Definition and Overview

Tendinitis is one of the diseases that are characterized by the acute inflammation of the tendon. This is an acute condition, which means that it occurs suddenly and temporarily, but may cause the patient severe pain, swelling, and other symptoms. It can affect any tendon in the body, and present in different forms depending on which part is affected. This is why the condition also goes by many names, such as golfer’s elbow, jumper’s knee, pitcher’s shoulder, swimmer’s shoulder, and tennis elbow.

Tendons are soft tissues that attach a person’s muscles to his bones. They are tough, fibrous, and can withstand tension, allowing the muscles to stretch and extend. However, certain factors may irritate the tendons and cause inflammation. Some of these include advanced age, overuse, and injury.

Treatment options for tendinitis include pain medications, corticosteroid injections, physical therapy, and surgery.

Causes of Condition

The three most common causes of inflamed tendons are:

  • Overuse – The most common cause is when the tendons are used in the same repetitive movement over and over. This typically develops among athletes, especially those who play sports that involve repetitive motion. These include running, swimming, golf, bowling, and baseball. Tendinitis due to tendon overuse is also common among people whose jobs involve repetitive awkward movements that stretch the tendons beyond their natural range of motion.

  • Old age – Over time, tendons lose their natural flexibility, making inflammations and ruptures more common among older individuals.

  • Injury – Tendons can be irritated and become inflamed due to injury or trauma.

There are also some risk factors that make tendinitis more likely to develop. These include:

The condition also occurs in different types depending on which part of the body is affected. Below are the most common:

  • Achilles tendinitis – This affects the Achilles tendon and is a common injury caused by sports or wearing shoes that do not adequately support the feet. The Achilles tendon is located between the calf muscle and the heel.

  • Patellar tendinitis, also known as jumper’s knee – This affects the patellar tendon in the knee.

  • Suprastinatus tendinitis – This affects the tendon located near the shoulder joint and is typically accompanied by pain during upward arm movements.

Other common types, which take into consideration both the affected body part as well as the cause of the inflammation, include:

  • Golfer’s elbow
  • Tennis elbow
  • Pitcher’s shoulder
  • Swimmer’s shoulder

Both tennis and golfer’s elbow affects the elbow. In tennis players, however, the lateral epicondylitis is affected, whereas in golfers, the medial epidondylitis is affected. The pain usually extends from the side of the elbow to the wrist area.

Key Symptoms

The common symptoms of tendinitis include:

  • Pain
  • Dull ache
  • Tenderness
  • Swelling
  • Warmth
  • Redness or flushing
  • Lump along the tendon
  • Crackling or grating sensation when the tendon moves
  • Hindered movement, which occurs when the inflamed tendon becomes ruptured

In some cases, the symptoms go away within a few days, when the inflammation has subsided. However, in other cases, they may affect the individual for several weeks and even for months, especially when the activities that caused the problem are continued.

Tendinitis should not be confused with tenosynovitis, which is when the sheath surrounding the tendon becomes inflamed. However, it is possible for a person with tendinitis to also develop tenosynovitis at the same time.

To determine whether symptoms are caused by tendinitis, doctors use imaging scans such as x-rays, MRI, and ultrasound, all of which can detect swollen tendons.

Who to See and Types of Treatments Available

Early symptoms of tendinitis can be brought to the attention of a general physician or family doctor, who can make the necessary referrals to specialists, such as:

A person who experiences the symptoms of tendinitis should rest the affected area, which means he needs to stop the activities that caused the problem in the first place. This allows the inflammation to subside and also helps keep the condition from worsening or complications from occurring. If a person is unable to limit or control his movements, putting a bandage, brace, or splint on the affected area will help.

As a first aid treatment, an ice pack or warm compress can also be applied to the affected area. These heat and cold presses work in two ways: to relieve the pain and to bring down the swelling.

However, if pain and swelling persist, it is best to seek the help of a medical professional, who can prescribe other types of treatments, such as:

  • Pain medications – Doctors typically prescribe NSAIDs to help with the pain caused by tendinitis. These include ibuprofen and naproxen, among others. In patients who, for some reason, cannot take NSAIDs, paracetamol can also be prescribed.

  • Corticosteroid injections – These are steroids that are injected into the affected tendons to help bring down the swelling. These, however, should be used sparingly, as repeated injections can significantly weaken the inflamed tendons, making ruptures more possible.

  • Physical therapy – Physical therapy involving soothing massages and exercises that strengthen the tendons can help an inflamed tendon heal more quickly. It also helps prevent recurrences.

  • Occupational therapy – Occupational therapists can help people at risk of tendinitis to manage their risk while continuing their normal activities and work habits. The treatment may involve the use of custom hand splints, wrist splints, and other assistive devices that can provide the needed support for the affected tendons and prevent irritation despite repetitive movements.

  • Shockwave therapy – This is an option used when there are calcium deposits around the inflamed tendons. The therapy helps to break down the calcium deposits to facilitate healing. If the calcific tendinitis is persistent, surgically removing the calcium deposits is also an option.

If tendinitis symptoms persist but the patient does not seek proper care for it, there is a risk of more serious complications, such as a tendon rupture. If a tendon ruptures, physical therapy and corticosteroid injections will not be as effective, so surgery often becomes necessary. Another potential complication is tendinosis, wherein the tendon suffers some degenerative changes as well as abnormal blood vessel growth. This commonly develops in tendons that are left irritated, inflamed, and untreated for months.

In activities, hobbies, or jobs wherein repetitive movements cannot be avoided, it helps to be aware of how tendinitis can be avoided. Some techniques include:

  • Stretching and strengthening exercises – Regular exercise especially those involving the tendons that are regularly used can help strengthen the tendons and muscles, making irritation and injury less likely to occur.

  • Cooling-down exercises – It is important for athletes to perform correct cooling-down exercises after strenuous physical exertion. Doing so can help keep the risk of acute inflammation low.

  • Regular screening tests – People who cannot avoid doing repetitive movements should undergo screening tests to assess their risk of injury or inflammation.

  • Drezner JA, Harmon KG, O'Kane JW. Sports medicine. In: Rakel RE, ed. Textbook of Family Medicine. 8th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 29.

  • Jevremovic T, Asem K, Bonin M, et al. Overview of sport-specific injuries. In: Miller MD, Thompson SR, eds. DeLee and Drez'sOrthopaedic Sports Medicine. 4th ed. Philadelphia, PA: Saunders Elsevier; 2014:chap 12.

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