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Tendinitis What You Should Know

Tendinitis: Symptoms, causes, and treatment

Tendinitis What You Should Know

Tendinitis is inflammation or irritation of a tendon — the thick fibrous cords that attach muscle to bone. The condition causes pain and tenderness just outside a joint.

Tendinitis is inflammation of a tendon – a thick, flexible cord of tissue that attaches muscle to bone. Tendons help muscles move bones. Tendinitis most commonly occurs in the shoulder, bicep, elbow, hand, wrist, thumb, calf, knee or ankle.  Since the pain of tendinitis occurs near a joint, it is sometimes mistaken for arthritis. The condition is more common in adults over the age of 40 and athletes. Some forms of tendinitis are named after certain sports (e.g., tennis elbow, golfer’s elbow, pitcher’s shoulder, swimmer’s shoulder and jumper’s knee). 

Tendinitis, also known as tendonitis, is the inflammation of a tendon. It happens when a person overuses or injures a tendon, for example, during sport. It is normally linked to an acute injury with inflammation.

It often affects the elbow, wrist, finger, thigh, and other parts of the body.

The body part that is involved may give the injury its name, for example, Achilles tendinitis. Familiar terms are tennis or golfer’s elbow, jumper’s knee, and pitcher’s shoulder.

Tendinitis can occur at any age, but it is more common among adults who do a lot of sport. Older people are also susceptible, because the tendons tend to lose elasticity and become weaker with age.

What Is Tendinitis?

Tendinitis is an inflammation of a tendon, a group of sturdy fibers that connects a muscle to the nearby bone. Another commonly used term for tendinitis is tendinopathy. Tendinitis is generally caused by injury, trauma, or overuse of a joint. Tendinitis may be referred to by a more specific description depending on the location where it occurs, such as Achilles tendinitis or tennis elbow. The elbows, heel, shoulder and wrist are common locations for tendinitis.

Anyone may experience tendinitis, although the risk of developing tendinitis may be increased in older populations, people who do not exercise regularly, or people who experience excessive rotations of a joint. Some conditions that affect the entire body, such as rheumatoid arthritis (chronic autoimmune disease characterized by joint inflammation) or diabetes, can increase the risk of developing tendinitis.

Tendinitis is treated with rest along with medications to relieve pain and reduce inflammation. Physical therapy can be helpful to improve muscle strength and enhance healing. In some cases, surgery will need to be performed to repair tendon damage.

Tendinitis generally does not pose a serious medical risk. However, repeated or prolonged tendinitis may require treatment by a medical professional. If your tendinitis symptoms worsen or are persistent or recurring, you should seek prompt medical care.

Types

Different types of tendinitis affect different parts of the body.

Achilles tendinitis

The Achilles tendon is between the heel and the calf muscle. Achilles tendinitis is a common sports injury. It may also be caused by shoes that fit badly or do not properly support the foot. It is more likely among patients with rheumatoid arthritis.

Supraspinatus tendinitis

With supraspinatus tendinitis, the tendon around the top of the shoulder joint becomes inflamed, causing pain when the arm is moved, especially upwards.

Some patients may find it painful to lie on the affected shoulder at night. If other tendons in the same area are also affected, the patient may have rotator cuff syndrome.

Tennis or golfer’s elbow

A common symptom of lateral epicondylitis, commonly known as tennis elbow, is pain on the outer side of the elbow. It may radiate down towards the wrist.

Medial epidondylitis or golfer’s elbow is pain on the inner side of the elbow, and it is more common among golfers. Pain is more acute when trying to lift against a force. The pain sometimes radiates down to the wrist.

De Quervain’s stenosing tenosynovitis

The sheath that surrounds the thumb tendons, between the thumb and wrist, becomes inflamed. With the thickened sheath and swelling in the area, it becomes painful to move the thumb.

Trigger finger or thumb

The finger or thumb clicks when straightened out. It becomes fixed in a bent position because the tendon sheath in the palm of the hand is thickened and inflamed and does not allow the tendon to move smoothly. Sometimes a nodule forms along the tendon.

Tendinitis of the wrist

This can affect badminton players and production line workers, who repeatedly use the same motion with their wrist. Tendinopathy is another type of injury that affects the wrist tendons. This is a degenerative condition rather than an inflammation.

Symptoms

n general, tendonitis causes pain in the tissues surrounding a joint, especially after the joint is used too much during play or work. In some cases, the joint may feel weak, and the area may be red, swollen and warm to the touch.

When tendonitis is caused by an infection such as gonorrhea, there may be other symptoms, including rash, fever, or a discharge from the vagina or penis.

Other symptoms vary according to which tendon is affected:

  • Rotator cuff tendonitis – Usually dull, aching shoulder pain that can’t be tied to one location. It often radiates into the upper arm toward the chest. The pain is often worse at night and may interfere with sleep.
  • Tennis elbow – Pain in the outer side of the elbow. In some cases, the painful area extends down to the forearm and wrist
  • Golfer’s elbow – Pain in the inner side of the elbow
  • Jumper’s knee – Pain below the kneecap and, sometimes, above it
  • De Quervain’s disease – Pain at the back of the wrist, near the base of the thumb
  • Achilles tendonitis – Pain at the back of the heel or 2 to 4 inches above the heel

Causes

The most common causes of tendinitis are strain, overexertion, injury, repetitive movements, and sudden or unaccustomed movements. Tendinitis is most common in seniors and middle-aged people, since the tendons of older individuals lack the elasticity of younger people and have sustained hundreds of microscopic tears due to wear and tear over the years.

There are certain diseases that can cause tendinitis, such as rheumatoid arthritis, gout, Reiter’s syndrome, lupus, and diabetes. Sometimes, people with gout have uric acid crystals that appear in the tendon sheath that cause friction and tearing. Very high blood cholesterol levels may also be linked with this condition. Quinolone antibiotics (e.g., ciprofloxacin, levofloxacin, moxifloxacin)* may increase the risk of tendon rupture.

Some common types of tendinitis include the following:

Rotator cuff tendinitis affects tennis players, swimmers, and anyone who frequently lifts their arms above the head and in a forward motion. This causes several shoulder tendons to rub together. Inflammation can set in and, if severe and untreated, may start to erode the tendons. Rotator cuff tendons hold the upper arm bone in the shoulder socket.

Achilles tendinitis involves the strongest tendon in the body, the one that connects the heel to the leg muscles. It’s usually caused by running uphill or downhill, jumping, or engaging in sports that require sudden stopping and starting. Wearing shoes with either very soft-padded heels or very stiff soles, especially for someone whose ankles roll in, may also contribute to Achilles tendinitis. Achilles tendinitis requires special care, as the Achilles tendon must handle great force from the upper body. Special caution is especially warranted if the inflammation is due to the quinolone medications mentioned above.

Flexor digital tenosynovitis (trigger finger) may be seen in people with rheumatoid arthritis and diabetes. A protrusion or thickening of the tendon catches in the tendon sheath, causing the finger to bend and stick.

De Quervain’s tenosynovitis (De Quervain’s syndrome) affects the tendon sheaths extending from above the wrist to the thumb. The most common cause is excessive wringing of the wrist or other repetitive movements. In some cases, rheumatoid arthritis may be involved.

Tennis elbow is medically known as epicondylitis, since inflammation occurs at the part of the elbow where the tendon inserts. Of course, it has many other triggers besides tennis.

How Is Tendinitis Diagnosed?

At your appointment, your doctor will ask about your medical history and perform a physical exam of the area where the pain is concentrated. They’ll also examine your tenderness and range of motion.

Be prepared to tell your doctor about the following:

  • recent or past injuries to the area in pain
  • your past and present sports and physical activities
  • any previously diagnosed medical conditions
  • all prescription drugs, over-the-counter medications, and herbal supplements you take

If your doctor can’t make a diagnosis using just a physical examination, they may order additional tests. These could include:

  • X-rays
  • MRI scans
  • ultrasounds

During the physical exam, your doctor will look for tenderness, swelling, redness, muscle weakness and limited motion in the area of the sore tendon. Your doctor also may ask you to move in certain ways, such as raising your arm above your head or bending your wrist. These moves may hurt, but they are very important to help your doctor figure out which tendon is affected. In most cases, the diagnosis can be made based on your medical history and symptoms, together with your occupational and sports history and the results of your physical examination.

Some people may need blood tests to look for other causes of inflammation around the joints, such as gout or rheumatoid arthritis. X-rays also may be taken to confirm that there is no fracture, dislocation or bone disease. In people with Achilles tendonitis or rotator cuff tendonitis, ultrasound or magnetic resonance imaging (MRI) scans may be used to help evaluate the extent of tendon damage.

How Is Tendinitis Treated?

Treating tendinitis can reduce pain and swelling. Some common treatments include:

  • Resting and elevating the injured area.
  • Limiting your activity to reduce further injury.
  • Taking medicines that will reduce swelling, such as aspirin, naproxen, or ibuprofen.
  • Gentle stretching and strengthening exercises.
  • Applying compression to the injured area.
  • Soft tissue massage.
  • Putting a brace, splint, or band on the injured joint.

Your doctor may also recommend ice for sudden, severe injuries, but most cases of tendinitis are long term, and ice does not help.

If your tendinitis does not improve, your doctor may inject a medicine into the area surrounding the swollen tendon.

If your tendon is completely torn, you may need surgery. If your tendon is partially or completely torn, you may also need several months of physical therapy and exercises to restore your strength and prevent further injury.

Prevention

In many cases, tendonitis can be avoided by taking a few simple precautions. Some helpful strategies include:

  • Always warm up before beginning strenuous exercise.
  • f you want to intensify your exercise level, do it gradually.
  • Be careful about the “no pain, no gain” approach. It can be difficult to distinguish between an ache that indicates you’re building strength and an ache that means you injured a tendon.
  • Avoid activities that require prolonged periods of reaching over your head, such as painting the ceiling. If you must do this kind of work, take frequent breaks.
  • Wear shoes that fit properly, especially if you participate in a sport that requires a lot of running, such as track, cross-country or basketball.
  • If you are active in organized sports or exercise regularly, pay attention to your technique. Ask your coach or trainer for guidance. If you’re having exercise-related tendonitis, a doctor who specializes in sports medicine may be helpful as well.
  • For people with medial or lateral epicondylitis related to racquet sports, changing to a racquet with a larger head may help to prevent re-injury, as long as the new racquet is not heavier than the original. Some specialists believe that this type of racquet cuts down on the transmission of vibrations to the arm.
  • Tendonitis caused by gonorrhea can be prevented by abstinence or by practicing safe sex.

Read more What Foods Should You Eat and Avoid When You Have Tendinitis

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