What causes tendon microinjuries to become painful in the case of a tendinosis?
From www.tendonpain.org/injury.shtml:
Tendinosis/tendinopathy is a chronic degenerative tendon injury that is usually brought on by repetitive motion. The repetitive motion is often associated with activities in the workplace or with sports. Microinjuries gradually accumulate faster than they can heal until the area eventually becomes painful.
From {1}:
The term “lateral epicondylitis” is a misnomer
because, pathologically, this condition
consists of mucoid degeneration
with a paucity of acute or chronic inflammatory
cells. The condition is, therefore,
more appropriately referred to as “tendinosis.”
It is believed that tendinosis is the
result of repetitive trauma causing microtearing
of the tendon. Scar tissue
forms during the healing process, which is then subjected to further tearing with
repeat trauma (1,3,7). Eventually, as the
cycle of injury and repair continues, the
patient will become symptomatic.
I wonder what causes tendon microinjuries to eventually become painful in the case of a tendinosis. I.e., how comes pain from a tendinopathy often suddenly appears one day even though the microinjuries accumulated over the preceding weeks didn't create any pain at the time.
I am mostly interested in the tendons that attach to the epicondyles of the humerus.
References:
{1} Levin, Dayna, Levon N. Nazarian, Theodore T. Miller, Patrick L. O'Kane, Rick I. Feld, Laurence Parker, and John M. McShane. "Lateral Epicondylitis of the Elbow: US Findings 1." Radiology 237, no. 1 (2005): 230-234. scholar.google.com/scholar?cluster=8668317182298519154&hl=en&as_sdt=0,22 ; dx.doi.org/10.1148/radiol.2371040784; http://sci-hub.cc/10.1148/radiol.2371040784
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