Other Names

Tendinitis

What is Tendonitis?

A tendon is a whitish, cord-like structure, consisting of numerous parallel bundles of fibers that serve to attach a muscle to a bone. Tendons are inelastic but flexible. Tendons assist in concentrating the pull of the muscle on the bone it is attached to, facilitating movement across a joint. Tendonitis is a painful inflammation of such tendons.

Causes, Incidence and Risk Factors

Tendonitis, most commonly, is the result of excessive use of the joints. Sometimes it is due to bacterial infection or generalized diseases such as rheumatoid arthritis. Tendonitis primarily affects the shoulders, elbows and knees but may also occur in the hips, heels and wrists, as well. Many people often use other common names such as, golfer's elbow, pitcher's shoulder, swimmer's shoulders and jumper's knee, to describe tendonitis in specific joints.

Risk Factors:

• Excessive use of a particular joint
• Trauma
• Infection
• Chronic systemic diseases such as rheumatoid arthritis

Signs and Symptoms

• Pain aggravated by movement
• Tenderness
• Mild swelling

Specific forms of tendonitis produce pain at different sites and include the following:

Tennis Elbow - pain felt on the side of the elbow, facing away from the body, due to inflammation of tendons attached to the lateral epicondyle of the humerus.


Golfer's Elbow - pain on the side of the elbow facing the body due to involvement of tendons attached to the medial epicondyle of the humerus.


Achilles' Heel - Tendonitis of the Achilles tendon attached to the heel. Pain is felt just above the heel.


Adductor Tendonitis - Pain in the groin.


Rotator Cuff Tendonitis - Pain on lifting the arms above the head.


Iliotibial Band (IT Band) Tendonitis - Inflammation of the tendons surrounding the hip.

Screening and Diagnosis

A thorough clinical examination is required to assess which movements are impaired. This involves testing the different actions of each and every joint, to identify which tendon is affected. X-rays may be needed to rule out any other causes of pain, like bursitis or fractures.

Treatment

Since tendonitis occurs most commonly due to excessive use, resting the involved joint is the best approach to treatment. Analgesics are usually prescribed and you are advised to take plenty of rest and fluids. In some cases, injection of steroids into the area brings relief.

Physiotherapy techniques, such as Transcutaneous Electrical Nerve Stimulation (TENS), can also sooth the pain. With TENS Mild vibrations are applied across the skin at the affected joint to decrease pain perception.

In case of a tendon rupture, surgical treatment is needed. Surgery involves tendon repair in case of a clean cut injury. In cases of crush injuries to multiple tendons, a tendon transfer may be necessary.

Recovery

Tendonitis is a common condition that resolves easily by resting the affected joint adequately and taking appropriate treatment.

Complications:

• Persistence of pain
• Deformity
• Loss of movement and limitation of activities.

Post operatively, adhesions (scar tissue) between repaired joints and adjoining tissue can develop. This can impair joint dexterity and produce pain on movement.

Prevention

Having a regular schedule and defining the hours of work or sport can prevent tendonitis. Taking regular breaks and taking adequate rest are also part of the prevention plan.

References

1. Turek's orthopedics 5th edition, Weinstein and Buckwalter Pages 586, 587, 392, 393, 405, 406.
   
   
2. Outline of Orthopedics, John Crawford Adams. Pages 255, 277, 114.