Cell and Tissue Research

, Volume 320, Issue 1, pp 201–206 | Cite as

The innervation pattern of the human Achilles tendon: studies of the normal and tendinosis tendon with markers for general and sensory innervation

Short Communication


Pain-free normal Achilles tendons and chronic painful Achilles tendons were examined by the use of antibodies against a general nerve marker (protein gene-product 9.5, PGP9.5), sensory markers (substance P, SP; calcitonin gene-related peptide, CGRP), and immunohistochemistry. In the normal tendons, immunoreactions against PGP9.5 and against SP/CGRP were encountered in the paratendinous loose connective tissue, being confined to nerve fascicles and to nerve fibers located in the vicinity of blood vessels. To some extent, these immunoreactions also occurred in the tendon tissue proper. Immunoreaction against PGP9.5 and against SP/CGRP was also observed in the tendinosis samples and included immunoreactive nerve fibers that were intimately associated with small blood vessels. In conclusion, Mechanoreceptors (sensory corpuscles) were occasionally observed, nerve-related components are present in association with blood vessels in both the normal and the tendinosis tendon.


Achilles tendon Innervation Tendinosis Neuropeptides Human 



The authors wish to thank Ulla Hedlund and Lena Jonsson for excellent technical services. Financial support was obtained from the Faculty of Medicine and Odontology, Umeå University and the Swedish National Centre for Research in Sports.


  1. Ackermann PW, Finn A, Ahmed M (1999) Sensory neuropeptidergic pattern in tendon, ligament and joint capsule. A study in the rat. Neuroreport 13:2055–2060Google Scholar
  2. Ackermann PW, Li J, Lundeberg T, Kreicbergs A (2003) Neuronal plasticity in relation to nociception and healing of rat Achilles tendon. J Orthop Res 21:432–441CrossRefGoogle Scholar
  3. Albuerne M, De Lavallina J, Esteban I, Naves FJ, Silos-Santiago I, Vega JA (2000) Development of Meissner-like and Pacinian sensory corpuscles in the mouse demonstrated with specific markers for corpuscular constituents. Anat Rec 258:235–242CrossRefGoogle Scholar
  4. Alfredson H, Forsgren S, Thorsen K, Fahlström M, Johansson H, Lorentzon R (2001) Glutamate NMDAR1 receptors localised to nerves in human Achilles tendons. Implications for treatment? Knee Surg Sports Traumatol Arthrosc 9:123–126Google Scholar
  5. Alfredson H, Öhberg L, Forsgren S (2003) Is vasculo-neural ingrowth the cause of pain in chronic Achilles tendinosis? An investigation using ultrasonography and colour Doppler, immunohistochemistry, and diagnostic injections. Knee Surg Sports Traumatol Arthrosc 11:334–338Google Scholar
  6. Andres KH, During M, Schmidt RF (1985) Sensory innervation of the Achilles tendon by group III and IV afferent fibers. Anat Embryol 172:145–156CrossRefGoogle Scholar
  7. Brain SD (1997) Sensory neuropeptides: their role in inflammation and wound healing. Immunopharmacology 37:133–152CrossRefGoogle Scholar
  8. Carlton SM, Zhou S, Coggeshall RE (1998) Evidence for the interaction of glutamate and NK-1 receptors in the periphery. Brain Res 790:160–169CrossRefGoogle Scholar
  9. Cook JL, Feller JA, Bonar SF, Khan KM (2004) Abnormal tenocyte morphology is more prevalent than collagen disruption in asymptomatic athletes’ patellar tendons. J Orthop Res 22:334–338CrossRefGoogle Scholar
  10. Fan T-P D, Hu D-E, Guard S, Gresham GA, Waitling KJ (1993) Stimulation of angiogenesis by substance P and interleukin-1 in the rat and its inhibition by NK-1 or interleukin-1 receptor. Br J Pharmacol 110:43–49Google Scholar
  11. Halata Z, Wagner C, Baumann KI (1999) Sensory nerve endings in the anterior cruciate ligament (lig. cruciatum anterius) of sheep. Anat Rec 254:13–21CrossRefGoogle Scholar
  12. Hansson M, Forsgren S (1995) Immunoreactive atrial and brain natriuretic peptides are co-localized in Purkinje fibers but not in the innervation of the bovine heart conduction system. Histochem J 27:222–230CrossRefGoogle Scholar
  13. Höckerfelt U, Franzén L, Norrgård Ö, Forsgren S (2002) Early increase and later decrease in VIP and substance P nerve fiber densities following abdominal radiotherapy—a study on the human colon. Int J Radiat Biol 78:1045–1053Google Scholar
  14. Józsa L,, Bálint BJ, Kannus P, Järvinen M, Lehto M (1993) Mechanoreceptors in human myotendinous junction. Muscle Nerve 16:453–457CrossRefGoogle Scholar
  15. Messner K, Wei Y, Andersson B, Gillqvist J, Rasanen T (1999) Rat model of Achilles tendon disorder. A pilot study. Cells Tissues Organs 165:30–39CrossRefGoogle Scholar
  16. Öhberg L, Alfredson H (2002) Ultrasound guided sclerosis of neovessels in painful chronic Achilles tendinosis: pilot study of a new treatment. Br J Sports Med 36:173–177Google Scholar
  17. Stilwell DL Jr (1957) The inervation of tendons and aponeurosis. Am J Anat 100:289–317Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  1. 1.Department of Integrative Medical Biology, Section for AnatomyUmeå UniversityUmeaSweden
  2. 2.Department of Surgical and Perioperative Sciences, Sports MedicineUmeå UniversityUmeaSweden

Personalised recommendations