Injury: Tendinitis

Definition
Description
Demographics
Causes and Symptoms
Diagnosis
Treatment
Prognosis
Prevention
The Future
For more information

Definition

Tendinitis (also spelled tendonitis) is inflammation or irritation of a tendon—one of the thick cords of white connective tissue that attach muscle to bone. Tendons are less elastic than muscle; they transmit the force of a muscle's expansion or contraction to the bone or joint to cause movement. A tendon becomes inflamed when it is overused or injured by a blow or some other trauma, resulting in warmth, pain, swelling in the affected joint, and some loss of motion in the joint.

Description

Tendons are located all over the body and range in size from the very small tendons in the hands to large tendons like the Achilles tendon at the back of the heel. The most common locations where tendinitis develops are the shoulders, elbows, knees, wrists, and heels. Some forms of tendinitis are named for the athletic activities that are known to cause them, such as golfer's elbow (inner tendon of the elbow), tennis elbow (outer tendon of the elbow), pitcher's shoulder (rotator cuff tendinitis), and jumper's knee (quadriceps or patellar tendons of the knee). Although these types of tendinitis are associated with sports, they can also develop in people whose occupations require repetitive movements of the hands, arms, or legs.

Tendinitis begins when microscopically small tears develop in the tissue of the tendon as a result of overuse. In some cases the tendon may have been previously weakened by normal aging or by such diseases as rheumatoid arthritis. If the activity that has caused the first small tears in the tendon is continued, the tendon becomes irritated and inflamed, leading to swelling and pain in the soft tissues surrounding the joint. In most cases, the pain becomes noticeably worse when the joint is moved or used.

Demographics

Tendinitis is a very common health problem in the general population. No exact statistics are kept because many people treat mild tendinitis at home without going to their doctor. It is known, however, that middle-aged adults are the age group most likely to develop tendinitis.

People who are most at risk of developing tendinitis are:

• Those over forty-five years of age.
• People whose occupations require repetitive movements of the upper arm, wrist, or shoulder. These include carpenters, gardeners, painters, musicians, dancers, manicurists, dental hygienists, and dentists (tennis elbow and golfer's elbow); construction work, electrical repair, or other jobs requiring reaching overhead (pitcher's shoulder); and typing or data entry (wrist tendinitis).
• People with rheumatoid arthritis, osteoarthritis, thyroid disorders, diabetes, or gout.
• People who take a type of prescription antibiotic known as fluoroquinolones.
• People who have been recently injured in an accident or are recovering from burns.
• People who abuse steroids for muscle building.

Home Care for Tendinitis

There are five points to keep in mind in treating tendinitis at home. The word PRICE is a good way to remember them:

• Protection. Protecting the injured tendon involves the use of slings, splints, crutches, or elastic bandages to prevent unnecessary movement of the affected area.
• Rest. Rest means avoiding activities or body movements that make the pain or swelling worse; it does not mean complete bed rest. Swimming or exercising in a pool is often a good way to keep active without harming the injured tendon.
• Ice. An ice pack can be applied to the affected area for fifteen to twenty minutes every four to six hours for three to five days, or a few days longer if the doctor recommends it.
• Compression. Compression refers to the use of a wrap or Ace bandage to keep swollen muscles from restricting movement in an injured joint.
• Elevation. Raising the affected arm or leg on a pillow or cushion is helpful in relieving swelling in the affected joint.

Although rest is an important part of self-care at home for tendinitis, gentle movement of the affected joint after a few days of complete rest is necessary to prevent stiffness. Doctors recommend moving the sore area slowly and gently through its full range of motion or doing slow stretching exercises.

Nonsteroidal anti-inflammatory drugs, or NSAIDs, can be used to relieve pain and inflammation in the sore joint. These drugs include aspirin as well as Advil and Motrin.

Causes and Symptoms

Tendinitis is caused primarily by overuse of specific muscles; however, the aging process and diseases associated with joint inflammation may speed up the development of tendinitis or make the symptoms worse.

In general, the symptoms of tendinitis include pain and swelling of the soft tissues near the affected tendon. Symptoms in specific tendons are as follows:

• Golfer's elbow: Pain when the wrist is flexed or turned outward, as when shaking hands or using certain kinds of handheld tools.
• Tennis elbow: Pain spreading into the upper arm or lower arm when the patient grips an object or extends the wrist (as when pouring liquid from a pitcher).
• Achilles tendinitis: Pain in the heel as the foot is flexed while running.
• Tendinitis in the knee: Pain in the side of the knee during downhill running, or pain just below the kneecap during or after physical activity.
• Rotator cuff tendinitis: Pain when the arm is raised above the head; pain worsened when the arm is lowered across the chest.

Diagnosis

It is important to have tendinitis diagnosed and treated promptly because continued overuse of a damaged tendon can lead to complete rupture (tearing) of the tendon. The doctor will begin by taking a patient history, noting any recent injuries and medications taken as well as any previously diagnosed conditions like diabetes or rheumatoid arthritis.

The next step is a physical examination of the painful joint. This part of the examination involves asking the patient to hold or move the affected limb or joint according to the doctor's instructions while the doctor puts pressure on the muscles and tendons. For example, to detect golfer's elbow, the doctor will ask the patient to place the forearm on the examining table with the inside of the wrist upward. The patient is then asked to make a fist while the doctor holds the forearm down. If the patient has golfer's elbow, he or she will feel pain in the elbow. There are similar tests for the tendons in the shoulder, knee, wrist, and heel.

Imaging tests are not usually necessary unless the doctor wants to check for bone chips or fractures in addition to the tendinitis. If the patient does not get better after rest and medications for the tendinitis, the doctor may order an ultrasound or magnetic resonance imaging (MRI) test. A blood test is usually performed only when the doctor needs to rule out rheumatoid arthritis as the cause of the pain and swelling.

Treatment

Treatment of tendinitis is conservative, usually consisting of pain relievers, rest, ice applications, and limiting the movement of the affected joint by splints or a sling (for rotator cuff tendinitis). After recovering from the acute pain, the patient should consider a program of physical therapy and exercise to increase muscle strength and range of motion in the affected joint.

For severe pain that is not helped by NSAIDs, the doctor may inject steroid drugs to decrease pain and inflammation. Steroid injections should not, however, be used more than a few times because they may weaken tendons and increase the risk of a ruptured tendon. Ruptured tendons require prompt surgical treatment to prevent permanent disability.

Other treatments for tendinitis that are currently considered experimental include ultrasound therapy, vitamin E, nitric oxide, and extracorporeal

shockwave therapy or ESWT. ESWT was originally developed to treat kidney stones but has been approved by the Food and Drug Administration (FDA) for the treatment of tennis elbow.

Prognosis

The prognosis for recovery from tendinitis is very good with appropriate medical treatment and self-care at home.

Prevention

The National Institute for Arthritis and Musculoskeletal and Skin Diseases (NIAMS) recommends the following steps to prevent tendinitis:

• Warm up or stretch before exercising.
• Stop and rest if there is pain during a particular exercise or body movement.
• Try different types of exercise; alternate high-impact sports like running or tennis with lower-impact activities like swimming or yoga.
• Make sure that the technique involved in the sport or occupational activity is correct. An improper stance or swing, or poor posture when typing or practicing music, can contribute to tendinitis. If necessary, consult a doctor or physical therapist for guidance.
• Begin slowly when starting a new form of exercise or other physical activity and work up gradually to longer workouts.
• Take frequent breaks from repetitive jobs or chores.
• Cushion joints at risk of tendinitis; use pads for the knees when gardening, padded gloves for heavy tools, and additional grips on golf clubs.
• Use a two-handed grip for heavy tools.
• Do stretching exercises after a workout as well as before, to maintain full range of motion in the joints.

The Future

New treatments for the pain of tendinitis are currently being studied. One treatment is an NSAID patch that could be applied to the skin and allow the drug to relieve pain in the affected joint without upsetting the

stomach, which oral NSAIDs often do. Another experimental treatment for tendinitis is injections with tissue plasminogen activator (tPA) factor, an enzyme that is presently used primarily to treat heart disease and stroke by breaking up blood clots.

SEE ALSO Diabetes; Rheumatoid arthritis; Sprains and strains; Steroid use

WORDS TO KNOW

Achilles tendon: The tendon that connects the calf muscle to the back of the heel. Tendinitis in the Achilles tendon is common in sports that involve running and jumping.

Rotator cuff: A group of four muscles that attach the arm to the shoulder blade.

Tendon: A thick band or cord of dense white connective tissue that attaches a muscle to a bone.

For more information

BOOKS

Bellenir, Karen, ed. Sports Injuries Information for Teens. Detroit, MI: Omni-graphics, 2008.

Leonard-Brown, Sarah. Sports Injuries. Chicago, IL: Raintree, 2005.

WEB SITES

American College of Rheumatology (ACR). Fact Sheet: Tendonitis/Bursitis. Available online at http://www.rheumatology.org/public/factsheets/tendonitis_new.asp? (accessed June 19, 2008).

How Stuff Works. How to Ease Tendinitis. Available online at http://health.howstuffworks.com/how-to-deal-with-tendinitis.htm/printable (accessed June 19, 2008).

Mayo Clinic. Tendinitis. Available online at http://www.mayoclinic.com/health/tendinitis/DS00153 (accessed cited June 18, 2008).

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Questions and Answers about Bursitis and Tendinitis. Available online at http://www.niams.nih.gov/Health_Info/Bursitis/default.asp (accessed June 19, 2008).

National Library of Medicine (NLM). Tennis Elbow. Available online at http://www.nlm.nih.gov/medlineplus/tutorials/tenniselbow/htm/index.htm (accessed June 19, 2008). This is an online tutorial with voiceover; viewers have the option of a self-playing version, a text version, or an interactive version with questions.