University of North Carolina School of Medicine, Chapel Hill, NC, USA.
University of Tennessee College of Medicine, Knoxville, TN, USA.
Am Fam Physician. 2019 Aug 1;100(3):147-157.
Chronic tendon injuries are common athletic and occupational injuries that account for many physician visits. Tendons have a complex biology that provides a unique combination of strength, flexibility, and elasticity but also predisposes them to injury. The term tendinopathy is preferred to tendinitis because of the presence of a disordered and degenerative healing process-not inflammation-in the pathologic tendon. Insidious onset of pain and dysfunction is a common presentation for most tendinopathies, and patients typically report that a change in activity affected the use of the tendon. Diagnosis is typically based on history and physical examination findings, but radiography is an acceptable initial imaging modality. Ultrasonography and magnetic resonance imaging may be useful when the diagnosis is unclear. The mainstays of treatment are activity modification, relative rest, pain control, and protection. Early initiation of rehabilitative exercises that emphasize eccentric loading is also beneficial. Despite a lack of high-quality evidence, cryotherapy has a role in controlling pain. Nonsteroidal anti-inflammatorydrugs and corticosteroids have a role in treatment despite the lack of histologic evidence of inflammation. Short-term use of these drugs reduces pain and increases range of motion, which can assist patients in completing rehabilitative exercises. Care should be taken when injecting corticosteroids into and near major load-bearing tendons because of the risk of rupture. Topical nitroglycerin, extracorporeal shock wave therapy, and platelet-rich plasma injections have varying levels of evidence in certain tendinopathies and are additional nonsurgical treatment options.
慢性肌腱损伤是常见的运动和职业性损伤，导致许多患者就诊。肌腱具有复杂的生物学特性，提供了强度、灵活性和弹性的独特组合，但也容易导致损伤。术语 tendinopathy 优于 tendinitis，因为病理肌腱中存在紊乱和退行性愈合过程，而不是炎症。大多数 tendinopathies 的常见表现为隐匿性疼痛和功能障碍，患者通常报告活动方式的改变影响了肌腱的使用。诊断通常基于病史和体格检查结果，但 X 线摄影是一种可接受的初始影像学检查方式。当诊断不明确时，超声检查和磁共振成像可能有用。治疗的主要方法是活动调整、相对休息、疼痛控制和保护。早期开始强调离心加载的康复锻炼也有益。尽管缺乏高质量证据，但冷冻疗法在控制疼痛方面具有作用。尽管缺乏炎症的组织学证据，但非甾体抗炎药和皮质类固醇在治疗中具有作用。这些药物的短期使用可减轻疼痛并增加活动范围，这有助于患者完成康复锻炼。由于存在断裂的风险，应谨慎将皮质类固醇注射到主要承重肌腱内和附近。局部硝酸甘油、体外冲击波治疗和富含血小板的血浆注射在某些 tendinopathies 中有不同程度的证据，是额外的非手术治疗选择。
