What Is Tendinitis?
Tendinitis is inflammation of a tendon, one of the fibrous cords that join a muscle to a bone. Injury or repetitive overuse can cause microscopic tears and painful swelling in a tendon. Sites most commonly affected include the shoulder (rotator cuff), the elbow (tennis or golfer’s elbow), the wrist (de Quervain’s tenosynovitis), the fingers (trigger finger), and the ankle (Achilles tendinitis).
When the muscles in the affected area are used regularly despite pain, the injured tendon may be slow to heal. While many cases of tendinitis last no more than two weeks and are usually alleviated by rest and proper conditioning, repeated use of the injured tendon may lead to chronic inflammation and degeneration of the tendon (referred to as tendinopathy), characterized by scarring of the involved tissues, weakness, and limited flexibility. Those over age 40 are most prone to the chronic form of tendinitis.
Who Gets Tendinitis?
Tendinitis is a fairly common condition. Overall incidence and prevalence increases with age. Some types are more common in men (e.g., golfer's elbow) and some are more common in women (e.g., trigger finger). Trigger finger occurs more often in patients who have diabetes.
- Pain in the affected area (often worse at night, disturbing sleep).
- Limited joint movement.
- Crackling (crepitus).
- Muscle spasms concurrent with pain.
- Sudden pain, often accompanied by a snapping sound, with the rupture of an Achilles tendon.
- Overuse due to prolonged, repetitive movements as required by tennis, golf, bowling, hobbies such as gardening, playing a musical instrument for long hours, and certain occupations, like carpentry and painting.
- Physical trauma, such as falling on an arm, twisting an ankle, or lifting heavy objects.
- Inadequate conditioning or insufficient warm-up prior to exercise.
- Degenerative changes owing to aging and years of continual use.
- Calcium deposits in a tendon (calcific tendinitis).
- Diseases such as rheumatoid arthritis, hypothyroidism, diabetes, and tuberculosis are risk factors.
What If You Do Nothing?
Tendinitis usually occurs through repetitive physical stress, so altering or eliminating the activity responsible for it should cause the pain to go away. If you continue with the activity that caused the tendinitis and do nothing to eliminate the problem, the ailment may become chronic.
- Patient history including recent physical activity.
- Physical examination may include palpation (physically touching and manipulating the area) and range of motion tests to determine the area and extent of the injury.
- Ultrasound scans or MRI (magnetic resonance imaging) may be used to identify tendinopathy or tearing.
- Blood tests may be performed to check for diseases like rheumatoid arthritis. [HC]
- Rest is essential, although gentle exercise may be advised to prevent stiffness. Slings or splints may be used for a few days to immobilize the injured area.
- Take over-the-counter anti-inflammatory pain relievers like aspirin, ibuprofen, or naproxen for relief of acute pain and inflammation.
- Ice packs should be used immediately after an injury to reduce swelling. Do not apply ice to one area for more than 20 minutes at one time. After 72 hours, applying heat—via hot compresses, a heating pad, or warm showers—may soothe discomfort and increase blood flow to speed healing.
- In some cases, elastic wraps or Ace bandages can be used to compress the affected area, keep it still, and protect it from further damage and stress. Compression also can help decrease swelling so that motion may be regained more quickly.
- Physical therapy, ultrasound, and electrical stimulation can be used to reduce pain and inflammation. Patients are taught strengthening exercises and to help prevent further injury. Returning to the same activity level as before the injury should be a gradual process.
- Temporarily switch to low-impact exercise, like bicycling or swimming, if you suspect high-impact exercise is responsible.
- Corticosteroids may be injected directly into the affected area to relieve pain and inflammation (not routinely recommended for Achilles tendinitis, where injections may weaken or rupture the tendon).
- Surgery to repair the tendon may be required if the tendon is torn.
- Avoid highly repetitious movements, or interrupt them with activities requiring other muscle groups.
- Engage in regular, moderate exercise to maintain strength and flexibility.
- Be sure to stretch and warm up adequately before engaging in exercise or other demanding physical activity.
- If tendinitis results from improper techniques in sports or other recreational activities, it may help to have a professional instructor evaluate motions and equipment.
- Employees should make sure that their workspaces are designed as ergonomically as possible. For example, office workers can adjust the height of their computer keyboards to prevent wrist strain.
When To Call Your Doctor
Call a doctor if muscle or joint pain persists for more than two weeks and interferes with activities despite treatment with rest and pain relievers.
Reviewed by Andrew W. Piasecki, M.D., Camden Bone and Joint, LLC, Orthopaedic Surgery/Sports Medicine, Camden, SC. Review provided by VeriMed Healthcare Network.