Tendinopathies in the wrist, shoulder, elbow, knee, and ankle likely share a biologic mechanism characterized by a loss of microvasculature to the tendons, which declines between the fourth and fifth decades of life.

“those tendinopathy 'z whether they occur in the wrist the shoulder the elbow the knee the ankle I'm absolutely certain have the same biologic mechanism and I do think the blood flow to these tendons as they decline between the fourth and fifth decade of life that loss of blood flow that loss of reparative mechanism is what leads to this sort of again uniform biologic problem in these very joints”