Tendinitis is a condition caused by the tearing of tendon fibers and subsequent inflammation in the tendon. Tendons are the strong connective tissue that connect muscle to bone.
When a muscle contracts, it pulls on the tendon, which is composed of tissue that cannot stretch. The tendon then transmits that pulling force to the bone and moves the bone, producing movement. Tendinitis usually results from excessive repeated demands placed on the tendon by the muscle. Tendinitis is not usually caused by a sudden injury; it is more commonly a result of a long period of overuse. Tendinitis occurs frequently with active individuals and those whose occupational tasks require repetitive motion.
Tendons that commonly become inflamed include:
- tendons of the hand
- tendons of the upper arm that affect the shoulder
- tendons of the forearm at the elbow
- the tendon of the quadriceps muscle group at the knee
- the Achilles tendon at the ankle
Causes & symptoms
Repeated overuse of the tendon will cause small tears to develop in the tendon fibers. As a result, the body will initiate the injury repair process in the area and lay down scar tissue. Inflammation will develop in the area as part of the injury repair process. Inflammation increases the blood supply, bringing nutrients to the damaged tissues along with infection-fighting agents. The result is swelling, tenderness, pain , and heat. Redness may occur if the injury is close to the skin. Since many cases of tendinitis result from chronic inflammatory conditions that develop from long periods of overuse, the inflammatory process is not as exaggerated as with an acute injury. Therefore swelling, heat, and redness are not always visible in a tendinitis complaint because the inflammation is really at a low level.
Recent research has found that tendinitis sometimes develops as a side effect of treatment with quinolones, which are a group of antibiotics frequently used to treat bacterial infections . The tendon most likely to be affected by these drugs is the Achilles tendon, and the tendinitis usually develops within the first few weeks of antibiotic treatment.
Some common tendon injuries are superficial and easy to identify. These include lateral epicondylitis (commonly referred to as tennis elbow ) and Achilles' tendinitis, which affects the tendon just above the heel of the foot. While tennis elbow occurs more often in workers than in athletes (in spite of its name), tendinitis affecting the Achilles tendon is almost always related to sports. Tendinitis in the shoulder area is almost always found in workers who frequently carry heavy loads as part of their job.
Tendinitis is most often diagnosed by evaluating factors in the patient's history that indicate muscular overuse. Tendinitis will often develop when an individual suddenly increases his or her level of activity without adequate training or conditioning. This occurs frequently in occupational and recreational settings.
In addition to evaluating factors in the patient's history that are likely to lead to tendinitis, the clinician may use several physical examination procedures. Most tendons are near the surface of the skin and therefore can be easily palpated (touched or pressed in order to make a diagnosis), especially by practitioners of manual therapy who have highly developed palpation skills. Pressure placed directly on these tendons is likely to cause discomfort. In addition, the practitioner may ask the patient to contract the muscle attached to the tendon, usually against resistance, to see if this maneuver causes pain.
Ice is often advocated for tendinitis when the tendon is in an irritated state. Ice is particularly useful for limiting inflammation in the tendon. Ice may be applied by placing a bag of ice on the skin. It may also be applied directly to the skin using an ice cube wrapped in a paper towel or ice frozen in a paper cup with the top portion of the cup peeled away to expose the ice. An ice massage—rubbing the skin and underlying tissue with ice in a slow, circular, or back-and-forth motion—will cool the injured area quickly. If ice is applied to the skin without a barrier between the ice and the skin, the patient should be carefully monitored so that frostbite does not occur. Generally no more than about five minutes of treatment in one area is necessary with ice massage.
Compression wraps, such as elastic bandages, may be used to help provide mechanical support for the tendon during active movement. These compression wraps can be helpful, but they may also slow the healing process in the tendon if left on for long periods because they decrease blood supply in the area.
Various types of soft tissue manipulation are very effective for treating tendinitis and may be employed by a variety of practitioners, including chiropractors, massage therapists, physical therapists, and osteopaths. One of the most common methods of soft tissue treatment for tendinitis is a vigorous friction massage to the damaged tendon. This friction massage will stimulate the healing of tissue in the area. It is also thought to help produce a healthy and strong scar-tissue repair of the damaged tendon fibers. Practitioners of manual therapy are also likely to advocate a regular stretching program to help decrease tension in those muscles that may be pulling excessively on the tendon.
Acupuncture and traditional Chinese medicine are quite effective in treating tendinitis. Acupuncture may be used in the immediate vicinity of the tendinitis to help address muscular dysfunction. Acupuncture treatment may also use more distant points along the energy meridians to help address pain and reduce inflammation. Acupuncture may also have significant benefits in creating an optimum environment for healing of the tendon fiber to take place.
Topical liniments and herbal preparations are often used to treat tendinitis. They have anti-inflammatory properties and will help heal the torn tendon fibers. If the condition is chronic, treatment with moxibustion (burning a small amount of mugwort near the skin) may hasten the healing process. Some oral herbal preparations may also be used in order to create the optimal healing environment for the tendon and address any underlying problems. Practitioners of traditional Chinese medicine may also use a special form of acupressure massage called tui-na.
Pain and anti-inflammatory medications (aspirin, naproxen, and ibuprofen) will help and are often used to treat tendinitis along with ice, compression wraps, and activity modification, as mentioned earlier. Sometimes the inflammation lingers and requires additional treatment. Injections of anti-inflammatory medication, such as cortisone, often relieve chronic tendinitis, but they should be used with caution. Research has indicated that cortisone may have detrimental effects on the healing of connective tissues and may, in fact, weaken them in the long run. This side effect would make the person susceptible to a greater injury in the future.
If tendinitis is persistent and unresponsive to non-surgical treatment, the afflicted portion of the tendon can be removed through surgery. Surgery is also performed to remove the calcium buildup that comes with persistent tendinitis.
Generally, tendinitis will heal if the activity that provokes it is stopped. Various kinds of treatments may accelerate the healing process. Some tendinitis complaints may last for a long time because they are not given adequate healing time before the individual returns to a vigorous level of activity.
If given enough time, tendons will strengthen to meet the demands placed on them. The blood supply to tendons is poor, which means that tendons grow slowly. Therefore, adequate time is required for good conditioning. Stretching the muscles that are associated with problematic tendon will also help decrease overuse of the tendon.
Hammer, Warren I. Functional Soft Tissue Examination and Treatment by Manual Methods: New Perspectives. 2nd ed. Gaithersburg, MD: Aspen, 1999.
Kaptchuk, Ted J. The Web That Has No Weaver. Chicago: NTC Publishing Group, 1999.
Pelletier, Kenneth R. The Best Alternative Medicine: What Works? What Does Not? New York: Simon & Schuster, 2000.
Malone, Terry R., Thomas G. McPoil, and Arthur J. Nitz, eds. Orthopedic and Sports Physical Therapy. St. Louis: Mosby, 1997.
Weintraub, William. Tendon and Ligament Healing: A New Approach Through Manual Therapy. Berkeley, Calif.: North Atlantic Books, 1999.
Fenwick, S. A., B. L. Hazleman, and G. P. Riley. "The Vasculature and Its Role in the Damaged and Healing Tendon." Arthritis Research 4 (March 2002): 252-260.
Frost, P., J. P. Bonde, S. Mikkelsen, et al. "Risk of Shoulder Tendinitis in Relation to Shoulder Loads in Monotonous Repetitive Work." American Journal of Industrial Medicine 41 (January 2002): 11-18.
Oliphant, C. M., and G. M. Green. "Quinolones: A Comprehensive Review." American Family Physician 65 (February 2002): 455-464.
Schepsis, A. A., H. Jones, and A. L. Haas. "Achilles Tendon Disorders in Athletes." American Journal of Sports Medicine 30 (March-April 2002): 287-305.
Stahlmann, R. "Clinical Toxicological Aspects of Fluoroquinolones." Toxicology Letter 127 (February 28, 2002): 269-277.
Rebecca J. Frey, PhD
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Tendinitis is the inflammation of a tendon, a tough rope-like tissue that connects muscle to bone.
Tendinitis usually occurs in individuals in middle or old age because it is often the result of overuse over a long period of time. Tendinitis does occur in younger patients as a result of acute overuse.
tendons that commonly become inflamed include:
- tendons of the hand
- tendons of the upper arm that effect the shoulder
- achilles tendon and the tendon that runs across the top of the foot
Causes and symptoms
Sudden stretching or repeated overuse injures the connection between the tendon and its bone or muscle. The injury is largely mechanical, but when it appears, the body tries to heal it by initiating inflammation. Inflammation increases the blood supply, bringing nutrients to the damaged tissues along with immunogenic agents to combat infection. The result is swelling, tenderness, pain, heat, and redness if the inflammation is close to the skin.
Some tendon injuries are superficial and easy to identify. These include "tennis elbow" (extensor tendinitis) over the outside of the elbow, and Achilles' tendinitis just above the heel of the foot. There are several tendons in the shoulder that can be overused or stretched, and usually a shoulder will have more than one injury at a time. Tendinitis in the biceps, the infraspinatus, or the supraspinatus tendon may accompany a tear of the shoulder ligaments or an impingement of one bone or another. Careful pressure testing and movement of the parts is all that is necessary to identify the tendinitis.
Rest, ice, compression, and elevation (RICE) will treat the acute condition. The best way to apply ice is in a bag with water. The water applies the cold directly to the skin. Chemical ice packs can get too cold and cause frostbite. Compression using an elastic wrap minimizes swelling and bleeding in an acute sprain. Splinting may help rest the limb. Pain and anti-inflammatory medications (aspirin, naproxen, ibuprofen) will help. Sometimes the inflammation lingers and requires additional treatment. Injections of cortisone-like medicine often relieve chronic tendinitis, but should be reserved for resistant cases since cortisone can occasionally cause problems of its own.
If tendinitis is persistent and unresponsive to non-surgical treatment, a surgery to remove the afflicted portion of tendon can be performed. Surgery is also conducted to remove calcium buildup that comes with persistent tendinitis.
An osteopathic soft-tissue treatment on the tendon may relieve pain and increase mobility. Increasing intake of antioxidant-rich foods and lowering intake of animal fats may help reduce the inflammation. Acupuncture has also been used to combat tendinitis. Hydrotherapies, such as whirlpool baths, help relax the surrounding muscles.
Generally, tendinitis will heal if the provoking activity is stopped.
If given enough time, tendons will strengthen to meet the demands placed on them. They grow slowly because of their poor blood supply, so adequate time is required for good conditioning.
Gilliland, Bruce C. "Relapsing Polychondritis and Other Arthritides." In Harrison's Principles of Internal Medicine, edited by Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.
Biceps— The muscle in the front of the upper arm.
Infraspinatus— A muscle at the middle of the shoulder blade.
Supraspinatus— A muscle at the top of the shoulder blade.
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Tendinitis (pronounced tehn-duh-NI-tiss) is the inflammation of a tendon. Tendons are tough, rope-like tissue that connect muscle to bone.
Tendinitis usually occurs in middle or old age. The condition develops when people have used the same motion over and over again for a long time. When tendinitis occurs in younger people, it is usually caused by performing the same motion very frequently over a short period of time.
A classical example of tendinitis is tennis elbow. Tennis elbow gets its name because it occurs most commonly among tennis players. Tennis players may use the same swing of their arm over and over again many times during a few hours or few days. At the end of many weeks of play, the tendon at the player's elbow may become sore and inflamed.
Tendinitis occurs most commonly in three parts of the body. They are:
- Tendons of the hand
- Tendons of the upper arm that connect with the shoulder
- Tendons that run across the top of the foot and the Achilles tendon. The Achilles tendon connects the muscles in the calf of the leg with the heel bone in the foot
Tendons can be injured in two ways; by sudden stretching or repeated use. In either case, the tendon may be pulled, twisted, torn, or otherwise damaged.
When the body tries to heal injured tendons it increases the blood flow to the injured tissues and sends nutrients to the tissues to help them heal. It also sends chemicals designed to fight possible infection to the damaged area.
These steps all help the tendon to get better. But they may also produce swelling, pain, heat, and redness in the damaged tissue, as well as discomfort in the injured area.
Tendinitis is usually easy to diagnose. The discomfort described by the patient provides the first clue as to the disorder. The doctor will also ask about the patient's work and recreational experiences. Activities that are repeated over and over again in the injured area also suggest the possibility of tendinitis. Tennis elbow is an example of a condition that can be diagnosed by studying the patient's daily activities. The doctor can usually confirm a diagnosis by applying pressure on an injured area or trying to move a sore joint.
Tendinitis: Words to Know
- A substance that prevents oxidation from taking place. Oxidation is a chemical reaction that can create heat, pain, and inflammation in the body.
- The term stands for the program of rest, ice, compression, and elevation that is recommended for treating tendinitis.
- A tough, rope-like tissue that connects muscle to bone.
- Tennis elbow:
- A form of tendinitis that occurs among tennis players and other people who engage in the same movement of the elbow over and over again.
Tendinitis is best treated by a series of steps known as RICE. The four letters in this acronym stand for:
- R est
- I ce
- C ompression
- E levation
The best way to apply ice is with ice water in a bag. The water insures that the cold will be applied directly to the skin. Chemical ice packs are not advised. They are too cold to use directly on the skin.
An elastic wrap, such as an Ace bandage, can be used to provide compression. Compression is a means of reducing swelling and keeping the joint in its proper position. In some cases, a splint may be used to keep the joint from moving.
Nonsteroidal anti-inflammatory drugs (NSAIDs) can also be used to reduce pain and swelling. Common NSAIDs are aspirin, acetaminophen (trade name Tylenol), and ibuprofen (trade names Advil, Motrin). When these medications are not effective, corticosteroids drugs may be used. Corticosteroids also reduce inflammation and swelling but are usually injected directly into the joint that has been damaged.
In extreme cases, surgery may be necessary. One purpose of surgery is to remove and/or reconstruct the damaged tendon. Another purpose of surgery may be to remove calcium buildups in the joint. Calcium tends to
collect in joints that are chronically (continuously) affected with tendinitis and may restrict the joint's ability to move normally.
Hydrotherapy is sometimes effective in treating tendinitis. Warm water helps injured tissue to relax and begin healing. Acupuncture has also been used to treat the disorder. Very gentle forms of massage may also relieve pain and increase mobility in the joint. Finally, increasing the intake of certain foods that are rich in anti-oxidants (such as carrots) may help reduce inflammation.
Injured tendons tend to heal by themselves if given sufficient time and rest. The four elements of RICE treatment can help speed up this process. Healing also occurs sooner if the patient discontinues the activities that caused the problem in the first place.
Tendinitis can be prevented if a person avoids the kinds of activities that causes injuries to tendons. This instruction is easy to give, but not so easy to follow. An automobile worker, for example, may find it difficult not to perform a particular movement over and over again if that movement is part of his or her regular job. Workers and employers can often work together to arrange conditions so that tendinitis is less likely to occur.
FOR MORE INFORMATION
O'Shea, Kate S. Healing Hip, Joint, and Knee Pain: A Mind-Body Guide to Recovering from Surgery and Injuries. Berkley, CA: North Atlantic Books, 1998.
Scott, W. Norman, Robert S. Gotlin, and Johanna Warshaw. Dr. Scott's Knee Book: Symptoms, Diagnosis, and Treatment of Knee Problems, Including: Torn Cartilage, Ligament Damage, Arthritis, Tendinitis, and Arthritis. New York: Fireside, 1996.
Villar, Richard. Knee Problems: A Patient's Guide to Treatment and Recovery. London: Thorsons Publications, 1996.
American College of Rheumatology. "Tendinitis and Bursitis." HealthTouch Online. [Online] http://www.healthtouch.com/level1/leaflets/ACR/ACR035.htm (accessed on November 5, 1999).
"Tendonitis." [Online] http://www.yourhealth.com/ahl/2109.html (accessed on November 5, 1999).
"Tendinitis." UXL Complete Health Resource. . Encyclopedia.com. (July 19, 2018). http://www.encyclopedia.com/medicine/news-wires-white-papers-and-books/tendinitis
"Tendinitis." UXL Complete Health Resource. . Retrieved July 19, 2018 from Encyclopedia.com: http://www.encyclopedia.com/medicine/news-wires-white-papers-and-books/tendinitis
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"tendinitis." A Dictionary of Nursing. . Encyclopedia.com. (July 19, 2018). http://www.encyclopedia.com/caregiving/dictionaries-thesauruses-pictures-and-press-releases/tendinitis
"tendinitis." A Dictionary of Nursing. . Retrieved July 19, 2018 from Encyclopedia.com: http://www.encyclopedia.com/caregiving/dictionaries-thesauruses-pictures-and-press-releases/tendinitis