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Tendinitis

What is Tendinitis?

A tendon is a cord of tough tissue that connects muscle to bone. The tendon is surrounded by a sheath that protects and lubricates the tendon. This sheath is lined by a layer of cells called the synovium. Occasionally, the tendon will become inflamed (called tendinitis) or the tendon sheath will become inflamed (called tenosynovitis). These conditions together are known as tendinitis and result in pain, stiffness and sometimes swelling.

Tendinitis usually is caused by a specific injury or by repetitive overuse, especially when using poor body position. Tendinitis can occur in young athletic people in response to sports injuries and overuse. However, tendons become less flexible with aging and tendinitis is common in middle aged and older adults.

In general, tendinitis can occur suddenly, may last for days, weeks or longer, and then go away. It can, however, occur again in the same place. When properly treated, it generally doesn’t result in permanent damage or disability.

Treatment usually consists of rest, activity changes, nonsteroidal anti-inflammatory drugs, steroid injections to the inflamed area and physical therapy.

What causes it?

By and large, tendinitis is caused by injury to or overuse of the tendon. This is especially true when abnormal body position or poor body mechanics are used during the activity. Tendinitis may also occur as a result of inflammatory arthritis, such as rheumatoid arthritis or ankylosing spondylitis. The hormonal changes during and after pregnancy are thought to leave a woman’s tendons vulnerable to injury and inflammation. Occasionally, an infection within the tendon sheath is responsible for the inflammation.

What are the symptoms/effects?

Tendons all over the body can become inflamed, including shoulders, elbows, wrists, fingers, hips, back, knees, ankles and feet. The symptoms usually include pain, stiffness and swelling.

  • Rotator cuff tendinitis: This is the most common cause of shoulder pain and is associated with overhead activities. The condition may be acute or chronic. In acute tendinitis, pain comes on suddenly and may be excruciating. This type of onset tends to occur in younger patients and often is associated with calcium deposits within the rotator cuff. Chronic rotator cuff tendinitis starts as an ache in the shoulder made worse with various movements. Shoulder movement is restricted due to pain. You may have difficulty dressing yourself and sleeping may be difficult because you can’t find a comfortable shoulder position
  • Bicipital tendinitis: The biceps is the muscle in the front of the arm that allows you to bend your elbow. The tendon that attaches that muscle to the shoulder often becomes inflamed in conjunction with the rotator cuff tendons. Both of these ailments are associated with repetitive overhead arm use. Bicipital tendinitis will cause the front of your shoulder to hurt and feel stiff
  • Tennis elbow (lateral epicondylitis): Your forearm muscles attach via tendons to your elbow at bony prominences called an epicondyle. Inflammation of the tendon and epicondyle on the outside of the elbow is called lateral epicondylitis or, commonly, tennis elbow. It results in pain during handshakes or lifting a briefcase, as well as tenderness when pressure is placed on the outside of the elbow where the muscle attaches
  • Golfer’s elbow (medial epicondylitis): Similar to tennis elbow, this is the result of inflammation of the tendon and epicondyle on the inside of the elbow. It causes pain and tenderness on the inside of the elbow where forearm muscles attach
  • de Quervain’s tenosynovitis: Pain, tenderness and, occasionally, swelling on the wrist side of the thumb can be the result of de Quervain’s tenosynovitis. It may be caused by repetitive pinching of the thumb while moving the wrist, as may be seen in writing, needlework, assembly line work, etc. It also can be seen during and shortly after pregnancy
  • Tenosynovitis of the wrist: Several tendons in the wrist attach to muscles that move the hand and fingers. Any or all of these tendons can become inflamed and will result in tenderness and pain when you move your wrist. It may be misinterpreted as arthritis of the wrist
  • Volar flexor tenosynovitis: Inflammation of tendons in the palm of the hand causes pain in the palm when the fingers are bent. The middle and index fingers are involved most frequently
  • Trigger finger (stenosing tenosynovitis): The sheath of one or more finger tendons will sometimes become inflamed and thickened. When this happens, the finger will lock in a bent position, resulting in painful clicking and popping when you open your fingers
  • Popliteal tendinitis: The tendon that attaches the hamstring to the knee can become inflamed, resulting in pain at the back of the knee. Running downhill can cause this injury
  • Patellar tendinitis (jumper’s knee): Inflammation of the patellar tendon causes pain and tenderness below the kneecap. This is seen in athletes who engage in repetitive running, jumping, or kicking
  • Achilles tendinitis: Pain, tenderness and swelling of the Achilles tendon (attaching your calf muscle to the back of the heel) is often the result of repetitive strain from recreational sports. It also can be caused by trauma or improperly fitting shoes
  • Posterior tibial tendinitis: Inflammation of this ankle tendon causes the most discomfort after athletic activity. Swelling and tenderness on the inside of the ankle may also be symptoms
  • Peroneal tendinitis: Inflammation of this ankle tendon causes tenderness on the outside of the ankle.

How is it diagnosed?

Diagnosing tendinitis is based primarily on a physical exam and a medical history. Your doctor will look for swelling and tenderness in the area that is bothering you. He or she will rule out infection if there is no heat and redness associated with the swelling and tenderness. He or she will ask you about the pain and about what types of activities you are involved in. That is usually enough for the doctor to diagnose tendinitis. If the diagnosis is in question or if the doctor suspects that you may have an underlying inflammatory disease, he or she may run some routine laboratory tests and X-rays.

What are the treatment options?

Tendinitis is common in people who are otherwise healthy. It may go away on its own over time. In most cases, a primary-care physician can treat tendinitis. Some people may need to be referred to a rheumatologist, an orthopaedic surgeon or a physical therapist for treatment.

Tendinitis is treated with a conservative approach. Your doctor may recommend a combination of rest, activity modification, heat and cold, medications, and physical therapy.

  • Rest: The affected tendon should be rested so it can heal. You may have to stop performing the offending activity for a short period of time.
  • Activity modification: The activity that caused the injury should be modified in such a way as to relieve the stress on the tendon. For example, if running gave you Achilles tendinitis, you may need to reduce your mileage, wear different shoes and then increase your mileage slowly.
  • Splints: Sometimes splints are used to keep the affected joint in alignment during activities so stress is taken off the tendon (such splints and wraps are available for tennis elbow). Splints may also be used during the initial resting period to allow the tendon to heal.
  • Cold and heat: Cold packs, slush baths, and ice rubs can reduce pain and swelling when the tendon is newly injured or is really bothering you. Hot packs, heating pads, or warm baths can feel good for the long-term ache that you may feel from an overuse injury.
  • Medication:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) can be taken to relieve the pain and swelling of tendinitis. Other analgesics (such as acetaminophen) can be added for pain relief.
    • Steroids can be injected into the tendon sheath for very direct pain and inflammation relief. Certain tendons should not be injected with steroids because it puts the tendon as risk of rupture (the Achilles for example).
    • Physical therapy: A physical therapist can teach techniques to stretch the affected tendon, thereby reducing the likelihood of reinjury. He or she can also assess your body mechanics and teach you better ways to perform the activities that give you trouble. Shoe inserts (orthotics) may be needed to adjust your running form, relieving pressure on your knee and Achilles tendons.
    • Surgery: Rarely surgery may be needed to relieve the symptoms of tendinitis. Surgery would also be necessary if the affected tendon tore or ruptured.

Who is at risk? /How can I prevent it?

Anyone can develop tendinitis. Often times an athlete or a “weekend warrior” will develop tendinitis because of overuse or because of inadequate training. People with underlying inflammatory diseases, such as rheumatoid arthritis or ankylosing spondylitis, are at higher risk of developing tendinitis as well. As people age, tendons become less flexible, so your risk of developing tendinitis without athletic overuse increases with age. Some types of tendonitis, particularly de Quervain’s tenosynovitis, are more common among women during and shortly after pregnancy.