Types and epidemiology of tendinopathy
Section snippets
Basic pathology of overuse tendon conditions
The most common tendon injuries in sports are presented in Table 1. Any tendon and its surrounding tissues can undergo a tendinopathic process, however. The intrinsic and extrinsic factors have varying significance in the background of different tendon problems in sports, but some can be discussed in general.
Lack of consistent nomenclature for histopathological findings has limited progress in understanding the pathological basis of tendon conditions [4], [5]. The understanding that the
Tendinopathies: new definitions
We have recently advocated the use of the term tendinopathy as a general clinical descriptor of tendon injuries in sport [21]. In overuse clinical conditions in and around tendons, frank inflammation is infrequent, and, if seen, is associated mostly with tendon ruptures [24], [25], [26]. Tendinosis implies tendon degeneration without clinical or histological signs of intratendinous inflammation, and is not necessarily symptomatic [21]. When the term tendinitis is used in a clinical context, it
Epidemiologic approach to sports injuries
Many studies on sports injuries are based on reports from outpatient or accident and emergency departments, whereas others have been based on reports from specialist sports centers. Often studies cannot be compared, due to lack of uniformity in definitions of injuries, level of sports participation, insufficient information on the population at risk and on the exposure time to the sport, and variability in study design and data collection [27], [28], [29].
The epidemiological approach in sports
Injury risk factors
An important part of sports injury epidemiology is the identification of factors that contribute to the occurrence of athletic injuries [41]. This process is complicated by many risk factors that play a role before the actual occurrence of injury events. These have been classically divided into two types—intrinsic and extrinsic [36], [41], which interact to make the athlete more susceptible to injury [42].
Intrinsic risk factors:
Malalignment (ie, excessive pronation, femoral neck anteversion,
Injury prevention
Most of the preventive measures suggested in the literature have arisen from descriptive research, and have not been derived from risk factors that have been substantiated as defensible injury predictors through correlational or experimental research [28]. Once the analytical evidence points to an association between certain risk factors and injury, thereby establishing a degree of predictability for those participants who are likely to sustain injury, a method of intervention can be devised to
Age
In children, tendons and ligaments are relatively stronger than the epiphyseal plate, and considerably more elastic. Therefore, in severe trauma, the epiphyseal plate, being weaker than the tendons and ligaments, gives way. As a result, growth plate damage is more common than ligamentous and tendon injuries [43], [44].
Injuries to the insertions of tendons onto bone are more frequent than injuries to the main body of the tendon [45]. The Osgood-Schlatter lesion is by far the most common tendon
Gender
Most tendon injuries occur in males. Male predominance in tears of the Achilles tendon varies between 7 to 1 and 4 to 1 [47]. Although 60% of overuse injuries sustained in running occur in men, women under the age of 30 are at the greatest risk for overuse injuries. The proportion of female participants in sports injury surveys has increased dramatically during the past few decades [48]. The reasons for the increased female proportion are probably the increased female participation in physical
Blood group distribution
Josza et al [50] reported a significant association between the increased risk of tendon ruptures and the blood group O in Hungary, where they found that in over 800 patients with tendon rupture, 53% had blood group O. The distribution in the normal Hungarian population was 31%. The ratio of blood groups A to O (A/O ratio) was 0.51 (1.36 in the normal population). Of the patients with multiple tendon ruptures or rerupture, 68% had blood group O, and the A/O ratio was 0.25.
In Finland, a similar
Achilles tendinopathy
The etiology of Achilles tendon overuse injuries is multifactorial [53]. Training errors have been reported in 60% to 70% of the running injuries [54]. Rapid increase in mileage, increased interval training, and running on sloping and slippery roads are associated with Achilles paratendinopathy [55]. In a report on 698 patients with Achilles tendon injuries, 66% had paratenonitis and 23% had Achilles tendon insertional problems. In 8% of the patients, the injury was located at the myotendineal
Summary
During the last few decades, the role of sports and physical activity has become more and more important in all modern communities. The risk of tendon injury has thus increased, and prevention has become important. Epidemiologic studies are important when planning prevention programs for tendon injuries. Because of individual sport cultures and different sport habits in different countries, national epidemiologic studies are of importance in each individual country.
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