What is Tendinopathy?

Tendinopathy describes a complex multifaceted pathology of the tendon, characterized by pain, decline in function and reduced exercise tolerance. The most common overuse tendinopathies involve the rotator cuff tendon, medial and lateral elbow epicondyles, patellar tendon, gluteal tendons and the Achilles tendon.

Tendinopathy symptoms include pain, swelling and reduced function. The prominent histological and molecular features of tendinopathy include disorganization of collagen fibers, an increase in the microvasculature and sensory nerve innervation, dysregulated extracellular matrix homeostasis, increased immune cells and inflammatory mediators, and enhanced cellular apoptosis.

The etiology of tendinopathy seems to be a multi-factorial process, involving promoting factors that are intrinsic or extrinsic, working either alone or in combination. Tendinopathies are divided into three groups, “tendinosis”, “tendinitis” and “tenosynovitis”.

Some of the common causes of tendinopathy can include overuse of the tendons by repetitive actions, calcium deposit along the tendon at the site of insertion (where it attaches to the bone, bone spurs on the heels), any sporting activity that requires lots of jumping and running, running on hard surfaces, poor sporting technique such as holding a tennis racquet or golf club incorrectly, inappropriate sporting equipment such as a tennis, racquet that's too heavy, lifting weights that are too heavy or without warming up properly, neglecting to warm up properly before doing sport or exercise, extreme and regular physical effort, such as an intensive sports training schedule, not taking enough time between training sessions to allow full recovery, exercising in cold temperatures, awkward positions that are maintained for a long time, being obese which puts excessive pressure on the tendons of the legs.

Also, Read - Tendinopathy Market Report

The diagnosis of tendinopathy is primarily clinical, differential diagnosis for tendinopathy involves De Quervain’s disease, carpal tunnel syndrome, rhizarthrosis, golf elbow, coxarthrosis, hamstring tenosynovitis etc.

The treatment of painful chronic tendinopathy is challenging. Multiple non-invasive and tendon-invasive methods are used. Usually, the treatment can be grouped in pharmacological therapies, physical therapies, and therapeutic exercise. NSAIDs (non-steroidal anti-inflammatory drugs), SAIDs (steroidal anti-inflammatory drugs), and other alternative injective approaches have been used. Nutrition also plays a role.

Different theories have been advanced to explain pain and chronicity mechanisms, but these mechanisms remain largely unknown. “Conventional”treatments are generally employed empirically to fight pain and inflammation but they do not modify the histological structure of the tendon. However, these treatments are not completely satisfactory and the recurrence of symptoms is common..

About one third of sports injuries treated in sports clinics concern the knees and one quarter of athletes treated for a knee injury are diagnosed with Tendinopathy. Most common clinical Achilles disorders are mid-portion tendinopathies, followed by insertional problems (insertional Tendinopathy and retrocalcaneal bursitis).

Tendinopathy of the gluteus medius tendon is the main cause of greater trochanter pain syndrome, the incidence of which is reported to be1.8 patients per 1000 per year. As per the DelveInsight estimates, the United States has the highest diagnosed incident population of Tendinopathy.

Tendinopathy is still predominantly a medical condition which requires much patience from both therapist and patient. Nonoperative management should still be the first-line choice of treatment. A variety of conservative treatments have been proposed to manage of tendinopathy, including physiotherapy and pharmacotherapy. This last class of intervention presents a growing number of injectable substances (corticosteroids, prolotherapy, autologous blood, platelet-rich plasma, polidocanol). Biophysical Treatments include Extracorporeal Shock Wave, Low-Intensity Pulsed Ultrasound, Laser Therapy; Injection Therapies are corticosteroids, Sclerotherapy, blood products; surgical treatment.

In the initial acute phase, rest and immobilization are considered to try and control exacerbating factors, but prolonged immobilization should be avoided. Moreover, training regimes modifications and specific exercises are necessary. NSAIDs inhibit tendon cell migration and proliferation and impair tendon healing. NSAIDs are nevertheless commonly used for the management of Achilles Tendinopathy, but have little or no effect on the clinical outcome.

Thermic treatments like Cryotherapy (e.g., ice packs and baths) and Thermotherapy (heat) are there. Few Achilles tendon injuries require surgical treatment, including suturing, implantation of autologous tissue (e.g., strip of the central aponeurosis of gastrocnemius, peroneal tendon, fascia lata, flexor digitorum longus or flexor halluces longus), an allograft or a synthetic scaffold.

Tendinopathy treatment is recommended to start with the less invasive ones, moving towards more invasive options if the conservative treatment fails. Targeted therapies for Tendinopathy have been lacking due to poor understanding of the underlying pathology. Accumulating data from several research centers are starting to unravel the pathophysiology of tendinosis and mechanisms that lead to tendon pain. Thus, novel targeted therapies are evolving. These new treatments, however, need to be clinically tested in adequate studies before generally applied.

The market size shall grow during the forecast period due to the increase in the Incident cases, with the better understanding of the disease and the emerging treatments.

The current emerging landscape for Tendinopathy is limited, mainly comprising of Phase II and Phase III candidate drugs. The key players for phase II and III clinical development are MiMedx Group, Ipsen, and others.

Original Source:- Tendinopathy Market Research Report