• Suwannika Palee, Ugur Yener, Alaa Abd-Elsayed, and Sayed Emal Wahezi.
• Department of Rehabilitation Medicine, Faculty of Medicine, Naresuan University, Mueng Phitsanulok, Thailand.
• Curr Pain Headache Rep. 2024 Jul 19.

BackgroundTendinopathy significantly impacts the quality of life and imposes a high economic burden, accounting for a large proportion of sports and musculoskeletal injuries. Traditionally considered a collagen-related inflammatory disorder, emerging evidence suggests a critical role of neuropathic processes in chronic tendon pain.ObjectiveThis review aims to evaluate the neuropathic mechanisms in tendinopathy and discuss innovative treatments targeting these pathways.MethodsWe analyze recent studies highlighting the tendon innervation, pathological nerve sprouting neuronal ingrowth in tendinopathy, and the associated increase in pain and neuronal mediators.ResultsChronic tendinopathy exhibits nociceptive sprouting from paratenon into the fibrous tendon proper. Innovative treatments such as Percutaneous Ultrasound-Guided Tenotomy (PUT) or high-frequency ultrasound interventions show promise in targeting these neuropathic components by paratenon separation. These approaches focus on disrupting the pathological innervation cycle.ConclusionChronic tendon pain may be predominantly neuropathic, driven by pathologic neuronal ingrowth from paratenon into the tendon proper. Interventions that accurately target and disrupt these nerve pathways could revolutionize the treatment of tendinopathy. Further research is required to validate these findings and refine treatment modalities to ensure safety and efficacy.© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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