Terminology of Tendon Disorders Editorial Summary Often, we come across random terms such as Haglund’s deformity, Pump Bump, Cucumber Heel, Knobbly Heels and high prow heels; etc. As clinicians, we tend to use such terms as tendonsis, paratendinitis, tenosynovitis, peritendinitis or tendonosis in different circumstances quite interchangeably. The suffix ‘itis’ is traditionally supposed to imply an underlying inflammatory pathology. Most currently practicing general practitioners were told and many still believe that patients who present with overuse syndromes have a largely inflammatory cause, and will benefit from anti-inflammatory medication. This dogma seems to be deep rooted. We now know that inflammation and inflammatory cytokines are more important in the acute injuries and are not universally prominent across the spectrum of some other tendon disorders.2 This article is a concise exploration of these themes.
Introduction
T
he ambiguity of the nomenclature appears to stem from the lack of standard terminology and the large pool of confusing terms and definitions often used interchangeably.
Dr Naeem Jagani Specialist Registrar in Trauma and Orthopaedics, Manchester University NHS Foundation Trust Manchester, United Kingdom
In this article, we highlight the use of uniform terminology which may help promote more effective communication and documentation and also could go a long way in information sharing and affording clarity to our patients. This can possibly aid progress in the management of these conditions.
The first modern classification of tendon pathologies has to be credited to Lipscomb (1950) who brought in new definitions such as:
a. Paratendinitis: inflammation of tendons/ parts of tendons without sheath. b.
Tenosynovits : inflammation of tendons within a sheath.
c.
Peritendinitis : general descriptor could be either a/b.
Anatomy It is important to understand the anatomy of a tendon before we talk about pathology. Anatomically, a tendon has 3 coverings named epitenon, endotenon and paratenon. The epitenon having vascular, lymphatic and nerve supply extends into the tendon between tertiary bundles as endotenon. The epitenon is covered by the paratenon (loose type 1 and 3 collagen). Together, the paratenon and epitenon are known as the peritenon.
In the 1970s Perugia and in 1998 Puddu increased the focus on histology and described the terms:
a. Peritendinitis: inflammation in peritendinous sheaths, no tendon pathology. b.
Tendinosis : tendon degeneration without histological inflammation.
c.
Peritendinitis associated with Tendinosis
Discussion Prof Anand Pillai Consultant Orthopaedic Foot & Ankle and Adult Reconstruction Surgeon Manchester, United Kingdom
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Historically there have been attempts to tackle this variability Hippocratic first described a ‘Tendo Magnus of Hippocrates’. In 1693, Philip Verheyen attempted to further clarify this and in 1883 Raynal’s description of ‘Cellulite Peritendineuse’, also tries to shed some light on this problem.
Wound Masterclass - Vol 1 - December 2022
Clain & Baxter (1992) tried to subdivide this based on anatomic location with the introduction of the terms insertional and noninsertional to further focus the pathology. More recently, Maffulli (1998) suggested
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