04/12/2025
๐ ๐ง๐ต๐ฒ ๐ง๐ต๐ฟ๐ฒ๐ฒ ๐ฆ๐๐ฎ๐ด๐ฒ๐ ๐ผ๐ณ ๐ง๐ฒ๐ป๐ฑ๐ผ๐ป ๐ฃ๐ฎ๐๐ต๐ผ๐น๐ผ๐ด๐
โช๏ธ Tendinopathy is a prevalent tendon disorder causing persistent, localized pain, and loss of strength and function.
โช๏ธ These common musculoskeletal injuries result from factors like overuse or excessive mechanical loading, which push the tissue beyond its physiological threshold and lead to an insufficient healing response.
โช๏ธ Tendon pathology is generally understood to progress through a three-stage continuum: reactive tendinopathy, tendon disrepair, and degenerative tendinopathy.
โช๏ธ Recognizing these stages is crucial, as the severity of the injury and the likelihood of successful repair are often dependent on the stage of progression.
๐ต ๐๐ฉ๐๐๐ 1: ๐๐๐๐๐ฉ๐๐ซ๐ ๐๐๐ฃ๐๐๐ฃ๐ค๐ฅ๐๐ฉ๐๐ฎ
โช๏ธ This is the initial stage following an acute injury.
โช๏ธ Key Features: Inflammatory responses begin immediately.
โช๏ธ Tissue Changes: The tendon displays minimal collagen damage. This stage is characterized by the release of pro-inflammatory cytokines, increased fluid in the extracellular matrix (ECM), altered tenocyte shape, and de-tensioned collagen.
โช๏ธ Reversibility: If treated within this first stage, the process is generally reversible.
๐ก๐๐ฉ๐๐๐ 2: ๐๐๐ฃ๐๐ค๐ฃ ๐ฟ๐๐จ๐ง๐๐ฅ๐๐๐ง
โช๏ธ If the pathology progresses, the tendon enters the disrepair stage.
โช๏ธ Key Features: This stage is characterized by the proliferation of abnormal tenocytes.
โช๏ธ Tissue Changes: Features include collagen splitting and neovascularization (the formation of new blood vessels, often indicated by grouped endothelial cells). There is also an increase in type III collagen production.
โช๏ธ Reversibility: The process is still generally reversible if treated during this stage.
๐ด ๐๐ฉ๐๐๐ 3: ๐ฟ๐๐๐๐ฃ๐๐ง๐๐ฉ๐๐ซ๐ ๐๐๐ฃ๐๐๐ฃ๐ค๐ฅ๐๐ฉ๐๐ฎ
โช๏ธ This is considered the final or terminal stage of tendon pathology.
โช๏ธ Key Features: This stage marks the most severe damage.
โช๏ธ Tissue Changes: There is further disruption of collagen fibers, diffused cell death, and permanent ECM disorganization. Stage 3 also shows further increases in type III collagen production.
โช๏ธ Treatment Outlook: Treatment becomes challenging in this terminal stage.
๐งฉ ๐ง๐ต๐ฒ ๐๐ถ๐ด๐ด๐ฒ๐ฟ ๐ฃ๐ถ๐ฐ๐๐๐ฟ๐ฒ
โช๏ธ Throughout these stages, the tendon fibers become de-tensioned (represented via thinning and looser organization of fibrils).
โช๏ธ The progression involves the aggregation of endothelial cells, continuous inflammation, and a sustained increase in type III collagen.
โช๏ธ It is important to note that Type I collagen constitutes more than 85% of the dry weight of a normal tendon.
โช๏ธ Therefore, the progressive alterations in collagen phenotype (such as the increase in Type III collagen) are critical factors in determining the severity of the injury and the likelihood of successful repair.
โช๏ธ Early detection and treatment of tendinopathies are challenging partly because of a prolonged asymptomatic phase during which ECM disorganization occurs.
