Tendinitis refers to an inflammation of the tendons which produces pain and tenderness near a joint. Much of the time it is associated with an overuse injury brought on by a specific motion that is either repeated often or with intensity. Tendinitis is a generic, general term that refers to the inflammation of the tendons which supports the joints. The particular name of the tendinitis is often preceded by the joint which is affected. For instance, individuals can suffer from wrist tendinitis, elbow tendinitis, DeQuervain\’s tendinitis or hip tendinitis.
Because the word tendinitis is a derivative of the word tendon it is often misspelled as \’tendonitis\’.
The tendons themselves are chords of fibrous connective tissue that actually act to connect muscle to the bone. They are found throughout the entire human body and are responsible for the smooth gliding motion which muscles are able to produce only with their help. (1)
Diagnosis is always accomplished on physical examination with a medical history. History will include pain with motion and often a description of repeated motion using that joints. The individual will suffer from tenderness directly over the tendon and pain with motion as well as swelling. Any imaging studies, such as x-rays and MRIs, are usually not necessary to diagnose tendinitis. However, physicians may recommend imaging studies in order to rule out other bone issues which also may accompany a traumatic injury.(2,3)
Each of these different imaging studies will show a variety of different factors and problems in the bone and muscle. X-rays may show evidence of swelling around the tendon but MRIs will identify swelling and can show evidence of tendinitis. However, these studies are not necessary to confirm a diagnosis and are only done if another problem is also suspected.
Tendinitis is most commonly found in several different areas of the body depending upon the overuse involved. Wrist tendinitis is a problem that causes pain and swelling around the wrist and is due to the inflammation of the tendon which supports the muscles in the wrist joint. Treatment includes rest and rehabilitation and seldom requires surgery.
Patellar tendinitis or inflammation of the patellar tendon, is a condition that is often called jumpers knee. It affects the tendons which attaches the patella (kneecap) to the shinbone. Together with the quadriceps muscles they allow the knee to straighten and provides strength during extension. It is in this motion that individuals are more at risk to develop tendinitis. Treatment usually consists of rest and anti-inflammatory medications. (4)
Achilles tendinitis is pain and swelling at the insertion point of the Achilles\’ tendon to the heel. Achilles tendinitis is a common overuse injury in runners and jumpers. It can also be triggered in women who commonly wear high heels and whose tendon becomes shortened, setting them up for an overuse injury. Unfortunately, this common problem can also result in a serious complication, an Achilles\’ tendon rupture. When the tendon ruptures the only adequate treatment is surgical repair and the recovery time is significant. (5)
Rotator cuff tendinitis is an inflammation of the tendons which holds together the rotator cuff of the shoulder. More often than not this particular diagnosis can be misdiagnosed. The rotator cuff is a series of tendons which attach the muscles of the upper arm to the shoulder girdle. These tendons enable the upper arm to rotate through the shoulder girdle and a smooth motion. Individuals who use their shoulder frequently and with intensity, such as baseball pitchers or volleyball players, may find that they are at higher risk to develop this condition.
Treatment should be given immediately. Initial steps can be nothing more than avoiding any aggravating motion to the particular joint which is involved. Sometimes this means taking a break from your favorite activity but it is definitely necessary to allow the inflamed tendon to heal. (6)
Tendinitis responds well to R.I.C.E., or rest, ice, compression and elevation. Icing the area of inflammation will help decrease the inflammation and control the swelling. By decreasing the amount of swelling around the tendon you can actually decrease the amount of time needed in order to heal. Anti-inflammatory medications may also be used to decrease inflammation. However, they have secondary side effects which ice use does not. If the injury is mild or moderate the athlete may be able to use only ice as long as it is done once every one or two hours.
When the joint is accessible, such as the knee, elbow or wrist, the athlete may choose to use compression and elevation to decrease inflammation, swelling and speed healing. Some joints suffering from tendinitis lend themselves better to splinting, such as the knee, thumb or elbow. This splinting can help decrease the inflammation and swelling as well as allow the joint to rest and heal.
If the symptoms are persistent your physician or orthopedic surgeon may recommend cortisone injections. Cortisone is a powerful anti-inflammatory medication. When it is given orally it will affect the entire body but when injected directly to the site of inflammation there is less chance of side effects and issues with the liver and kidneys. Not all types of tendinitis are helped by cortisone injections, so consider the recommendations carefully. For example, because cortisone decreases pain so significantly, it is never given to individuals who have Achilles tendinitis for fear of possible rupture of the tendon when the individual is pain-free but not injury free.
Once the inflammation has subsided and the pain has decreased these injuries require proper strengthening to avoid a repeat situation. Physical therapy can help teach the athlete how to use the muscle in a more safe and effective manner. Never start physical therapy until the inflammation has resolved because it will only increase the injury.
Athletes are not the only people who can suffer from tendinitis. Those who participate in gardening, raking leaves, carpentry, shoveling, painting and scrubbing all are at risk for tendinitis of specific areas and joints based on the activity. Incorrect posture at work, home or during recreational activities as well is poor stretching or conditioning also increase a person\’s risk.
Tendinitis can be avoided by increasing activity slowly and gradually building up activity levels. Individuals who are starting a new exercise program should use limited force and limited repetitions as well as stopped if unusual pain occurs.
While tendinitis may sideline an athlete for a short period of time they are not season ending or career ending injuries and many are able to return after a significant time of rest and rehabilitation. Most people can diagnose and treat mild injuries through rest, ice and strengthening exercises. If the injury does not respond quickly to the methods then it is best to consult with your primary care physician and receive an accurate diagnosis and recommended treatment protocols so you\’re able to get back to your activities as soon as possible.
(1) Orthopaedia: Form and function of tendon
(2) MayoClinic.com: Achilles Tendinitis
(3) American Family Physician: Diagnosis and Treatment of Biceps Tendinitis and Tendinosis
(4) KidsHealth.org: Jumper\’s Knee
(5) American Academy of Orthopedic Surgeons: Achilles Tendinitis
(6) Cleveland Clinic: Rotator Cuff Tendinitis