window]   Figure 1 The classical "inflammatory" and "structural" tendon pain models.

 

Despite the wide acceptance of these two classical models of pain production, a number of studies provide data inconsistent with either theory. Consider first the inflammation mechanism. Histopathological examination of surgical specimens from patients with chronic tendon pain are devoid of inflammatory cells.¹ This applies to tissue from the Achilles, patellar, lateral elbow, medial elbow, and rotator cuff tendons. Furthermore, prostaglandin E2 (a marker of the inflammatory process) is no more abundant in patients with Achilles tendon pain than in . . . [Full text of this article]

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