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Tendonitis / Tendinitis

A physical therapist helping an athlete with knee tendonitis.

What is tendonitis?

Tendonitis is a general term to describe inflammation of a tendon, a thick, rope-like tissue that attaches a bone to a muscle. Tendonitis differs from arthritis, which refers to inflammation of a joint. It is one of the most common causes of soft-tissue, musculoskeletal pain.

What is tendonitis vs. tendinitis?

"Tendinitis" is simply a variant spelling of “tendonitis.” Both terms are used for the same condition, which can be confusing to patients.

The confusion regarding these two spellings is complicated further by the fact that tendonitis is one of the two main types of “tendinopathy,” which refers more broadly to any painful condition in or around the tendons caused by overuse. The other main type of tendinopathy is tendinosis. This refers to a degeneration of and small tears in the tendon. A person who experiences recurring tendonitis problems may develop tendinosis, although the latter condition can also arise as a result of an acute injury or other cause.

What causes tendonitis?

Tendonitis is most commonly caused by overuse (repetitive stress), but less often, it can also occur in areas where calcium deposits have developed. As people age, repetitive motion, such as from sports or work activities, can injure the tendon where it attaches to the bone, promoting an inflammatory response by the body.

Who gets tendonitis?

Although tendonitis can occur at any age, it is more common in adults over 40 years of age. As tendons age, they tolerate less stress and are less flexible. Tendonitis is a fairly common problem. It is important to understand its symptoms and treatment so that you can avoid this painful condition

What are the symptoms of tendonitis?

The chief symptom is pain at the site of the injured tendon, especially during use. The pain may be chronic or it may come on suddenly and feel sharp. Other symptoms include swelling, warmth, tenderness, and redness. The last of these is called “erythema,” which is the dilation of the blood’s capillaries that occur as part of the inflammatory process.

Tendonitis can be confused with a muscle strain. The way to distinguish between the two is that with a muscle strain, the pain is felt in the muscle itself, whereas in tendonitis, the pain is felt near where the muscle attaches to the bone.

Don’t be fooled by the myth of “no pain, no gain” exercise approach. It can sometimes be difficult to distinguish between aches associated with building muscle during strength training versus an ache that means you have injured a tendon.

Where does tendonitis occur?

Tendonitis can occur at almost any site of the body where a tendon connects a bone to a muscle. Common areas for the condition include the shoulder (especially in the rotator cuff), elbow, wrist, knee and ankle.

Some common condition names that indicate frequent sites for tendon problems:

  • Swimmer’s shoulder (sometimes also called shoulder impingement): Shoulder tendonitis involves inflammation at one of the tendons of the rotator cuff, at the top of the shoulder.
  • Tennis elbow affects the lateral (outer) side of the elbow.
  • Golfer’s elbow affects the medial (inner) side of the elbow.
  • De Quervain’s syndrome is tendonitis at the back of the wrist.
  • Jumper’s knee is tendonitis at the front of the knee. This should not be confused with runner’s knee, which is a separate condition.
  • Achilles tendonitis affects the back of the ankle and heel of the foot.

What are the treatment options for tendonitis?

The first line of treatment for tendonitis involves the “RICE” protocol, which stands for “Rest, Ice, Compression and Elevation.” The quicker your tendonitis is treated, the quicker you will recover to full strength and flexibility. Tendonitis usually responds to nonsurgical care. Surgery may be needed only in select cases.

Methods of treating recurring tendonitis differ for the various locations in the body, and can include:

  • immobilization with a splint, sling or crutches
  • physical therapy
  • the application of heat, including skin balms, hot packs and soaking
  • anti-inflammatory medications such as NSAIDs (nonsteroidal anti-inflammatory drugs)
  • corticosteroid injections (cortisone shots)
  • orthopedic surgery (for the most severe cases)

Nonsurgical treatments

Most cases of tendonitis can be successfully treated with rest, ice, compression (a sleeve or wrap), elevation, stretching, and modification of activities. To reduce pain, it is recommended that you avoid activities or movements that aggravate the injured tendon and take over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs).

When should I see a doctor for tendonitis?

If pain does not improve in a few days, see your doctor, who may prescribe physical therapy to work on the flexibility and strength of the involved tendon, and possibly modify mechanics (how one performs the physical activity). Additionally, a local cortisone shot (an injection of corticosteroids) may help decrease the pain. As a last resort, if the symptoms are not resolved, surgical options may be necessary.

It is very important that you do not neglect persistent tendonitis, since recurring tendonitis can lead to degeneration of the tendon, known as tendinosis. In addition, you should consult a specialist in orthopedics or sports medicine to properly diagnose and treat your pain. Surgical intervention by an experienced orthopedist may be necessary to avoid ongoing unresponsive symptoms, particularly if your weakened tendon is at risk of tearing or rupture.

Surgery for tendonitis

In the most severe cases where nonsurgical treatments do not lead to good outcomes, surgery can realign tendons, remove bone spurs that may be causing pressure on tendons, and remove areas of calcium buildup. In some cases, persistent tendon inflammation combined with overuse – especially of the Achilles tendon or shoulder rotator cuff tendons – may lead to weakening and subsequent rupture of the tendon. Once a tendon has become irreversibly damaged or has ruptured, treatment options (and ultimate outcomes) are often very limited.

The precise surgery for tendonitis depends greatly on which part of the body the affected tendon is located.

How do I prevent tendonitis from returning?

It is important that you do not to return to exercising until your symptoms have resolved. Your physical therapist or doctor can recommend proper stretching and strengthening techniques. They may also advise you to modify your biomechanics (how you perform certain activities).

Other tips include:

  • Always warm up before beginning strenuous exercise.
  • Take breaks to relieve stress on your tendons by varying your workouts and not performing one activity for hours at a time.
  • Protect the tendons when returning to the task or sport. For example, wear a wrist splint while gardening or using the computer, or a knee strap while playing sports.

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