Tendinitis (Tendonitis)

What Is Tendinitis (Tendonitis)? What Causes Tendinitis?

Tendinitis, also known as tendonitis, is the inflammation of a tendon. Tendinitis is a type of tendinopathy - a disease of the tendon. Tendinosis is similar to tendinitis, but requires different treatment. Tendinitis refers to larger-scale acute (sudden, short-term) injuries with inflammation.

Usually tendinitis is referred to by the body part involved, for example, Achilles tendinitis which affects the Achilles tendon, or patellar tendinitis which affects the patellar tendon (jumper's knee). Tendinitis can occur in various other parts of the body, including the elbow, wrist, finger, or thigh. It is caused by overusing a tendon or injuring it, as may happen during sport.

Tendinitis can affect people of any age, but is more common among adults who do a lot of sports. Elderly individuals are also susceptible to tendinitis because our tendons tend to lose their elasticity and become weaker as we get older.
According to Medilexicon's medical dictionary:

Tendonitis is "Inflammation of a tendon."

Some common lay terms for tendinitis include:

• Golfer's elbow
• Jumper's knee
• Pitcher's shoulder
• Swimmer's shoulder
• Tennis elbow

What are tendons?

A tendon is tissue which attaches muscle to bone. It is flexible, tough and fibrous and is capable of withstanding tension. A ligament extends from bone to bone at a joint, while a tendon extends from muscle to bone. Tendons and muscles work together and can only exert a pulling force. Although tendons and ligaments are tough and fibrous, they are referred to as soft tissue, because of their common comparison to bone or cartilage.

The Latin word tendere and the Greek word teinein mean "to stretch".

Inflamed tendons (tendinitis) are more likely to get ruptured. If the sheath around the tendon becomes inflamed, rather than the tendon itself, the condition is called tenosynovitis. People can have tendinitis and tenosynovitis simultaneously.

What are the signs and symptoms of tendinitis?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.

Tendinitis signs and symptoms occur where the tendon attaches to a bone; and usually include:

• Pain - if the affected area is moved the pain worsens
• A feeling that the tendon is crackling or grating as it moves. This sensation is more common on examination.
• Swelling in the affected area
• The affected area may be hot and red
• A lump that develops along the tendon

If there is a rupture a gap may be felt in the line of the tendon and movement will be very difficult.

What are the causes of tendinitis?

The condition is commonly caused by repetition of a particular movement over time. It can also be caused by a sudden injury. In the majority of cases, tendinitis develops in people whose jobs or hobbies involve repetitive movements; aggravating the tendons.
A tear in the tendon caused by an injury may cause swelling (inflammation).

What are the risk factors for tendinitis?

A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.

Age - tendons become less flexible as we get older, making them more susceptible to injury.

Some jobs - if a person's job includes the following tasks their risk of developing tendinitis is higher:

• Repetitive movements
• Awkward positions
• Reaching overhead frequently
• Vibration
• Forceful exertion

Sports - people who practice certain sports regularly are more likely to develop tendinitis, especially sports that involve repetitive movements, including:

• Running
• Tennis
• Swimming
• Basketball
• Golf
• Bowling
• Baseball

Diabetes - people with diabetes have higher risk of developing tendinitis. Experts are not sure why.

Rheumatoid arthritis - people with rheumatoid arthritis have a higher risk of developing tenosynovitis (when the sheath surrounding the tendon is inflamed).

Diagnosing tendinitis

Tendinitis can be diagnosed by a GP (general practitioner, primary care physician) based on the patient's symptoms and a physical examination (as well as tenosynovitis). When attempting to move the tendon a creaky sound may be heard; this is because the tendon sheath has become thicker.

X-ray pictures that show up calcium deposits around the tendon may help confirm a diagnosis.

Imaging tests, such as ultrasound or MRI (magnetic resonance imaging) may reveal swelling of the tendon sheath.

Achilles tendinitis is a common sports injury - it may also be caused by ill-fitting shoes, or those that do not properly support the foot. The Achilles tendon is between the heel and the calf muscle. Achilles tendinitis is much more likely among patients with rheumatoid arthritis.

Suprastinatus 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/golfer's elbow (lateral epicondylitis) - the side of the elbow is painful. Medial epidondylitis is pain in the middle of the elbow and is more common among golfers. Pain is more acute when trying to lift against a force. The pain sometimes radiates down to the wrist.

DeQuervain's stenosing tenosynovitis - the sheath that surrounds the thumb tendons (between the thumb and wrist) become inflamed. The thickened sheath, as well as swelling in the area makes it painful to move the thumb.

Trigger finger/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. Sometimes a nodule forms along the tendon.

What are the treatment options for tendinitis?

Treatment is aimed as relieving pain and reducing inflammation. In many cases rest, applying ice packs to the affected area, and OTC (over-the-counter, no prescription required) pain relievers are all that the patient needs. Tendinitis symptoms may last from just a few days to several weeks or months.

Rest - the patient needs to stop doing whatever caused the tendinitis to develop in the first place, for example, some sporting activity, or even just typing. If a total stop is not possible, a significant reduction in the activity will help prevent complications. For the inflammation to go down the affected area needs to rest. A bandage, splint or brace may help reduce movement. In severe cases, resting in plaster may be required.

Heat and cold - either an ice pack or warm towel may alleviate pain and swelling in the affected area. It is important not to apply ice directly onto the skin - wrap the ice in a towel, or use a proper ice pack device.

Pain relievers - Ibuprofen and other NSAIDs (non-steroidal anti-inflammatory drugs) have been found to help pain associated with tenosynovitis. If you suffer from asthma, kidney disease or liver disease do not take NSAIDs without first checking with your doctor. Some patients may find that Tylenol (paracetamol) helps.

Corticosteroid injections - injecting a steroid around the affected tendon, or even into the tendon sheath may help alleviate symptoms. However, repeated injections may weaken the tendon, significantly increasing the risk of a rupture.

Physical therapy (UK: physiotherapy) - a physical therapist may be able to manipulate and massage the affected area, providing helpful relief and accelerating the healing process. A program of specific exercise designed to stretch and strengthen the affected tendon and muscle may help.

Shock wave therapy or surgery - if there is calcific tendinitis (calcium deposits around the tendon) ESWT (extracorporeal shock wave therapy) may help in persistent cases. A shock wave is passed through the skin, resulting in the calcium deposits breaking up. The deposits may also be removed surgically.

What is a possible complication of tendinitis?

Untreated or improperly treated tendinitis can more easily result in a tendon rupture. Tendon rupture is a much more serious condition that often requires surgery.

Prevention of tendinitis or its complications

Exercise - exercises specifically designed to strengthen the muscles around the tendon may help prevent tendinitis from recurring. It is important to seek professional help for strengthening and stretching exercises (e.g. from a qualified physical therapist).

Stretching and cooling down - people engaged in sporting activities should make sure they warm up and stretch properly. Cooling-down exercises and stretches after finishing may also help prevent tendinitis from developing.

Repetitive movements - repetitive movements may significantly raise the risk of tendinitis, or recurrences of the condition. Avoiding them, or at least taking regular rests will help reduce the risk. People whose jobs involve repetitive movements which may raise the risk of tendinitis occurring should discuss preventive strategies with their employer.