Tendinitis - Symptoms, Causes, Prevention, Diagnoses and Treatments

What Is Tendinitis?

Tendon is a thick fibrous structure in the body, which connects muscle to bone. Inflammation of the tendon is known as tendinitis or tendonitis. The exact cause is still debatable, but the most common theory excepted is it occurs due to overuse, which causes microtrauma to the tendon. It commonly affects the shoulder, elbow, wrist, knee, thigh, ankle, etc. Tendinitis is common in athletes though it can occur at any age. Older people are more susceptible as tendons become weaker and less elastic with age. When the sheath around the tendon is inflamed, it is called tenosynovitis. Tendinosis is a similar condition, but it is a chronic degenerative condition, which causes long-term pain. Depending on the location, the common tendinitis problems are:

• Tennis elbow.

• Achilles tendinitis.

• Golfer's elbow.

• Pitcher's shoulder.

• Swimmer's shoulder.

What Are the types of tendinitis?

Depending on the parts of the body affected, the different types of tendinitis are:

• Achilles tendinitis - The Achilles tendon attaches the calf muscles to the heel. Inflammation of this tendon is commonly seen in athletes and rheumatoid arthritis patients. It can also be caused by wearing ill-fitted shoes.

• Supraspinatus tendinitis - Inflammation of the tendon around the top of the shoulder joint. It results in shoulder pain while lifting the arm upwards.

• Tennis elbow - Otherwise called lateral epicondylitis, is the inflammation of the extensor muscles of the elbow. It causes pain on the outer side of the elbow and the wrist.

• Golfer’s elbow - Otherwise called medial epicondylitis, is the inflammation of the flexor muscles of the elbow. It causes pain on the inner side of the elbow and wrist. Pain is severe when the person tries to lift something heavy.

• De Quervain's tenosynovitis - Here, the patient finds it difficult to move the thumb as the sheath covering the tendons responsible for its movement become inflamed and painful.

• Trigger finger - Here, the finger movements, most commonly ring finger, are not smooth. There is an obstruction while straightening of the finger at a point and then suddenly it straightens upon applying some force. Hence it is known as trigger finger. A clicking sound can be heard while straightening out the fingers. It is due to inflammation and swelling of tendon responsible for straightening of the finger and due to swelling there are interrupted movements when it passes below the pulley covering the tendon.

What Are the Symptoms of Tendinitis?

The symptoms of tendinitis include:

• Dull ache or pain on moving the joint or limb.

• Swelling.

• Redness.

• Tenderness.

• Formation of a lump along the tendon.

• The feeling of the tendon crackling on movement.

What Causes Tendinitis?

The common causes of tendinitis are:

• Repetitive action.

• Sudden injury.

• Conditions like rheumatoid arthritis and diabetes.

• Aging.

• Tennis, golf, bowling, or basketball players are at a higher risk of developing tendinitis.

What Are the Risk Factors for Tendinitis?

The factors that increase the risk of tendonitis are:

• Old age, as the tendons become less flexible.

• Work that involves repetitive motions, sitting in awkward positions, and forceful exertion.

• Athletes who play baseball, golf, bowling, tennis, or running.

What Are the Complications Associated With Tendinitis?

If left untreated, tendinitis can lead to:

• Tendon Rupture - It is a serious condition, which might need surgery. Rupture occurs because the tendon becomes weak in the inflamed part.

• Tendinosis - It causes degenerative changes in the tendon, which results in pain lasting for several weeks to months.

How to Diagnose Tendinitis?

A doctor will take medical history and perform a physical examination. The doctor will check your range of motion and will ask you about any recent injury, work type, previously diagnosed medical condition, and the medicines consumed by the affected individual. Diagnosis of tendinitis is usually clinical, but to confirm the diagnosis, a doctor might refer to get X-rays, MRI (magnetic resonance imaging) scans, or ultrasounds.

What Are the Treatment Options for Tendinitis?

The treatment helps relieve pain and reduce inflammation. Some of the treatment options include:

Home Remedies:

Most of the time, RICE (rest, ice, compression, and elevation) protocol is all the treatment that is needed to treat tendinitis. The home remedies include:

• Rest - Do not work and move with pain as it will worsen the pain and swelling. For the tissues to heal, it is important to take rest. Bed rest is not necessary, just avoiding the activities that strain the injured joint or limb is good enough. The individual can still go for a swim or do water aerobics.

• Ice - Apply ice to the injured area, several times for 20 minutes, to decrease pain and swelling. Wrap ice cubes in a towel or freeze a cup full of water to apply cold directly to the skin.

• Compression - Compressing the area with the help of wraps and elastic bandages help to alleviate the swelling.

• Elevation - The affected part should be raised above the level of the heart to reduce swelling.

One has to rest to for healing the tissues, but avoid prolonged inactivity, as it can result in joint stiffness. After some days, move the joint gently to maintain flexibility.

Physiotherapy:

Manipulating, massaging, and exercise designed to stretch and strengthen the affected tendon and muscle might help reduce chronic pain. For example, eccentric strengthening. Also, ultrasonic or laser therapy is also one of the options in physiotherapy.

Medications:

Always consult a doctor before taking any medication. Some of the medicines used are:

• Painkillers - Aspirin, Naproxen sodium, or Ibuprofen tablets or topical creams.

• Corticosteroids - To reduce inflammation, corticosteroids can be used. It is not recommended to use steroids for tendinitis that lasts for more than three months, as steroids can weaken the tendon and can rupture it. Steroids can also be injected locally at the inflamed part, which is safe and more effective than any other oral or intravenous medications.

• Platelet-Rich plasma (PRP) - One's platelets are injected into the area of tendon irritation. This treatment method is still under research.

Surgery:

The surgical options include:

• Dry needling - Here, small holes are made in the tendon with a fine needle to stimulate factors that help in the healing of the tendon.

• Extracorporeal Shock Wave Therapy (ESWT) - A small incision is made through which a special device that removes tendon scar tissues are inserted.

• Surgical Repair - In cases where the tendon has torn from the bone, surgical repair might be needed.

Can Tendinitis Be Prevented?

Follow these tips to reduce the chance of developing tendinitis:

• Avoid performing activities that stretch the tendons excessively. If there is any pain while doing an exercise, then rest and start over.

• Avoid doing one type of exercise, instead, mix it up.

• Take time to stretch and warm-up.

• Maintain proper posture.

• Adjust the chair, keyboard, and desktop to make it as comfortable as possible. This will avoid excessive strain on the shoulder and joints.

• Strengthening exercises can help strengthen the tendons and muscles.

Conclusion

As tendinitis is typically associated with overuse, the most effective approach to prevent it from recurring is to avoid activities that cause the issue. Seeking guidance from a physical or occupational therapist can offer valuable insights into the modification of daily activities. Additionally, incorporating range-of-motion exercises into the routine can alleviate stiffness and enhance flexibility.