How to know whether an inflammation is present in a tendinopathy?

Question

I wonder how to know whether an inflammation is present in a tendinopathy. In other words, how to distinguish a tendinosis from a tendonitis.

http://physical-therapy.advanceweb.com/Features/Articles/Tendinitis-or-Tendinosis.aspx says:

Therapists should be using a sort of process of elimination when it comes to figuring out whether their patient has degeneration or inflammation, advised Bishop. Since the patellar tendon is so close to the skin, PTs should be looking for obvious, visible symptoms of tendonitis to rule out tendinosis.

"What you should see with tendonitis patients are the hallmark signs of inflammation, like swelling, redness, or palpable amounts of fluid in or around the tendon," said Bishop. And if you don't see these signs, the pain the patient is experiencing is most likely caused by the degenerative condition rather than the inflammatory. "In the absence of those symptoms, the likelihood is that people don't have tendonitis -- but they have tendinosis, and this condition must be managed in a different way

I wonder whether they are other ways to detect an inflammation. I am mostly interested in epicondyles of the humerus.

Answer 1

You can use an ultrasound probe with power doppler to look at blood flow to see if there is increased blood flow present that would be compatible with an inflammatory process.

And, neovascularization demonstrated by power Doppler may be present in more painful lesions

http://pubs.rsna.org/doi/full/10.1148/radiol.2272012069 but currently it's not possible to distinguish between tendinitis and tendinosis as the distinction may not exist. Cell activation studies suggests inflammation occurs in what was thought to be microscopically non inflammatory tendon lesions. http://m.bjsm.bmj.com/content/early/2013/03/08/bjsports-2012-091957.full

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References:

Wakefield, Richard J., Andrew K. Brown, Philip J. O'Connor, and Paul Emery. "Power Doppler sonography: improving disease activity assessment in inflammatory musculoskeletal disease." Arthritis & Rheumatism 48, no. 2 (2003): 285-288.

Traditional gray-scale US has been successfully used for some time for the detection of joint and soft tissue inflammation (1–15). More recently, additional US techniques, including Doppler, have been introduced, offering the potential for improving the accuracy of a US assessment. Doppler US is a technique for making noninvasive measurements of blood flow and was developed from the principles first described by Austrian physicist Christian Doppler in 1842 (16). He was the first to observe the effect of motion on sound when he detected a change in the frequency of a sound wave as a result of movement of either its source or receiver.

[...] US has a number of advantages over other imaging techniques. It is safe, noninvasive, and emits no ionizing radiation. The equipment can be situated in the rheumatology outpatient clinic, improving patient access and enabling rapid, “real-time” dynamic examinations of multiple joints in multiple planes at one sitting. In addition, both the capital and running costs of US are significantly lower than those of other imaging modalities, such as magnetic resonance imaging (MRI) and computed tomography (CT).