Tendinopathy: Current Concepts in Pathophysiology, Clinical Presentation, and Management – An Updated Review

Tendinopathy is a common musculoskeletal disorder characterized by tendon pain, impaired function, and reduced loadbearing capacity. It affects both athletic and non-athletic populations and represents a significant cause of disability and healthcare burden worldwide. Traditionally regarded as an inflammatory condition, current evidence suggests that tendinopathy is a multifactorial disorder involving mechanical overload, extracellular matrix degradation, collagen disorganization, cellular dysfunction, oxidative stress, neurovascular ingrowth, and a failed healing response. Commonly affected tendons include the Achilles tendon, patellar tendon, rotator cuff tendons, and lateral elbow extensor tendons. Several intrinsic and extrinsic risk factors, including aging, obesity, diabetes mellitus, repetitive occupational activities, and sports-related overuse, contribute to disease development and progression. Advances in imaging modalities such as ultrasonography and magnetic resonance imaging have improved the diagnosis and monitoring of tendon pathology. Management strategies include exercise-based rehabilitation, physiotherapy, extracorporeal shockwave therapy, pharmacological interventions, platelet-rich plasma therapy, regenerative medicine approaches, and surgical treatment in refractory cases. Emerging therapies such as stem cell therapy, growth factor delivery, gene therapy, and tissue-engineered scaffolds offer promising future directions for tendon regeneration. This review provides a comprehensive overview of the epidemiology, pathophysiology, clinical manifestations, diagnosis, and current as well as emerging treatment strategies for tendinopathy, highlighting recent advances and future perspectives in tendon research and clinical practice