Presence of Neuropathic-Like Symptoms in Individuals with Painful Tendinopathy/Overuse Injuries

Objective: This meta-analysis evaluated the prevalence of neuropathic-like symptoms in individuals with painful tendinopathies/overuse injuries. Methods: Electronic literature searches on MEDLINE, CINAHL, PubMed, SCOPUS and Web of Science databases were conducted up to January 20 th , 2025. Studies reporting the prevalence of neuropathic-like symptoms in painful tendinopathy/overuse injury were included. The methodological quality was assessed with Newcastle-Ottawa Quality Assessment Scale in cohort/case-control studies or Physiotherapy Evidence Database (PEDro) in clinical trials. Random-effects models were used for meta-analytical pooled prevalence of neuropathic-like symptoms. Results: From 1,285 studies identified, eight (one case-control, five cohorts and two clinical trials) met inclusion criteria. The sample included 920 subjects with painful tendinopathy/overuse injury (47.6% female, age: 51, SD: 12.5 years). All studies included self-reported questionnaires for evaluating neuropathic-like symptomatology. The methodological quality was moderate-high. The overall prevalence of neuropathic-like symptoms in painful tendinopathies was 30% (95%CI 22%-38%, n=8, I 2 =79%). The prevalence by each tendinopathy was: plantar heel pain (44%, 95%CI 17%-75%, n=2, I 2 =96%), lateral epicondylalgia (42%, 95%CI 30%-56%, n=2, I 2 =30%), insertional Achilles tendinopathy (38%, 95%CI 20%-60%, n=2, I 2 = 71%), greater trochanteric pain syndrome (32%, 95%CI 26%-39%, n=2, I 2 =0%), patellar-quadricipital tendinopathy (16%, 95%CI 5%-41%, n=3, I 2 =29%), non-insertional Achilles tendinopathy (11%, 95%CI 2%-41%, n=5, I 2 =86%). Conclusion: This meta-analysis suggests the presence of neuropathic-like symptoms in 30% of subjects with painful tendinopathy, although this prevalence rate depends on specific condition. Identification of neuropathic symptoms in musculoskeletal pain conditions is important for diagnosis as it impacts its management.