Schematic diagram illustrating two basic consequences of tendon damage. We postulate that the abundant neovascularisation in chronic tendinopathy is responsible for the clinical symptoms (pain, swelling). In the absence of a vascular response, the degenerative process is asymptomatic, and may lead directly to tendon rupture. Subclinical degeneration may also lead to the clinical condition of tendinopathy. Painful tendinopathy, however, does not necessarily lead to tendon rupture. The black box signifies our lack of understanding of the processes that distinguish these two potentially different pathways.
Fenwick et al. Arthritis Res 2002 4:252 doi:10.1186/ar416