Tendonitis, also called tendinitis, is a condition in which the tendon is inflamed and painful. Tendons are the connective bands that attach muscles to the bone; when muscles contract, the tendons transmit the force to the bone, moving the limb. Tendonitis is caused by overuse, and since tendons connect at the joint, it is felt as joint pain. Tendonitis is often indistinguishable from bursitis, which is an inflammation of the fluid sacs that cushion joints.
Tendonitis can affect tendons around the:
shoulder
elbow
wrist
finger
thigh
knee
back of the heel
While tendonitis can occur in any of your body's tendons, it's most common around your shoulders, elbows, wrists and heels.
Common types of tendonitis:
Achilles Tendonitis. As the name itself shows, it is the inflammatory condition of Achilles tendon present at the back of the heel. Generally, it is characterized by swelling and pain. Early measures to be taken to cure it as it has the possibility of leading into further complicated rupture.
Wrist Tendonitis. Characterized by tenderness of tendon cover, it requires only medication and rest to heal.
Patellar Tendonitis. Commonly known as Jumper's Knee, this inflammation is associated with Patellar tendon.
Rotator Cuff Tendonitis. Also known as Shoulder Bursitis, inflammation is associated with Rotator Cuff Tendon.
Epicondylitis. Also known as Tennis Elbow, associated with inflammation of tendons in elbow region. It has got its peculiar name as almost 50 percent of tennis players suffer from this problem. It can be cured by surgery, medication, rest and slow but steady return to exercise.
Some common names for various tendinitis problems are:
Golfer's elbow
Tennis elbow
Pitcher's shoulder
Swimmer's shoulder
Jumper's knee
Tendonitis is a common sports injury and can take six weeks to heal properly. Continuing to use the inflamed joint can further damage the tendon, making recovery time longer and more debilitating. Tendonitis can also be a work-related injury in cases of repetitive stress.
If tendinitis is severe and leads to the rupture of a tendon, you may need surgical repair. But most cases of tendinitis can be successfully treated with rest, physical therapy and medications to reduce pain.
Symptoms of tendonitis include:
pain, often described as a dull ache, especially when moving the affected limb or joint
a sensation that the tendon is grating or crackling as it moves (this may be felt on examination)
swelling, sometimes with heat or redness
weakness in the affected area, because of the pain
a lump that develops along the tendon
If symptoms persist, the tendon may rupture (split) and a gap may be felt in the line of the tendon. Movement of that area will become more difficult.
Tendonitis can occur in many different parts of the body. If the sheath surrounding the tendon, rather than the tendon itself, becomes inflamed, the condition is called tenosynovitis.
Supraspinatus tendonitis
is inflammation of the tendon around the top of the shoulder
joint.
It causes pain when you move the arm, particularly if
you lift it high.
The pain may also occur when you are lying on the shoulder at night. It is often part of a condition called rotator cuff syndrome, where other tendons in the same area are also affected.
Calcific tendonitis is when crystals of a mineral called calcium phosphate form in the supraspinatus tendon in your shoulder. It can cause long-term mild pain, combined with short episodes of more severe pain. The pain may also spread down your arm or up into your neck.
Calcific tendonitis may also cause weakness or stiffness of your shoulder. It is very similar to supraspinatus tendonitis, but the calcium crystals will be visible on an X-ray.
Biceps tendonitis affects the tendon that attaches the muscle on the front of your upper arm (bicep) to your shoulder. This can cause pain in your shoulder and upper arm, which may be worse if you lift or reach overhead.
Tennis elbow is pain in the side of the elbow. Golfer's elbow is pain in the middle of the elbow.
These conditions cause pain when you move your elbow, particularly when you lift it against a force. The pain is usually around the elbow but may spread down your forearm towards the wrist. You may have less grip strength because of the pain, and your elbow may feel stiff.
De Quervain's tenosynovitis is inflammation of the sheath that surrounds the thumb tendons, which run between the wrist and the thumb. There is obvious swelling and thickening of the sheath and it becomes very painful to move your thumb.
Trigger finger or thumb is where the finger or thumb become fixed in a bent position and there is a clicking sensation when it is straightened out. This is because of thickening and inflammation of the tendon sheath in the palm of the hand. It may also be caused by a small lump forming along the tendon.
Achilles tendonitis is inflammation of the tendon between the heel and the calf muscle. It is commonly caused by a sports injury. It may also be caused by wearing shoes that do not fit or support the foot properly, causing you to walk awkwardly. It can also be associated with rheumatoid arthritis.
Risk factors for developing tendinitis include age, working in particular jobs or participating in certain sports.
As people get older, their tendons become less flexible — which makes them easier to injure.
Tendinitis is more common in people whose jobs involve:
Repetitive motions
Awkward positions
Frequent overhead reaching
Vibration
Forceful exertion
You may be more likely to develop tendinitis if you participate in certain sports that involve repetitive motions, especially if your technique isn't optimal. This can occur with:
Baseball
Basketball
Bowling
Golf
Running
Swimming
Jumping
Tennis
An episode of tendonitis may last for only a few days, but it can be more persistent and last for several weeks or months.
There are several different treatment options, although what's best for you may depend on which tendon you have injured.
You can treat tendonitis yourself using the self-care techniques below.
Rest the tendon
Stop doing the activity that caused tendonitis, such as sport or typing, or at least reduce the amount you do. This will help prevent any further inflammation (swelling) or damage.
It's important to rest the affected area. This will allow the inflammation to settle. Some form of support, such as a bandage, splint or brace, may help as this will reduce movement. If tendinitis affects your knee, raise the affected leg above the level of your heart to reduce swelling.
How long you need to rest may depend on which tendon is affected and how severely it is damaged. For example, if you have golfer's elbow, which causes pain in the middle of your elbow, you may need to rest your elbow for at least six weeks.
Ice packs
You can ease the pain and swelling by applying an ice pack to the affected area. Do not put ice directly on your skin as this may cause a cold burn. Wrap it in a towel or put a towel over the injured area before applying the ice pack. If you do not have an ice pack, wrap ice cubes or a bag of frozen vegetables in a towel and use this.
Hold the ice pack on the affected area for around 15-20 minutes several times a day. You can also use an ice pack after exercise to try and prevent symptoms occurring.
Painkillers
Tendonitis can be treated with mild non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. These are effective at providing short-term pain relief and are available as a medicine that you swallow or as a gel that you apply directly to the affected area.
These should not be used for long periods and are not recommended for people with asthma, or kidney or liver disease.
Other painkillers, such as paracetamol, will also help ease the pain. If your pain is more severe, a stronger painkiller, such as codeine, can be prescribed.
Physiotherapy
Physiotherapy, often referred to as physio, uses physical methods such as massage and manipulation to promote healing and wellbeing. There are many different physiotherapy techniques, such as:
special exercises to stretch and strengthen the tendon and surrounding muscles
massaging the affected area
using high-frequency sound waves (ultrasound)
using narrow beams of light (lasers)
Physiotherapy can be used to relieve pain and may result in more long-term improvement than corticosteroid injections.
Corticosteroid injections
Corticosteroids are medicines that contain steroids, a type of hormone, and can be used to reduce inflammation. If there is swelling and evidence of inflammation, corticosteroids can be injected around the affected tendon or into the tendon sheath.
Possible side effects of corticosteroid injections include:
thinning of the skin
lightening of the skin
Although corticosteroid injections can relieve pain, they do not have a long-term effect and it is common for the pain to return. You can have another injection, but you will need to wait at least six weeks. You cannot have more than three injections into the same area in a year as this can increase the risk of the tendon rupturing (splitting).
Local anesthetic injections
Local anesthetic is used during minor surgical procedures to numb a body part. In some types of tendonitis, local anesthetic can be injected into the affected area as well as corticosteroids.
Extracorporeal shock wave therapy
Extracorporeal shock wave therapy (ESWT) is a treatment option for tendonitis that has not responded to other treatments. ESWT involves passing shock waves through your skin to the affected area. This may be carried out over one or more sessions and local anesthetic may be used to numb the area first.
ESWT may relieve the pain caused by tennis elbow or Achilles tendonitis, but it is not clear if ESWT is better than some other treatment options. If you are considering this treatment, you may be asked to take part in a clinical trail (a type of medical research) to look at how effective the treatment is over time. There are also possible risks, such as:
the tendon rupturing – in one study, this happened to 2 out of 49 people who had ESWT for Achilles tendonitis
temporary redness or swelling
pain during the treatment
feeling sick
In some types of tendonitis, surgery may be a possible treatment. However, as most cases of tendonitis improve with time, it is not usually necessary. You may want to try other treatments for up to a year before considering surgery.
Tennis elbow
Several different surgical techniques have been used for tennis elbow, such as:
removing a damaged part of muscle from the elbow
removing part of a ligament in your elbow – ligaments are tough bands of tissue that link two bones together at a joint
damaging a nerve in your elbow so you no longer feel pain there
The benefits of surgery for tennis elbow have not yet been proven. It may improve your symptoms, but this could be because your condition was getting better anyway, or may be due to the placebo effect. This is when you feel better after having a "dummy" treatment, rather than a "real" treatment.
After surgery, you should be able to start playing sport again within four to six months.
Calcific tendonitis
If calcium deposits have formed in the tendon in your shoulder, you can have surgery to remove these. This can be done using a technique called Arthroscopy. An arthroscopy is a form of keyhole surgery that is used to look inside a joint and repair any damage that has occurred. Only a very small cut is made in your body.
Biceps tendonitis
Biceps tendonitis affects the tendon that attaches the muscle on the front of your upper arm (bicep) to your shoulder. You can have surgery to reattach the end of the tendon to the bone in your upper arm (humerus). This may be considered if you are in severe pain or if you have torn the tendon.
To reduce your chance of developing tendinitis, follow these suggestions:
Ease up. Avoid activities that place excessive stress on your tendons, especially for prolonged periods. If you notice pain during a particular exercise, stop and rest.
Mix it up. If one exercise or activity causes you a particular, persistent pain, try something else. Cross-training can help you mix up an impact-loading exercise, such as running, with lower impact exercise, such as biking or swimming.
Improve your technique. If your technique in an activity or exercise is flawed, you could be setting yourself up for problems with your tendons. Consider taking lessons or getting professional instructions when starting a new sport or using exercise equipment.
Stretch first. Before you exercise, take time to stretch in order to maximize the range of motion of your joints. This can help to minimize repetitive microtrauma on tight tissues. Remember to stretch after exercise, too.
Use proper workplace ergonomics. If possible, get an ergonomic assessment of your work space and adjust your chair, keyboard and desktop as recommended for your height, arm length and usual tasks. This will help protect all your joints and tendons from excessive stress.
Prepare your muscles to play. Strengthening muscles used in your activity or sport can help them better withstand stress and load.