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Tendinitis

Definition:
Tendinitis is inflammation or irritation of a tendon — any one of the thick fibrous cords that attach muscles to bone. The condition, which causes pain and tenderness just outside a joint, is most common around your shoulders, elbows and knees. But tendinitis can also occur in your hips, heels and wrists.

Some common names for tendinitis are tennis elbow, golfer's elbow, pitcher's shoulder, swimmer's shoulder and jumper's knee.

If tendinitis is severe and leads to the rupture of a tendon, you may need surgical repair. But many times, rest and medications to reduce the pain and inflammation of tendinitis may be the only treatments you need. You can also take preventive measures to reduce your chance of developing tendinitis or to keep tendinitis from affecting your normal range of motion in joints such as your shoulder.

Causes:
Tendons are usually surrounded by a sheath of tissue similar to the lining of the joints (synovium). They're subject to the wear and tear of aging, direct injury and inflammatory diseases. The most common cause of tendinitis is injury or overuse during work or play. The pain is usually the result of a small tear in or inflammation of the tendon that links your muscles to your bone. Tendinitis can also be associated with inflammatory diseases that occur throughout your body, such as rheumatoid arthritis.

Risk Factor:
You have a greater risk of developing tendinitis if you perform excessive repetitive motions of your arms or legs. For instance, professional baseball players, swimmers, tennis players and golfers are susceptible to tendinitis in their shoulders, arms and elbows. Soccer and basketball players, runners and dancers are more prone to tendon inflammation in their legs and feet. But you don't have to be a professional athlete to develop this condition. The incidence of tendinitis increases with age as muscles and tendons lose some of their elasticity. Improper technique in any sport is one of the primary causes of overload on tissues, including tendons, which can contribute to tendinitis.

When to seek medical advice:
Most cases of tendinitis don't require a doctor's care. But if you experience pain that interferes with your normal day-to-day activities or have soreness that doesn't improve despite self-care measures, see your doctor. He or she may be able to help you find ways to reduce your discomfort. Your doctor may also want to conduct tests to rule out other conditions that may be causing the problem.

See your doctor if you have a fever and the area affected by tendinitis appears red or inflamed (swollen, warm). These signs and symptoms may indicate you have an infection.

Symptoms:
Tendinitis produces the following signs and symptoms near a joint that is aggravated by movement:
  • Pain
  • Tenderness
  • Mild swelling, in some cases
Tendinitis in various locations in your body produces these specific types of pain:
  • Tennis elbow. This type causes pain on the outer side of your forearm near your elbow when you rotate your forearm or grip an object.
  • Achilles tendinitis. This form causes pain just above your heel.
  • Adductor tendinitis. This type leads to pain in your groin.
  • Patellar tendinitis. In this type, you experience pain just below your kneecap.
  • Rotator cuff tendinitis. This form leads to shoulder pain.
If the sheath of tissue that surrounds the tendon becomes scarred and narrowed in small joints, such as the finger, it may cause the tendon to lock in one position, such as occurs in the condition called trigger finger. The pain of tendinitis is usually worse with activities that use the muscle that is attached to the involved tendon.

Dignosis:

Your doctor may suspect you have tendinitis after observing the signs and symptoms of the condition or discussing them with you. But to make a diagnosis of tendinitis, your doctor will most likely want to review your medical history and conduct a thorough physical examination. An X-ray often isn't helpful in diagnosing tendinitis because tendons generally aren't visible in these images. Still, your doctor may order an X-ray if he or she wants to rule out a more serious condition involving the bone. Although rarely necessary, a special imaging test known as magnetic resonance imaging (MRI) might be ordered to reveal any weakening or tearing of the tendon or changes in the tendon sheath or covering. Your doctor may also recommend blood tests if he or she suspects that a condition such as rheumatoid arthritis may be an underlying cause of your tendinitis.

Complications:
Tendinitis may become chronic or long-term and can lead to the rupture of a tendon. Tendinitis can also cause permanent damage to the tissue that makes up your tendons.

Sometimes the discomfort of tendinitis disappears within a matter of weeks, especially if you rest the involved joint. If you continue to use the affected area while you still have signs and symptoms of tendinitis, the condition often heals more slowly and is more likely to progress to a chronic condition termed tendonosis or tendinopathy. This condition often involves a change in the structure of the tendon to a weaker, more fibrous tissue.

Treatment:
The goals of tendinitis treatment are to relieve your pain and reduce inflammation. Often, home treatment — which includes rest, ice and over-the-counter pain relievers — is all that you need.

Other treatments for tendinitis include:
  • Corticosteroid injections. Sometimes your doctor may inject a corticosteroid medication around a tendon to relieve tendinitis. Injections of cortisone reduce inflammation and can help ease pain. However, there are potential side effects. For example, repeated injections may weaken a tendon, increasing your risk of rupturing the tendon. Also, corticosteroid medications should never be directly injected into the tendon itself because this can contribute to tendon rupture.
  • Strengthening exercises and physical therapy. People with tendinitis and tendonosis may also benefit from a program of specific exercise designed to strengthen the force-absorbing capability of the muscle-tendon unit.
  • Surgery. Depending on the degree and type of tendon tear, you may benefit from a surgical procedure that can improve tendon health. Damaged tendons can be removed to promote the formation of more healthy tissue. In select individuals, surgeons can repair full-thickness tendon tears to reduce pain and restore function.
Prevention:
To reduce your chance of developing tendinitis, follow these suggestions:
  • Ease up. Avoid activities that place excessive stress on your tendons, especially for prolonged periods. For example, long or intense periods of uphill running can contribute to Achilles tendinitis. If you notice pain during a particular exercise, stop and rest.
  • Mix it up. If one exercise or activity causes you a particular, persistent pain, try something else. Cross-training can help you mix up an impact-loading exercise, such as running, with lower impact exercise, such as biking or swimming.
  • Improve your technique. If your technique in an activity or exercise is flawed, you could be setting yourself up for problems with your tendons. Consider taking lessons or getting professional instructions when starting a new sport or using exercise equipment.
  • Stretch first. Before you exercise, take time to stretch in order to maximize the range of motion of your joints. This can help to minimize repetitive microtrauma on tight tissues.
  • Use proper workplace ergonomics. At your workplace, get a proper ergonomic assessment. Fitting your work space to your body is essential to ensure that no tendons are continually stressed or overloaded.
To avoid a recurrence of tendinitis, warm up before exercising and cool down afterward. Strengthening exercises also may help prevent further episodes of tendinitis.
 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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