What is attachment tendinopathy?
A tendon connects the muscle to the bone. Tendinopathies are diseases of the tendons that involve a chronic state of irritation. In attachment tendinopathy, the tendon is damaged at the base of the bone. The clinical picture is also known as insertional tendopathy or enthesiopathy. The causes of attachment tendinopathy are overloading, incorrect loading and wear and tear, which lead to very fine tears at the tendon attachment.
In principle, all tendons in the body can be affected. However, attachment tendinopathy often manifests itself in the Achilles tendon, which is exposed to enormous strain throughout life – when running and during sport. This is known as Achillodynia. However, the tendons of the shoulder, elbow or the patellar and biceps tendons can also be damaged if a person overuses them. People who play certain sports are particularly prone to the disease: running, weightlifting or throwing, jumping and ball sports that require rapid changes of direction.
The most common symptoms of attachment tendinopathy are pain. Depending on the stage of the tendon disease, they initially only occur after physical exertion, but later also at the beginning, during and after physical activity. If the attachment tendinopathy remains untreated and continues to progress, many people experience pain even at rest. In addition, they usually intensify over time. As the disease progresses, it can also lead to increasing functional impairment.
Attachment tendinopathy can be treated with physiotherapy and painkillers. Sometimes an injection or extracorporeal (outside the body) shock wave therapy and low-dose radiation are also helpful.
Attachment tendinopathy – frequency and age
The frequency of attachment tendinopathy cannot be precisely quantified. Tendinopathy often affects athletes who place incorrect or excessive strain on muscles, tendons and joints through jumping, throwing or running sports. Such tendinopathies due to strain have increased in recent decades. The reason is that more people in the middle and older age groups are active in sport. But younger people are also very susceptible to tendon disorders. They are usually involved in high-risk sports that are particularly susceptible to injury.
Attachment tendinopathy: causes and risk factors
The causes of attachment tendinopathy are incorrect and excessive strain as well as wear and tear of the tendon attachments. In addition, poor posture, incorrect sports technique, misalignment of joints and bone axes and obesity appear to promote tendinopathy. Experts assume that permanent overuse irritates the tendon insertion. The affected tendon swells, is roughened and sometimes the finest tears, so-called microtrauma, occur. Pull-outs and spurs can form on the adjacent bone due to the incorrect and excessive strain.
Attachment tendinopathy – male and female athletes are most at risk
Attachment tendinopathy particularly often affects people who play certain sports. Some examples:
- Throwing sports, such as handball, basketball and volleyball, often involve rapid changes of direction, which strain the tendons and tendon insertions.
- Jumping sports, for example. High jump, long jump or triple jump, pole vault
- Golf
- Tennis
- Running
- Weightlifting
Attachment tendinopathy – these tendons are often affected
In principle, attachment tendinopathy can develop at any tendon attachment. However, there are some tendons that are considered to be particularly at risk. Depending on the tendon affected, we speak of different clinical pictures:
- Tennis elbow (radial epicondylopathy): The tendons and the bone-tendon junction at the hand and finger extensor muscles on the outer elbow are diseased (radial humeral epicondyle).
- Golfer’s elbow (ulnar epicondylopathy): The tendons and the bone-tendon junction on the inner elbow (ulnar humeral epicondyle) are affected.
- Patella tip syndrome (“jumpers knee”) – the bone-tendon junction at the kneecap (patella) is damaged.
- Achillodynia: The damage affects the Achilles tendon, which connects the calf muscle to the heel bone.
- Fasciitis plantaris (often referred to as heel spur): Inflammatory change in the plantar aponeurosis with formation of a bony spur at the distal border of the calcaneus
- Supraspinatus tendon syndrome – the tendon of the supraspinatus muscle on the shoulder is affected
- Periarthropathia humeroscapularis (PHS): The attachments of the rotator cuff to the humeral head or the individual tendons are diseased.
- Bursitis trochanterica: alsoknown as “trochanteric pain syndrome” or “greater trochanter pain syndrome”, is an acute or chronic, abacterial inflammation of the bursa around the large rolling hill
Symptoms: Attachment tendinopathy causes pain
The symptoms of attachment tendinopathy are pain in the region where the affected tendon is located. Initially, those affected usually feel the pain after physical activity. If the attachment tendinopathy progresses further, the pain can occur before (so-called “start-up pain”), during and after physical exertion.
Not only movement, but also pressure on the affected body part or stretching can be very painful. It is also typical that the pain usually worsens if the disease progresses and is not treated. In addition, the function, mobility and freedom of movement of the affected extremity are usually restricted.
The muscle to which the tendon attaches hardens increasingly. Most people no longer use the affected muscles due to pain – over time, they become weakened.
Attachment tendinopathy: Diagnosis at the USZ
The diagnosis of attachment tendinopathy begins with a discussion of the patient’s medical history (anamnesis). For example, we are interested in the following questions:
- What exactly are your symptoms?
- How severe are the symptoms?
- How long have the symptoms been present?
- In which situations do the complaints occur?
- When are the symptoms better, when are they worse?
- Do you play sport? If yes: Which sport and how intense?
- Do you have any known diseases? For example, inflammatory rheumatic diseases?
Procedure for attachment tendinopathy
Your answers will help us to make an initial assessment of what could be the cause of the complaints. The physical examination provides further information. We palpate the muscles, tendons and joints in the affected body region and look for conspicuous swelling. We check whether pain is felt during movement, traction, pressure or stretching. We also test how well the joints can move or whether the function and range of movement are restricted. We also pay attention to any misalignments and postural defects. If attachment tendinopathy is suspected, an ultrasound examination is often carried out, in which the tendon can be visualized and assessed very well.
Other imaging procedures are sometimes used. This also allows other diseases, such as inflammation, to be ruled out as the cause of the symptoms. These include, for example:
Attachment tendinopathy: prevention, early detection, prognosis
The cause of attachment tendinopathy is usually overloading and incorrect strain, for example due to incorrect movement patterns or incorrect running techniques in certain sports. You can start here yourself and prevent attachment tendinopathy to a certain extent. Learn correct throwing, jumping and running techniques. Practice the movement sequences well so that you internalize them. Warm-up training before you start exercising and regular stretching are also suitable preventative measures.
There are no special measures for the early detection of attachment tendinopathy. The general advice is therefore: always seek medical advice if you are in pain. There are several therapies to improve attachment tendinopathy.
Course and prognosis of attachment tendinopathy
The prognosis for attachment tendinopathy is generally good, but the course varies from person to person. It may take some time for the symptoms to improve. Early treatment in which you actively participate is important. Sometimes you need to have staying power and perseverance during therapy. The aim is to correct unfavorable movement patterns and avoid overloading and incorrect loading. However, you should also keep moving. The course and prognosis are then often good and the attachment tendinopathy heals again without consequences.
Attachment tendinopathy: treatment with several strategies
There are several treatment options for attachment tendinopathy, such as shock wave therapy, cortisone infiltrations, physiotherapy or pain medication. It is important that you cooperate well with the therapy so that it is successful. If the illness is caused by overwork, you should first avoid strain. However, this does not mean that you should rest the limb – on the contrary: you should move it regularly but carefully to avoid pain. In the event of incorrect loading, improve the movement sequence so that the tendon is not further irritated.
