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Tendon Innervation

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Metabolic Influences on Risk for Tendon Disorders

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 920))

Abstract

The regulation of tendon metabolism including the responses to loading is far from being well understood. During the last decade, however, accumulating data show that tendon innervation in addition to afferent functions, via efferent pathways has a regulatory role in tendon homeostasis via a wide range of neuromediators, which coordinate metabolic and neuro-inflammatory pathways.

Innervation of intact healthy tendons is localized in the surrounding structures, i.e paratenon, endotenon and epitenon, whereas the tendon proper is practically devoid of neuronal supply. This anatomical finding reflects that the tendon metabolism is regulated from the tendon envelope, i.e. interfascicular matrix (see Chap. 1).

Tendon innervation after injury and during repair, however, is found as extensive nerve ingrowth into the tendon proper, followed by a time-dependent emergence of different neuronal mediators, which amplify and fine-tune inflammatory and metabolic pathways in tendon regeneration. After healing nerve fibers retract to the tendon envelope.

In tendinopathy innervation has been identified to consist of excessive and protracted nerve ingrowth in the tendon proper, suggesting pro-inflammatory, nociceptive and hypertrophic (degenerative) tissue responses.

In metabolic disorders such as eg. diabetes impaired tendon healing has been established to be related to dysregulation of neuronal growth factors.

Targeted approaches to the peripheral nervous system including neuronal mediators and their receptors may prove to be effective therapies for painful, degenerative and traumatic tendon disorders.

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Funding Source

Studies from the author’s laboratories were supported by the regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutet (project nr. SLL 20110177), and the Swedish National Centre for Research in Sports, as well as the Swedish Medical Research Council (2012–3510) (PWA).

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Authors and Affiliations

  1. Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-17176, Stockholm, Sweden

    Paul W. Ackermann

  2. Department of Orthopedic Surgery, Karolinska University Hospital, SE-17176, Stockholm, Sweden

    Paul W. Ackermann

  3. McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, AB, Canada

    Paul Salo

  4. McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada

    David A. Hart

  5. Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada

    David A. Hart

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  1. Paul W. Ackermann
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Correspondence to Paul W. Ackermann .

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Editors and Affiliations

  1. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

    Paul W. Ackermann

  2. McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada

    David A. Hart

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Ackermann, P.W., Salo, P., Hart, D.A. (2016). Tendon Innervation. In: Ackermann, P., Hart, D. (eds) Metabolic Influences on Risk for Tendon Disorders. Advances in Experimental Medicine and Biology, vol 920. Springer, Cham. https://doi.org/10.1007/978-3-319-33943-6_4

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