CONDITIONS

What Is Tendonitis

Tendonitis (sometimes spelled tendinitis) is the inflammation of a tendon—which is a thickly corded, rope-like tissue that connects your muscles to your bones. When you move your muscles, the tendons pull the bones. There are tendons throughout your body, but the ones most likely to become inflamed, or red, hot, swollen, and/or painful, are found in the:

  • Shoulders
  • Elbows
  • wrists
  • Thumbs
  • Calves

These are the parts of your body that are subjected the most to repetitive actions and force. Because tendonitis can occur in different parts of the body, each is often given a name that relates to the sports or activity that may cause it, such as:

  • Tennis elbow (outer elbow)
  • Golfer’s elbow (inner elbow)
  • Pitcher’s shoulder (biceps)
  • Swimmer’s shoulder (rotator cuff)
  • Jumper’s knee (front aspect of your knee)

If your tendonitis is chronic or severe, and leads to rupture of a tendon—you may require surgical repair. Most cases of tendonitis, however, can be successfully treated with rest, physical therapy, and medications to reduce inflammation and pain.

What Causes Tendonitis

Tendonitis is usually the result of tendon overuse. It is a repetitive strain injury (RSI) or overuse injury. When you perform the same motions over and over again, the tendons become irritated, leading to inflammation and pain in the joint and surrounding area. Tendonitis can also be caused by a one-time injury, such as a direct trauma to the area.

These are the most common types and their causes:

  • Tennis elbow and golfer’s elbow can be caused by any repetitive activity that causes a person to twist or grip an object, like a tool.
  • Pitcher’s shoulder and swimmer’s shoulder can be caused by any repetitive activity that requires a person to pull, push, or lift above the shoulder level.
  • Jumper’s knee is caused by constant use by runners, dancers, and cyclists, as well as those who participate in any other activity that causes the knee to frequently bend. Jumper’s knee can also be caused by a trauma, such as falling on the knee.

A certain class of antibiotics, called quinolones, is associated with an increased risk of tendonitis and tendon rupture across all age groups. While this is not a common side effect, when it occurs it can be serious. The Achilles tendon is the most typical body area to experience this side effect, though it can happen in other areas as well. Symptoms of quinolone-related tendinopathy have occurred as early as 2 hours after the initial dose, and as late as 6 months after the medication was discontinued. Younger people generally experience good recovery rates, but permanent damage is possible, and is more commonly experienced by older patients.

Some antibiotics in this class include:

  • Ciprofloxacin
  • Levofloxacin
  • Lomefloxacin
  • Moxifloxacin
  • Norfloxacin
  • Ofloxacin
  • Sparfloxacin
  • Trovafloxacin

Risk Factors For Tendonitis

Anyone can develop tendonitis if their tendon becomes irritated enough, but there are some people who may be more prone to developing this condition than others. In general terms, age, working particular jobs, or playing certain sports are the biggest risk factors.

  • Sports. People who participate in certain types of sports can develop tendonitis. Recreational athletes may be at higher risk of developing tendonitis because they may not warm up effectively, or their technique may cause their body to move in a way that might irritate the tendon. Some sports with higher risk of tendonitis include:
    • Baseball
    • Basketball
    • Golf
    • Running
    • Swimmming
    • Tennis
  • Leisure and hobby activities that require constant repetition, also can increase the risk of developing tendonitis, such as:
    • Playing a musical instrument
    • Gardening
    • Knitting
    • Carpentry
  • Work activities with repetitive movements, as well as those that cause vibrations, are risk factors. Some examples include:
    • Using a jackhammer
    • Typing
    • Factory assembly work
    • Painting
  • Age is also a risk factor. As people get older, their tendons bcome less flexible and momre prone to damage.
    • Stress in the joint areas, perhaps from a joint deformity or problem such as one leg being longer than the other.
    • Joint problems, such as those caused some rheumatoid arthritis, osteoarthritis, and gout.
    • Metabolic conditions, such as diabetes.

Diagnosing Tendonitis

Before diagnosing if you have tendonitis, your doctor will:

Take a medical history. Your doctor will want to know:

  • If you have had something like this before.
  • What type of work you do and any hobbies or sports you participate in.
  • Your medical background (diabetes, arthritis, etc.)
  • If you have taken any medication recently.

A physical examination will allow the doctor to see:

  • Where the pain is.
  • How far the pain radiates (if it does).
  • If there is any redness or swelling in the area.
  • If the area is warm to touch.

X-ray, magnetic resonance imaging (MRI) and ultrasounds will not show if you have tendonitis, but your doctor may want an imaging test to rule out any other type of injury.

Blood tests do not show if you have tendonitis, but if your doctor is concerned about infection or another cause for the pain, he or she may order some blood tests.

Symptoms of Tendonitis

The symptoms for tendonitis include:

  • Joint pain or tenderness, may feel like a burning sensation.
  • Joint stiffness, possibly limited range of motion.
  • Increased pain during or after the activity that involves the affected joint and tendon.

For some people, there may be:

  • Lasting soreness, even after the original injury has healed.
  • Mild swelling of the area.

Prognosis

The prognosis or outlook for tendonitis depends on several factors:

  • What caused the problem
  • Changes made to reduce the risk of tendonitis returning
  • How severe the tendonitis is
  • The age of the patient
  • How effective treatment is

Some people with tendonitis never have a recurrence, while others develop it several times and may get worse, sometimes even rupturing the tendon in severe cases. Long-term irritation from tendonitis could cause tendinosis. Sometimes called chronic tendonitis, chronic tendinopathy, or chronic tendon injury, tendinosis is damage to a tendon at a cellular level, and is theorized to be caused by microtears in the connective tissue in and around the tendon that leads to an increase in tendon repair cells. Essentially—tendinosis is a chronic injury of failed healing in tendons. It can lead to reduced tensile strength, which may, in turn, increase the chance of tendon rupture. Tendinosis is often misdiagnosed as tendinitis due to the limited understanding of tendinopathies by the medical community.

What is the difference between tendinosis  vs tendonitis vs tendinopathy? The suffix “itis” means inflammation—the term tendonitis should be used to refer to tendon injuries that have inflammation. The suffic “osis” implies chronic degeneration without inflammation, which best describes tendinosis—chronic tendon injuries of failed healing. Tendinopathy is a more general term that does not specifically detail any pathology of the injury.

Living With Tendonitis

If you are prone to developing tendonitis, you may have to make adaptations to reduce the risk of flare-up. This could mean avoiding the activities that trigger the irritation or finding way to adapt how you perform the activities.

Medication And Treatment

Most suggestions for treating tendonitis focus on giving the joint a chance to rest and heal:

  • Rest. Avoid using the joint as much as possible.
  • Ice. Apply ice to the painful area for short periods (15 to 20 minutes) every four to six hours for a few days. Do not place ice directly on the skin. Always have a barrier, like a towel, to prevent damaging the skin.
  • Castor oil pack. Apply oil to a clean, soft cloth. Cover in plastic wrap and apply to the affected area. Place a heat source over the pack and let sit for 30 to 60 minutes.
  • Splints. A splint or brace may protect the joint. There are some you can buy at the drugstore, but you may need a physiotherapist to recommend a specific type of brace for it to be effective.
  • Orthotics. Special inserts worn inside the shoe can change your step and relieve pressure on the tendon.
  • Medications. Oral analgesics (pain pills) and analgesic skin creams, called nonsteroidal anti-inflammatories (NSAIDs), can help reduce inflammation and pain. Common examples oral and ointment analgesics are:
    • Acetaminophen (best known as Tylenol)
    • Ibuprofen (best known as Advil)
    • Naproxen (best known as Aleve)
    • Diclofenac gel (Voltaren)
  • Corticosteroid injections. If the tendonitis does not go away, your doctor may want to inject a corticosteroid medicine directly into the area, to reduce the inflammation.
  • Physical therapy. A physical therapist (PT) can provide several types of treatment including ultrasound, heat/cold packs, and stretching, as well as provide you with information on how to move so you do not aggravate the tendon. A PT can also provide you with guidance for choosing a brace or splint if needed.
  • Occupational therapy. If the tendonitis keeps coming back, you may need to use adapted equipment. An occupational therapist can help you with finding equipment and tools to perform your every day activities, while reducing strain on the affected tendon and joint.
  • Surgery. In cases where the tendonitis is disabling and will not heal with less invasive treatment, your doctor may recommend surgery.

Complementary and Alternative Treatment

The following treatments may be helpful in managing tendonitis:

  • Acupunture. The National Institutes of Health, or NIH, has reported that acupuncture, a form of traditional Chinese medicine, may be helpful in treating tennis elbow and other types of tendonitis. To perform acupuncture, the practitioner inserts fine needles into specific parts of the body that are believed to conduct energy. This allows for the body’s energy to flow, promoting healing.
  • Chiropratic. Research is still being done on the effectiveness of chiropractic for treatment of tendonitis, but chiropractors often treat this condition with ultrasound, electrical stimulation, manual trigger point therapy (a mix of applying firm pressure on a trigger point for several seconds, followed by stretching the muscle after, and other forms of massage.
  • Massage. Trigger point massage, as detailed above, along with other deep tissue modalities are used to help alleviate symptoms of tendonitis. One of the most common methods of soft tissue treatment for tendonitis is an aggressive friction massage to the damaged tendon. It is a “transverse friction” massage technique that is deep, and the strokes are administered directly to the affected area, perpendicular to the direction of the tendon. This direct pressure will stimulate the healing of tissue. It also helps support strong scar-tissue repair of the damaged tendon fibers, by improving blood flow to the location.
  • Nutrition. Those who suffer from tendonitis should also make definitive changes to their diet and exercise habits. They should regularly consume fresh organic fruits and vegetables, flax seed meal and oil, deep water fish, and drink plenty of water. Hydration is all too often overlooked. Black cherry juice is a popular folk remedy for arthritis, and tendonitis. It should be mixed with four ounces fresh juice and four ounces of fresh water, and consumed twice a day. Barley Green, found in most health stores, is also a good agent against inflammation and pain, and may be sprinkled on salads or mixed into fruit smoothies.
  • Supplememts, A number of supplements can be helpful to those that suffer from tendonitis—but be sure to speak with your doctor first to see what is right for you.
    • Bromelain, 250 mg twice a day. An enzyme that comes from pineapples–bromelain reduces inflammation. Turmeric is sometimes combined with bromelain, because it makes the effects of bromelain stronger. Side effects may include risk of bleeding, so people who take anticoagulants (blood thinners) such as warfarin (Coumadin), clopidogrel (Plavix), and aspirin should not take bromelain without first talking to their doctor. People with stomach ulcers should avoid bromelain. If taken with antibiotics, bromelain may increase the levels of antibiotic in the body, which could be dangerous.
    • Vitamin C (250 – 500 mg two times a day) to aid in healing, improve immune function, and reduce inflammation.
    • Calcium (1,500 mg a day) and magnesium (750 mg a day) to aid healing of connective tissues and muscles
    • Vitamin A (15,000 IU a day) for immune function and healing. Do not use if you are, or may become, pregnant.
    • Vitamin E (400 – 800 mg a day) and essential fatty acids, such as fish oil or evening primrose oil (1,000 to 1,500 IU one to three times a day) to reduce inflammation. If you take blood-thinners, ask your doctor before taking any of these supplements
  • Herbal therapies. Some people find relief from tendonitis with the use of certain herbs:
    • Turmeric: Some studies have found that turmeric can ease pain and inflammation. Turmeric may increase bleeding risk, however. So if you take     blood thinners (anticoagulants) or aspirin, check with your doctor before using this herb.
    • Willow bark: Willow bark has properties similar to aspirin, which can relieve pain, but it also means that it can thin the blood. If you are allergic to aspirin or salicylates, do not take willow bark. It is also not recommended that children under the age of 18 take willow bark.
    • Licorice: Licorice has been reported to reduce inflammation. While effective for tendonitis, licorice may interact with a number of medications, so to be safe, ask your doctor before taking. It should not be taken by everyone—women who are pregnant or breast feeding should not take licorice, as well as people with the following health problems: high blood pressure, edema (swelling from fluid), hormone-sensitive cancers such as breast, ovarian, uterine, or prostate cancer, diabetes, kidney disease, liver disease, low potassium (hypokalemia, or erectile dysfunction

When To Contact A Doctor

You may be able to manage tendonitis on your own if it is not making it difficult for you to perform your every day activities. However, contact a doctor if:

  • The joint is warm to touch.
  • There is redness above or around the joint.
  • You have a fever.
  • The pain worsens instead of gets better or you feel a snap sensation.
  • You are unable to move the affected area.
  • You start to feel pins and needles below the area of the affected joint, or you lose sensation, or the skin below the affected join becomes paler than the rest of your body, or turns bluish.

Questions For A Doctor

You may want to ask your doctor the following questions:

  • How can I prevent this from happening again?
  • If the tendonitis returns, what should I do?
  • What are the best courses of treatment for me to follow?
  • Are there any supplements or diet changes I can make that might help?