Tendonitis (also called Tendinitis) is a common condition with a prevalence of over 11% in the general population. According to the Bureau of Labor Statistics, tendonitis causes over 70,000 people to miss work per year.
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What is tendonitis?
Tendons are thick pieces of connective tissue that attach muscles to bones and when they become inflamed, it is called tendonitis. This condition causes pain and swelling at the tendons which are located just outside of the joint. Tendonitis is caused by repetitive activities or overuse. Any joint in the body can be affected by tendonitis, though it is most common at the shoulders, elbows, wrists, knees, and heels. The most common upper extremity tendonitis affects the base of the thumb and is called De Quervain’s tenosynovitis. In the lower extremity, the most common tendonitis affects the heel cord and is called Achilles tendonitis.
Symptoms of Tendinitis
Symptoms of tendonitis occur locally at the specific tendon that is affected, usually close to where it attaches to the bone. Pain may come on gradually or suddenly and can range from mild to severe. Symptoms include:
- Pain, often described as a dull ache, when moving the joint around the affected tendon
- Tenderness to the touch at the affected tendon
- Stiffness upon waking up in the morning or after prolonged inactivity
- A lump on the affected tendon (more common with chronic symptoms)
- Weakness in the affected area
- Decreased range of motion
- Hearing and feeling a cracking or popping sensation when you move
Risk Factors for Tendinitis
Risk factors for tendinitis include activities requiring repetitive tasks and sports. It’s important to note that while these risk factors can increase the likelihood of developing tendinitis, it doesn’t guarantee that a person will develop the condition. Practicing proper body mechanics, warming up before physical activity, and allowing adequate rest and recovery time can help reduce the risk of tendinitis.
The following are the most common risk factors for developing tendonitis:
- Age: with increasing age, tendons lose their elasticity which increases the risk for injury (1)
- Work: jobs that require repetitive motions, awkward positions, frequent overhead reaching, or vibration such as gardeners, construction workers, and manual laborers more frequently develop tendonitis
- Training errors: examples of training errors that increase the risk of developing tendonitis include sudden increase in volume or difficulty of training, wearing ill-fitting or worn out shoes, training on hard surfaces such as concrete or gym floors, taking time off of training and jumping back in too fast, training using poor form
- Medical conditions: certain medical conditions increase the risk of developing tendinitis such as diabetes, rheumatoid arthritis, and gout (2)
- Medications: certain medications can increase the risk of developing tendinitis such as fluoroquinolone antibiotics, corticosteroids, and aromatase inhibitors (3)
- Muscle imbalances: imbalances around a joint can lead to abnormal stress on the associated tendons, increasing the risk of tendinitis
- Inadequate warm-up: failing to properly warm up before physical activity can leave tendons unprepared for the stress of exercise, making them more vulnerable to injury
- Obesity: excess body weight can put additional strain on tendons, especially those in weight-bearing joints like the knees and ankles (4)
- Previous injuries: previous history of tendon injuries or inflammation may make the affected tendons more prone to future episodes of tendinitis
- Sports participation: participation in certain sports that involve repetitive or high-impact movements can elevate the risk of tendinitis. These sports may include running, tennis, golf, baseball, and weightlifting
Summary: Risk factors for tendinitis include increasing age, activities that require repetitive motions such as certain occupations and sports, medical conditions, and medications.
Diagnosis of Tendinitis
Diagnosing tendinitis typically involves a combination of a thorough medical history, physical examination, and sometimes imaging studies. During a medical history, your doctor will begin by asking you about your symptoms, including the location, duration, and intensity of pain or discomfort. They will also inquire about any specific activities or sports you engage in regularly, as well as any recent changes in your physical activity level.
The physical examination will involve the doctor assessing the affected area for signs of tenderness, swelling, redness, and warmth. Your doctor may ask you to perform specific movements to see if they reproduce your symptoms or worsen the pain. This examination helps the doctor identify the involved tendon and rule out other possible causes of your symptoms.
Your doctor will then test your range of motion and strength around the affected joint or tendon. Tendinitis can often lead to limited range of motion and decreased strength due to pain and inflammation. The doctor may also gently press on and around the affected tendon to identify tender spots or areas of localized pain.
Imaging tests may be recommended after the medical history and physical examination to confirm the diagnosis and rule out other conditions like fractures or joint abnormalities. X-rays can be useful in examining bones and assessing for calcification near the tendon. Ultrasound or MRI scans can provide more detailed images of soft tissues like tendons, helping to visualize inflammation or potential tears.
In certain situations, laboratory tests may also be necessary. Blood tests may be done to rule out underlying medical conditions that can mimic tendinitis symptoms, such as rheumatoid arthritis or gout.
Summary: Diagnosing tendinitis involves a medical history and physical examination which may be followed by imaging studies and blood work.
Treatment Options for Tendinitis
The treatment of tendinitis aims to reduce inflammation, relieve pain, promote healing, and prevent further injury. The specific treatment options may vary depending on the severity of tendinitis and the affected tendon. The following are common treatment approaches for tendinitis:
- Rest: one of the essential components of tendinitis treatment is giving the affected tendon sufficient time to heal. Avoid or modify activities that exacerbate the pain and overuse of the affected area. Resting the tendon allows inflammation to subside and supports the healing process.
- Ice: applying ice to the affected area can help reduce inflammation and relieve pain. Use an ice pack wrapped in a thin cloth and apply it to the affected tendon for 15-20 minutes several times a day, especially after activities that cause pain.
- Medication: over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help reduce pain and inflammation. Always follow the recommended dosage and consult your doctor if you have any contraindications or concerns.
- Physical therapy: physical therapists can design an exercise program to strengthen the muscles around the affected tendon, improve flexibility, and correct any muscle imbalances to help the tendon heal and avoid re-injury once returning to activity.
- Bracing or splinting: in some cases, using a brace or splint to immobilize the affected area temporarily can help reduce stress on the inflamed tendon and promote healing.
- Corticosteroid injections: if tendinitis symptoms are severe and not responding to other treatments, a doctor may consider corticosteroid injections. These injections can provide powerful anti-inflammatory effects, but they are usually reserved for short-term use due to potential side effects.
- Platelet-Rich Plasma (PRP) therapy: PRP therapy involves injecting a concentration of platelets from your own blood into the affected area to promote healing. This treatment is gaining popularity for certain types of tendinitis (5).
- Surgery: in rare cases where conservative treatments do not provide relief, surgical intervention might be considered. The surgical procedure can involve removing damaged tissue, repairing tears, or releasing pressure on the tendon.
It’s important to consult with a healthcare professional for an accurate diagnosis and a personalized treatment plan. Early intervention and adherence to the recommended treatments are crucial for a successful recovery from tendinitis. Additionally, once you have recovered, it’s essential to continue preventive measures and exercises to minimize the risk of tendinitis recurrence.
Summary: Treatment for tendinitis involves a combination of rest from aggravating activities, medications, physical therapy and bracing or splinting as needed. Tendinitis is often resolved with conservative treatment, but in rare cases may need surgery or injections.