Sharma and Maffulli review tendon structure, injury mechanisms, healing biology, and treatment strategies. The central question: what do we actually know about how tendons fail and heal, and which interventions have credible evidence? The review covers terminology, histopathology of tendinopathy and rupture, the three phases of healing, physical modalities, and emerging biological therapies.
The word 'tendinitis' implies inflammation — but biopsy of chronically painful tendons shows no inflammatory cells. Calling it tendinopathy changes your treatment logic: anti-inflammatories are not the answer, and patients need to understand recovery is prolonged and incomplete.
When a patient asks why their tendon 'just snapped' without warning, this paper explains it: 97% of spontaneously ruptured tendons already had degenerative changes. The rupture is the final event in a silent process.
When considering ESWT, the calcification status of the tendon changes your recommendation. High-energy ESWT has RCT support for calcific rotator cuff disease. For noncalcific tendinopathy, a sham-controlled RCT showed no added benefit from moderate-energy ESWT.
Fluoroquinolone exposure in a patient with new tendon pain should raise your suspicion immediately. These drugs inhibit tenocyte metabolism and are directly linked to tendinopathy and rupture. Ask about antibiotic history in every tendon patient.
Sharma and Maffulli review tendon structure, injury mechanisms, healing biology, and treatment strategies. The central question: what do we actually know about how tendons fail and heal, and which interventions have credible evidence? The review covers terminology, histopathology of tendinopathy and rupture, the three phases of healing, physical modalities, and emerging biological therapies.
The word 'tendinitis' implies inflammation — but biopsy of chronically painful tendons shows no inflammatory cells. Calling it tendinopathy changes your treatment logic: anti-inflammatories are not the answer, and patients need to understand recovery is prolonged and incomplete.
When a patient asks why their tendon 'just snapped' without warning, this paper explains it: 97% of spontaneously ruptured tendons already had degenerative changes. The rupture is the final event in a silent process.
When considering ESWT, the calcification status of the tendon changes your recommendation. High-energy ESWT has RCT support for calcific rotator cuff disease. For noncalcific tendinopathy, a sham-controlled RCT showed no added benefit from moderate-energy ESWT.
Fluoroquinolone exposure in a patient with new tendon pain should raise your suspicion immediately. These drugs inhibit tenocyte metabolism and are directly linked to tendinopathy and rupture. Ask about antibiotic history in every tendon patient.