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The intrinsic pathogenetic mechanisms of tendinopathies are largely unknown and whether inflammation or degeneration has the prominent role is still a matter of debate. Assuming that there is a continuum from physiology to pathology, overuse may be considered as the initial disease factor; in this context, microruptures of tendon fibers occur and several molecules are expressed, some of which promote the healing process, while others, including inflammatory cytokines, act as disease mediators. Neural in-growth that accompanies the neovessels explains the occurrence of pain and triggers neurogenic-mediated inflammation. It is conceivable that inflammation and degeneration are not mutually exclusive, but work together in the pathogenesis of tendinopathies.
Abate, M., Gravare Silbernagel, K., Siljeholm, C., Di Iorio, A., De Amicis, D., Salini, V., … Paganelli, R. (2009). Pathogenesis of tendinopathies: inflammation or degeneration? Arthritis Research & Therapy. https://doi.org/10.1186/ar2723