Tendinitis

Answer 1

Definition

Tendinitis is inflammation, irritation, and swelling of a tendon, which is the fibrous structure that joins muscle to bone. In many cases, tendinosis (tendon degeneration) is also present.

Alternative Names

Calcific tendinitis; Bicipital tendinitis

Causes, incidence, and risk factors

Tendinitis can occur as a result of injury, overuse, or with aging as the tendon loses elasticity. It can also be seen in persons with body-wide (systemic) diseases such as rheumatoid arthritis or Diabetes.

Tendinitis can occur in any tendon, but some commonly affected sites include the:

• Elbow
• Heel (Achilles tendinitis)
• Shoulder
• Wrist

Symptoms

• Pain and tenderness along a tendon, usually near a joint
• Pain at night
• Pain that is worse with movement or activity

Signs and tests

The health care provider will perform a physical exam and look for signs of pain and tenderness when the muscle attached to the tendon is used against resistance. There are specific tests for specific tendons.

The tendon can be inflamed, and the overlying skin may be warm and red.

Treatment

The goal of treatment is to relieve pain and reduce inflammation.

Rest or immobilization of the affected tendons is helpful for recovery. This may be achieved using a splint or a removable brace. The application of heat or cold to the affected area can help.

Nonsteroidal anti-inflammatory medications (NSAIDs), such as aspirin or ibuprofen, can also reduce both pain and inflammation. Steroid injections into the tendon sheath can also be very useful in controlling pain and allowing physical therapy to start.

Physical therapy that stretches and strengthens the muscle and tendon is essential. This can restore the tendon's ability to function properly, improve healing, and prevent future injury.

Rarely, surgery is needed to physically remove the inflammatory tissue from around the tendon.

Expectations (prognosis)

Symptoms improve with treatment and rest. If the injury is caused by overuse, a change in work habits may be indicated to prevent recurrence of the problem.

Complications

• Long-term inflammation raises the risk of further injury, such as rupture
• Tendinitis symptoms return

Calling your health care provider

Call for an appointment with your health care provider if symptoms of tendinitis occur.

Prevention

• Avoid repetitive motion and overuse of the arms and legs.
• Keep all your muscles strong and flexible.
• Warm up by exercising at a relaxed pace before engaging in vigorous activity.

References

Choi L. Overuse injuries. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 14.

Shea K, Edmonds EW, Chambers H. Skeletal trauma in young athletes. In: Green NE, Swiontkowski MF, eds. Skeletal Trauma in Children. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 20.

Answer 2

Definition

Tendinitis is inflammation, irritation, and swelling of a tendon, which is the fibrous structure that joins muscle to bone. In many cases, tendinosis (tendon degeneration) is also present.

Alternative Names

Calcific tendinitis; Bicipital tendinitis

Causes, incidence, and risk factors

Tendinitis can occur as a result of injury, overuse, or with aging as the tendon loses elasticity. It can also be seen in persons with body-wide (systemic) diseases such as rheumatoid arthritis or diabetes.

Tendinitis can occur in any tendon, but some commonly affected sites include the:

• Elbow
• Heel (Achilles tendinitis)
• Shoulder
• Wrist

Symptoms

• Pain and tenderness along a tendon, usually near a joint
• Pain at night
• Pain that is worse with movement or activity

Signs and tests

The health care provider will perform a physical exam and look for signs of pain and tenderness when the muscle attached to the tendon is used against resistance. There are specific tests for specific tendons.

The tendon can be inflamed, and the overlying skin may be warm and red.

Treatment

The goal of treatment is to relieve pain and reduce inflammation.

Rest or immobilization of the affected tendons is helpful for recovery. This may be achieved using a splint or a removable brace. The application of heat or cold to the affected area can help.

Nonsteroidal anti-inflammatory medications (NSAIDs), such as aspirin or ibuprofen, can also reduce both pain and inflammation. Steroid injections into the tendon sheath can also be very useful in controlling pain and allowing physical therapy to start.

Physical therapy that stretches and strengthens the muscle and tendon is essential. This can restore the tendon's ability to function properly, improve healing, and prevent future injury.

Rarely, surgery is needed to physically remove the inflammatory tissue from around the tendon.

Expectations (prognosis)

Symptoms improve with treatment and rest. If the injury is caused by overuse, a change in work habits may be indicated to prevent recurrence of the problem.

Complications

• Long-term inflammation raises the risk of further injury, such as rupture
• Tendinitis symptoms return

Calling your health care provider

Call for an appointment with your health care provider if symptoms of tendinitis occur.

Prevention

• Avoid repetitive motion and overuse of the arms and legs.
• Keep all your muscles strong and flexible.
• Warm up by exercising at a relaxed pace before engaging in vigorous activity.

References

Choi L. Overuse injuries. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 14.

Shea K, Edmonds EW, Chambers H. Skeletal trauma in young athletes. In: Green NE, Swiontkowski MF, eds. Skeletal Trauma in Children. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 20.

Reviewed By

Review Date: 07/22/2010

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.