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Definition

Tendinitis (also known as tendonitis) is an inflammation of a tendon (a band of fibrous tissue connecting muscle to bone) that causes pain, tenderness and occasionally, restricted movement of the muscle attached to the affected tendon.

Description

Tendinitis can cause permanent damage to the tendons. The natural tendency to favor the painful area also can lead to stiffness. A vague discomfort at the age of 30, if overuse is continued for years, this can lead to a loss of flexibility due to scarring of the tissues. Sometimes the discomfort of tendinitis disappears within a matter of weeks, especially if you rest the affected area. In elderly people and those who continued to use the affected area, tendinitis often heals more slowly and usually progresses to a chronic condition. Types Of Tendinitis Almost any tendon in the body can be affected, however, those located around the knee, foot, elbow and shoulder are most frequently affected. Knee Tendinitis There are three (3) types of knee tendinitis: patellar tendinitis, quadriceps tendinitis and popliteus tendinitis. 1. Patellar tendinitis (also called "jumper's knee") affects the patellar tendon just below the patella (kneecap). The person complains of pain during an activity such as landing from a jump and going downstairs or lack of activity, such as sitting for long periods of time. 2. Quadriceps tendinitis affects the patellar tendon just above the kneecap. This condition is likely to be found in athletes who do a lot of rapid acceleration and deceleration. 3. Popliteus tendinitis affects the site of insertion of the popliteus tendon on the lateral epicondyle of the femur. Runners, particularly runners who run down hills or along sloping surfaces, are likely to complain of this type of tendinitis. Reducing the symptoms is the first step in alleviating the tendinitis. The doctor may tell you to use ice or heat, take certain medications, limit your activity to help control the pain and swelling and self-massaging of the area. Ice helps prevent swelling and reduces pain. Place ice on the painful area for 10 minutes at a time, several times a day. If you already have swelling, heat may help. Apply a heating pad or hot towels to the tendon for 30 minutes at a time, two or three times a day. Pain relievers and anti-inflammatory drugs are used to ease immediate symptoms, but by themselves will not cure the condition or keep it from recurring. Injecting cortisone and a local anesthetic into the area surrounding the tendon usually provides substantial relief within 24 to 72 hours. In rare cases, surgery is necessary to repair damaged tendons. Rest allows the tissues to heal. Returning to activity too soon may cause the symptoms to reoccur. Self massage with heat-inducing cream or oil may also help. Physical therapists suggest rubbing the ointment in semicircles in all directions away from the knotted tissue three times a day until healed. Foot Tendinitis Tendinitis can affect four different tendons of the foot - the achilles tendon, the posterior tibial tendon, the anterior tibial tendon and the peroneal tendon. The most common foot tendinitis occurs in the achilles tendon. The achilles is the large tendon connecting the two major calf muscles to the back of the heel bone. Symptoms of achilles tendinitis are pain and tenderness anywhere along the back of the tendon, limited ankle flexibility, redness or heat over the painful area, a nodule growth forming on the tendon and a cracking sound that can be heard when the ankle moves. This condition is caused by tight or fatigued calf muscles, inadequate warm-up of muscles, overtraining, excessive hill running, speedwork and inflexible running shoes. The treatment for achilles tendinitis is to stop running, take aspirin or ibuprofen and ice the area for 15 to 20 minutes several times a day until the inflammation subsides. Self-massage with heating cream or oil may also help. Physical therapists suggest rubbing the ointment in semicircles in all directions away from the knotted tissue three times a day until healed. Once the nodule is gone, stretch the calf muscles. Don't start running again until you can do toe raises again without pain. Next, move on to skipping rope, then jumping jacks and gradually begin running again. The achilles tendon should take about six to eight weeks to heal. If injury doesn't respond to self-treatment in two weeks, see a physical therapist or orthopedic surgeon. Surgery to scrape scar tissue off the tendon is a last resort. Be aware - the surgery is not very effective and it usually just stimulates more scar tissue. The posterior tibial tendon runs along the inside of the ankle and foot. If this tendon is strained, the foot may hurt when it moves forward to push off the ground or when the heel shifts from side to side. The anterior tibial tendon helps control the front of the foot when it meets the ground. If the tendon is strained, you may feel pain when you go downstairs or when you walk or run on hills. The peroneal tendon wraps across the bottom of the foot, from the outside to the inside. If the tendon is strained, you may feel pain when you stand or push off the ground. Symptoms of posterior tibial tendinitis, anterior tibial tendinitis and peroeal tendinitis are pain and tenderness anywhere along the tendon, limited flexibility, redness or heat over the painful area. Reducing the symptoms is the first step in alleviating the tendinitis. The doctor may tell you to use ice or heat, take certain medications, limit your activity to help control the pain and swelling, and self-massaging of the area. Ice helps prevent swelling and reduces pain. Place ice on the painful area for 10 minutes at a time, several times a day. If you already have swelling, heat may help. Apply a heating pad or hot towels to the tendon for 30 minutes at a time, two or three times a day. Pain relievers and anti-inflammatory drugs are used to ease immediate symptoms, but alone, they cannot cure the condition or keep it from recurring. Injecting cortisone and a local anesthetic into the area surrounding the tendon usually provides substantial relief within 24 to 72 hours. Rest allows the tissues to heal. Returning to activity too soon may cause the symptoms to reoccur. Self-massage with heat inducing cream or oil may also help. Physical therapists suggest rubbing the ointment in semicircles in all directions away from the knotted tissue three times a day until healed. Preventive measures for all types of foot tendinitis include, proper warm up and stretching exercises, wearing the right shoe for the activity, choosing shoes with good arch and heel support and varying your exercise route and routine. (This will help keep one set of muscles from being overstressed). Elbow Tendinitis Elbow tendinitis affects the lateral epicondyle and the medial epicondyle. The lateral epicondyle is the outside bony portion of the elbow where the large tendons attach to the elbow from the muscles of the forearm. When strained, this is called lateral epicondylitis or "tennis elbow." Tennis elbow results in pain over the outside of the elbow with flexion (bending down) or extension (bending up) of the wrist and tenderness, warmth and swelling of the affected area. The treatment for tennis elbow includes ice packs, resting the elbow, anti-inflammatory medications (such as aspirin, naproxen (Naprosyn), diclofenac (Voltaren) and Motrin) and bracing the elbow. Injecting cortisone and a local anesthetic into the area surrounding the tendon usually provides substantial relief within 24 to 72 hours. Some patients with severe or refractory symptoms may require operative treatment. The surgical procedure will remove any scar tissue that has been accumulating after years of overuse, as well as any rough bones. The surgeon will then repair the torn tendon. The medial epicondyle is the point when the tendons of the forearm attach to the bony prominence of the inner elbow. Straining of this tendon is called medial epicondylitis or "golfer's elbow". Symptoms of golfer's elbow include local pain and tenderness over the inner elbow. The treatment for golfer's elbow includes ice packs, resting the elbow, anti-inflammatory medications (such as aspirin, naproxen (Naprosyn), diclofenac (Voltaren) and Motrin) and bracing the elbow. Injecting cortisone and a local anesthetic into the area surrounding the tendon usually provides substantial relief within 24 to 72 hours. Shoulder Tendinitis There are three (3) types of shoulder tendinitis - rotator cuff tendinitis, calcific tendinitis and biceps tendinitis. The rotator cuff consists of four muscles around the shoulder joint that help control the shoulder's position and keep it stable. With rotator cuff tendinitis the pain is located about three inches below the top of the shoulder and is felt when reaching overhead or behind the back. Rotator cuff tendinitis will usually resolve with rest, anti-inflammatory medications or an injection of cortisone and a local anesthetic into the area surrounding the tendon, as well as exercising using light weights. If pain is not relieved with exercise and medication alone, an x-ray of the shoulder may reveal bony anatomy that pinches the rotator cuff tendons. This occurs between a bone at the top of the shoulder (acromion) and the ball at the top of the arm bone (head of the humerus). A procedure called an acromioplasty is performed to make more room for the rotator cuff tendons. Using an arthroscope (a steel tube containing optical fibers, a lens and a light source) it is inserted into the shoulder and the surgeon is able to remove some of the bone from the acromion through two or three small 1/4" incisions. Calcific tendinitis is caused by calcium deposits in the rotator cuff region. Symptoms include excruciating pain and severe restriction of shoulder motion. X-rays reveal calcium deposits within the rotator cuff or overlying the head of the humerus. Treatment includes injection of cortisone and a local anesthetic into the area surrounding the tendon. Multiple needle punctures into the calcium deposit may break up the deposit. If conservative treatment is ineffective, arthroscopic calcium removal and subacromial bursectomy are an alternative form of treatment. Subacromial bursectomy is removal of subacromial bursa sac (a small, fluid-filled sac that acts as a cushion at a pressure point in the body - often near joints where tendons or muscles cross either bone or other muscles). Biceps tendinitis is inflammation of the biceps tendons that attach to the shoulder. Biceps tendinitis usually affects individuals whose occupation involves repetitive biceps flexion against resistance or whose activities include forceful throwing of a ball. Biceps tendinitis will resolve with rest, anti-inflammatory medications or an injection of cortisone and a local anesthetic into the area surrounding the tendon, as well as a sling to immobilize the shoulder. Surgery is occasionally required to stabilize a displaced tendon.

Causes

The most common causes of tendinitis are injury, overuse, infection of the tendon sheath or disease (tendinitis is evident in rheumatoid arthritis, gout and psoriatic arthritis). More often than not, the cause of tendinitis is unknown.

Diagnosis

The diagnosis of tendinitis requires a careful medical history and physical examination. To eliminate other possible reasons for the inflammation, additional tests are sometimes ordered. X-rays are usually taken to rule out abnormalities of the bones and arthritis, blood tests are used to rule out rheumatoid arthritis or diabetes, and aspiration (removal of fluid) of a swollen tendon is used to diagnose an infection or gout.

Prevention

• Proper conditioning
• Gradual introduction of activity
• Warm-up and stretching prior to exercise
• Wearing appropriate shoes for the activity

Questions

Did the tendinitis result from any other disease or disorder other than trauma? How long should ice be kept on the affected area? Are there any medications that you will prescribe to help relieve the tendinitis? What are the side effects? What over-the-counter medications work best for this condition? Approximately how long does the affected tendon need to rest? When are cortisone injections used? What are the side effects or risks? If surgery is necessary, how is the procedure performed? How successful is the surgery for repairing damaged tendons? Will the affected tendon return to normal use?