TENDINITIS

General Information

DEFINITION--Painful inflammation of a tendon (tendinitis) and the lining of the tendon sheath (tenosynovitis). They most often occur simultaneously. Normally, tendon fibers merge into muscle fibers. A typical skeletal muscle has a tendon on each end that attaches to bone. The force of a muscle contraction is transmitted through the tendon to produce movement.

BODY PARTS INVOLVED--Common sites are the shoulder (rotator cuff), elbow, heel (Achilles' tendon), knee or hamstring.

SEX OR AGE MOST AFFECTED-- Adolescents and adults.

SIGNS & SYMPTOMS--

Symptoms may begin slowly or occur gradually over a 24 hour period after overuse of the affected joint:

• Restricted movement.
• Tenderness and swelling around the inflamed tendon.
• Weakness in the tendon.
• Pain in the affected joint (achy or burning).

CAUSES

• Injury, usually from strenuous athletic activity.
• Musculoskeletal disorders, including congenital defects and rheumatism.
• Poor posture.

RISK INCREASES WITH

• Overuse of certain tendons and joints from participation in active, competitive sports.
• Incorrect movement and strain during activity. For example, repeatedly holding and swinging a golf club or tennis racket incorrectly may cause tendinitis at the elbow (see Tennis Elbow in Illness section).

HOW TO PREVENT

• Precondition your body and build up strength gradually for a sport before beginning it on a regular, competitive basis.
• Warm up before each workout.
• Learn the proper techniques for any sport you intend to play regularly.

What To Expect

DIAGNOSTIC MEASURES--

• Medical history and exam by a doctor.
• Diagnostic tests usually unnecessary (x-rays do not show ligaments and tendons).

APPROPRIATE HEALTH CARE

• Self-care for mild cases.
• Doctor's treatment.
• Physical therapy for more severe injuries.

POSSIBLE COMPLICATIONS

• Chronic soreness; possible reinjury.
• Large deposits of calcium in the inflamed tendon, leading to permanent impairment ("frozen joint").

PROBABLE OUTCOME--Usually curable with treatment and rest of the tendon. Healing time varies with degree of injury; may range from a few days to 6 weeks.

How To Treat

GENERAL MEASURES----Treatment varies with the cause, severity and duration of the condition. Use the RICE therapy (rest, ice, compression, elevation):

• With severe pain, stiffness and tenderness, relax completely with the injured area resting on a pillow until pain becomes more bearable. Elevate the injured area.
• Apply ice packs to the affected area during the acute stage or after receiving injections.
• After using ice, wrap the area in an elastic bandage. Do this for several days. It helps keep swelling down and eases discomfort.
• When pain diminishes, you may temporarily want to use a sling or splint for upper extremity injury or use crutches, canes or braces for lower extremity injury.
• After the acute phase, apply heat. Take hot showers, soak in bath tub, apply hot compresses, use a heat lamp or heating pad.
• Chronic tendinitis may require lifestyle changes to prevent recurring joint irritation.

MEDICATION--

• You may use ibuprofen or aspirin for pain and inflammation. Acetaminophen helps pain, but not the inflammation.
• Your doctor may prescribe: Injections of local anesthetics. Injections of cortisone into painful and calcified tendons. This reduces pain and inflammation and allows movement, preventing a frozen joint. Stronger pain or anti-inflammatory drugs.

ACTIVITY--

• Resume your normal activities as soon as symptoms improve.
• Once pain is gone, begin range-of-motion and stretching exercises on the affected joint.

DIET--No special diet.

Call Your Doctor If

• You have symptoms of tendinitis that don't resolve with self-care.
• If the injured joint area appears distorted or discolored.
• Pain and swelling increases, despite treatment.