What is tendinitis?
Tendons are tissue bands that connect muscles and bones, allowing muscles to move the bones. Tendinitis or tendonitis refers to the inflammation or irritation of a tendon, causing pain and tenderness just outside the joint.
Tendinitis can occur in any tendon of the body, though it is more common around the shoulders, elbows, wrists and heels. Tendinitis is generally referred to by the body part involved and is of the following types:
- Shoulder tendinitis (Pitcher’s shoulder, Swimmer’s shoulder)
- Biceps tendinitis causes pain on the front or side of the shoulder, and may travel down to the elbow or forearm. It results from inflammation of the tendon that connects the biceps muscle in the front of the upper arm with the shoulder socket. Raising the arm over the head may also be painful.
- Rotator cuff tendinitis results in pain at the top of the shoulder and upper arm. The rotator cuff is a set of muscles that attach the arm muscles to the shoulder blade, while the cuff allows lifting and twisting motion of the arm.
Knee tendinitis (Jumper’s knee)
A very common cause of pain in athletes is in the inferior patellar region of the knee. Known as patellar tendinitis, it affects athletes who are involved in jumping sports like basketball and volleyball.
The Achilles tendon connects the calf muscle to the back of the heel. An injury to this tendon makes it stretch, swell or tear. It commonly occurs due to overuse, weak or tight muscles or ageing and arthritis, or may occur in athletes involved in sprinting sports.
Elbow tendinitis (Tennis elbow, Golfer’s elbow)
Tennis elbow results from an injury to the tendon present in the outer elbow. Golfer’s elbow results from an injury to the inner tendon of the elbow. These are common in people involved in activities that require a lot of hand gripping or wrist turning. The pain occurs near the elbow but may travel to the forearm or upper arm.
The hamstring is a muscle present in the back of the thigh; it allows the knee to bend. These muscles turn into tendons in the lower portion and attach at the back of the knee. Tightening and inflammation of these muscles behind the knee can cause tendinitis.
This affects the popliteus tendon that connects the popliteus muscle to the thigh bone (femur) near the knee. The popliteus muscle is responsible for bending and rotation of the knee.
What are the causes of the disorder?
Tendinitis can affect anyone, though it is more common in adults. Those above the age of 40 or in particular jobs or involved in certain sports are at higher risk of developing tendinitis.
- Age – With age, tendons tolerate less strain, lose elasticity and are more prone to tear.
- Occupation – Tendinitis is an occupational hazard in jobs that require repetitive motions, awkward positions, forceful exertion and frequently reaching overhead.
- Sports – Certain sports like basketball, golf, bowling, running and swimming involve repetitive motions that make tendons prone to injury.
What one needs to know about symptoms or signs?
Pain and inflammation in the affected tendon is the main sign of tendinitis. A patient may also experience:
- Worsening of pain upon moving the affected area
- A grating or crackling sensation when the tendon moves
- Swelling accompanied by redness or heat in the area
- Formation of a lump
Which specialist should be consulted in case of signs and symptoms?
A person experiencing tendinitis symptoms must consult a rheumatologist (doctor who treats conditions afflicting the joints). S/he may also be referred to sports medicine specialist for further treatment.
What are the screening tests and investigations done to confirm or rule out the disorder?
Diagnosis of tendinitis involves the following:
- Physical examination – The doctor begins by asking questions regarding the symptoms and their patterns followed by palpation of the area of concern.
- Aspiration – Using a fine needle, fluid sample is drawn to check for infection.
- Imaging tests – X-ray is conducted to rule out arthritis or other bone conditions, and a magnetic resonance imaging (MRI) scan shows any damage to bone or soft tissue.
- Other tests – Selective tissue tension tests can pinpoint the affected tendon while an anaesthetic injection test can confirm if the pain goes away or not.
What treatment modalities are available for management of the disorder?
Tendinitis treatment focuses on relieving pain and reducing inflammation.
- Medication – The doctor may recommend (a) Pain relievers like aspirin or ibuprofen to ease pain and discomfort, and/or (b) Corticosteroids injection to reduce inflammation and ease pain. Repeated injections, however, can weaken the tendon, increasing the risk of its rupture.
- Therapy – Physiotherapy helps recover movement and function in the affected area and provide a more long-term recovery through a variety of techniques like
- Exercises to strengthen tendon and surrounding muscles
- Massage of affected area
- Ultrasound waves
- Laser beams
- Surgery – In rare cases when the affected tendon gets ruptured or torn, surgery is carried out to relieve symptoms.
What are the known complications in management of the disorder?
Left untreated or improperly treated, tendinitis increases the risk of tendon rupture, which may require surgical repair.
What precautions or steps are necessary to stay healthy and happy during the treatment?
Recovery may take weeks or months, depending on the severity of the condition. It is important to avoid repetitive movements (like those required as part of job) of the affected area and take adequate rest. Relief can also be sought through:
- Ice packs
- Compression with wraps and bandages
- Elevation of legs to reduce swelling
How can the disorder be prevented from happening or recurring?
Preventing recurrence of the problem can be achieved through:
- Adequate rest – Discontinuing motion in the affected area promotes faster healing and prevents the condition from getting worse.
- Exercise – Exercise strengthens the muscles around the tendon. A physiotherapist can guide the patient through the correct stretching and strengthening exercises, along with the correct warming up and cooling down techniques.
“An overview of tendinitis,” WebMD.com, https://www.webmd.com/fitness-exercise/arthritis-tendinitis
“Fast Facts About Bursitis And Tendinitis,” NIAMS.NIH.gov, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), https://www.niams.nih.gov/Health_Info/Bursitis/bursitis_ff.asp
“Tendinitis,” MayoClinic.com, Mayo Clinic Staff, https://www.mayoclinic.org/diseases-conditions/tendinitis/basics/definition/con-20020309
“Tendinitis,” MedlinePlus, NLM, NIH, https://www.nlm.nih.gov/medlineplus/tendinitis.html
“Tendonitis,” NHS.uk, https://www.nhs.uk/Conditions/Tendonitis/Pages/Introduction.aspx
“Tendinitis,” Arthritis.org, The Arthritis Foundation, https://www.arthritis.org/conditions-treatments/disease-center/tendinitis/