Pathophysiology of Tendinopathy: Implications for Tennis Elbow

  • Per Renstrom
  • Paul W. AckermannEmail author


Targeted therapies of elbow tendinopathies have been limited due to lack of knowledge of the underlying pathophysiology. Recreational tennis players are mostly affected by the classical “tennis elbow”––humeral epicondylar lateral tendinopathy, while elite tennis players more commonly present with medial humeral epicondylar tendinopathy, reflecting differences in loading. Repetitive loading in combination with newly discovered intrinsic risk factors, such as genetic abnormalities of eg. matrix proteins and metabolic disorders lead to neuronal dysregulation and the development of tendinopathy. Aberrant sensory nerve sprouting in the tendon may cause pain and by constant release of mediators produce fibrosis. Targeted therapies should in a holistic way address loading abnormalities and intrinsic risk factors with eccentric exercise as a cornerstone of treatment.


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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
  2. 2.Stockholm Sports Trauma Research CenterKarolinska InstitutetStockholmSweden
  3. 3.Department of Orthopedic SurgeryKarolinska University HospitalStockholmSweden

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