Tendinitis: Symptoms, causes, and treatment
It often affects the elbow, wrist, finger, thigh, and other parts of the body.
The body part that is involved may give the injury its name, for example, Achilles tendinitis. Familiar terms are tennis or golfer's elbow, jumper's knee, and pitcher's shoulder.
Tendinitis can occur at any age, but it is more common among adults who do a lot of sport. Older people are also susceptible, because the tendons tend to lose elasticity and become weaker with age.
Tendinosis has similar symptoms, but it is a chronic, or long-term, condition, and it is degenerative.
Here are some key points about tendinitis. More detail is in the main article.
- Tendinitis usually happens when overuse or injury puts strain on the tendons.
- Common name includes Achilles tendonitis, tennis elbow, and housemaid's knee.
- Treatment includes rest, ice and heat treatment, and over-the-counter pain killers.
- Without treatment, it can result in a rupture, which may need surgery.
What is tendinitis?
Tendonitis is a painful inflammation that often results from overuse.
A tendon is tissue that attaches muscle to the bone. It is flexible, tough and fibrous and it can withstand 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 exert a pulling force. Tendons and ligaments are tough and fibrous, but they are known as soft tissue, because they are soft compared with bone.
If the sheath around the tendon becomes inflamed, rather than the tendon itself, the condition is called tenosynovitis. Tendinitis and tenosynovitis can occur together.
Different types of tendinitis affect different parts of the body.
The Achilles tendon is between the heel and the calf muscle. Achilles tendinitis is a common sports injury. It may also be caused by shoes that fit badly or do not properly support the foot. It is more likely among patients with rheumatoid arthritis.
With supraspinatus 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 or golfer's elbow
A common symptom of lateral epicondylitis, commonly known as tennis elbow, is pain on the outer side of the elbow. It may radiate down towards the wrist.
Medial epidondylitis or golfer's elbow is pain on the inner side of the elbow, and it is more common among golfers. Pain is more acute when trying to lift against a force. The pain sometimes radiates down to the wrist.
De Quervain's stenosing tenosynovitis
The sheath that surrounds the thumb tendons, between the thumb and wrist, becomes inflamed. With the thickened sheath and swelling in the area, it becomes painful to move the thumb.
Trigger finger or 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 and does not allow the tendon to move smoothly. Sometimes a nodule forms along the tendon.
Tendinitis of the wrist
This can affect badminton players and production line workers, who repeatedly use the same motion with their wrist. Tendinopathy is another type of injury that affects the wrist tendons. This is a degenerative condition rather than an inflammation.
Symptoms occur where the tendon attaches to a bone.
They usually include:
- pain which worsens on movement
- a feeling that the tendon is crackling or grating as it moves
- swelling, heat, and redness
- a lump may develop along the tendon
If there is a rupture, a gap may be felt in the line of the tendon, and movement will be difficult.
Symptoms may last from a few days to several weeks or months.
Causes and risk factors
Common causes include:
- sudden injury
- repetition of a movement over time
Tendinitis often develops in people whose jobs or hobbies involve repetitive movements, as this aggravates the tendons.
Other risk factors include:
Age: Tendons become less flexible with age and more susceptible to injury.
Profession: A person whose job involves repetitive movements, awkward positions, frequently reaching overhead, vibration, and forceful exertion has a higher risk. Painting a ceiling may trigger it.
Sports: Sports that involve repetitive movements can lead to tendinitis, for example, running, tennis, swimming, basketball, golf, bowling, and baseball.
Some health conditions: People with diabetes and rheumatoid arthritis are more likely to develop tendinitis.
If the pain suddenly gets worse, or if it suddenly becomes impossible to move a joint, the person should seek medical attention.
A physician will ask about symptoms and carry out a physical examination. When the doctor attempts to move the tendon, a creaky sound may be heard. This happens because the tendon sheath has become thicker and inflamed.
If there is tenderness at one specific point in the tendon, this can indicate tendinitis.
If the problem does not go away with rest, ice, and over-the-counter (OTC) medications, the doctor may recommend some tests.
An x-ray can show up calcium deposits around the tendon, which may help confirm a diagnosis.
Treatment aims to relieve pain and reduce inflammation.
In many cases, the following will be enough:
- resting the joint
- hot and cold treatment
- pain relievers such as ibuprofen, available over-the-counter (OTC) or online.
- splinting of the affected joint
Rest will allow the inflammation to go down. If a sporting activity or typing, for example, causes tendinitis, the person needs to rest from this activity, or reduce the intensity with which they practice it.
A bandage, splint or brace may help reduce movement. In severe cases, resting in plaster may be required.
Not resting can lead to complications.
Heat and cold
An ice pack or warm towel may alleviate pain and swelling in the affected area.
Applying ice within 48 hours of an injury may reduce inflammation.
Ice can be applied for 10 to 15 minutes, once or twice a day.
It is important not to apply ice directly onto the skin. Wrap it in a towel, or use a specially designed ice-pack device.
Relief may also come from taking a warm bath, applying hot towels, or applying a topical medication, such as a cream or ointment, that heats the area.
Ice is normally best for injuries that have occurred within the last 48 hours. After this, heat may be a better option.
OTC drugs: Ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs) have been found to help pain with tendon pain.
Corticosteroid injections: Around the tendon may help alleviate symptoms. However, repeated injections may weaken the tendon, significantly increasing the risk of a rupture.
Physical therapy: Manipulating and massaging the affected area may provide relief and accelerate the healing process.
Stretching and exercise: The physical therapist may also recommend specific exercises, designed to stretch and strengthen the affected tendon and muscle.
Shock wave therapy or surgery
If tendinitis persists, and there are calcium deposits around the tendon, extracorporeal shock wave therapy (ESWT) may help. A shock wave is passed through the skin, breaking up the calcium deposits. The deposits may also be removed surgically.
Without proper treatment, tendinitis can more easily result in a tendon rupture. This is a more serious condition that may need surgery.
Tendinitis is less likely if a person practices some of the following strategies.
Exercise: Activities that are 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, for example, a physical therapist.
Stretching and cooling down: When engaging in sporting activities, it is important to warm up and stretch properly. Cooling-down exercises and stretches after finishing may also help prevent tendinitis from developing.
Repetitive movements: These may significantly raise the risk of tendinitis developing or recurring. Avoiding repetitive movements or taking rests will help reduce the risk.
It is also a good idea to avoid staying in one position for too long, especially if it feels uncomfortable. It is better to change activities, or rest and come back to it later.
If a person's job involves repetitive movements that may increase the risk of tendinitis, they should discuss preventive strategies with their employer.
A complication of inflamed tendons, or tendons with tendinitis, is that they can rupture or tear. This most commonly affects the Achilles tendon. A rupture or tear will often need surgery.