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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.

  • If you see florid physical signs at a tendon bone interface like Bishop describes, that is more likely to be an enthesopathy, or involvement of an entheseal complex. – Graham Chiu Apr 10 '16 at 20:48
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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


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).

  • Welcome to health SE :-). Reliable references are strongly encouraged here and answers without them risk being deleted. You can always edit your post to add some. Please refer to the help center for more information on health SE policies. Thanks! – Lucky Apr 10 '16 at 13:49
  • @Lucky Unfortunately, answers with references may also be deleted (e.g., see my deleted answers), so I moved the question and this answer to quora.com/unanswered/… . Thanks Graham for the pointer! – Franck Dernoncourt Apr 10 '16 at 14:40
  • @Franck I'm aware of that issue, but I still like to inform the users new to healthSE that the policy on references is somewhat different here than on other SE sites. In most cases it works well because it's well intended. The backup of the answer is a good idea, but I think that the edit is a great improvement and will prevent the answer from being deleted. However, since it was generously edited by you, I can't give my +1 to this answer, but I hope your edit will serve as a good example for the future :-). – Lucky Apr 10 '16 at 18:21
  • @FranckDernoncourt Not at all comfortable with questioners editing answers. If you're so sure what a good answer contains then answer it yourself. – Carey Gregory Apr 10 '16 at 23:09
  • @GarthGregory I don't see an issue with anyone editing an answer to provide links to further explanation especially since in retrospect I should have done that myself. – Graham Chiu Apr 11 '16 at 0:48

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