tendonitis is the inflammation of a tendon, a tough rope-like tissue that connects
muscle to bone.
tendonitis usually occurs in individuals in middle or old age because it is often the
result of overuse over a long period of time. tendonitis does occur in younger patients as
a result of acute overuse.
Tendons that commonly become inflamed include:
- Tendons of the hand
- Tendons of the upper arm that effect the shoulder
- Achilles tendon and the tendon that runs across the top of the foot.
Causes & symptoms
Sudden stretching or repeated overuse injures the connection between the tendon and its
bone or muscle. The injury is largely mechanical, but when it appears, the body tries to
heal it by initiating inflammation. Inflammation increases the blood supply, bringing
nutrients to the damaged tissues along with immunogenic agents to combat infection. The
result is swelling, tenderness, pain, heat, and redness if it is close to the skin.
Some tendon injuries are superficial and easy to identify. These include "tennis
elbow" (extensor tendonitis) over the outside of the elbow, and Achilles' tendonitis
just above the heel of the foot. There are several tendons in the shoulder that can be
overused or stretched, and usually a shoulder will have more than one injury at a time.
Tendonitis in the biceps, the infraspinatus, or the supraspinatus tendon may accompany a
tear of the shoulder ligaments or an impingement of one bone or another. Careful pressure
testing and movement of the parts is all that is necessary to identify the tendonitis.
Rest, ice, compression, and elevation (RICE) will treat the acute condition. The best
way to apply ice is in a bag with water. The water applies the cold directly to the skin.
Chemical ice packs can get too cold and cause frostbite. Compression using an elastic wrap
minimizes swelling and bleeding in an acute sprain. Splinting may help rest the limb. Pain
and anti-inflammatory medications (aspirin, naproxen, ibuprofen) will help. Sometimes the
inflammation lingers and requires additional treatment. Injections of cortisone-like
medicine often relieve chronic tendonitis, but should be reserved for resistant cases
since cortisone can occasionally cause problems of its own.
If tendonitis is persistent and unresponsive to nonsurgical treatment, a surgery to
remove the afflicted portion of tendon can be performed. Surgery is also conducted to
remove calcium buildup that comes with persistent tendonitis.
Compression wraps, such as elastic bandages, may be used to help provide mechanical
support for the tendon during active movement. These compression wraps can be helpful, but
they may also slow the healing process in the tendon if left on for long periods because
they decrease blood supply in the area.
Various types of soft tissue manipulation are very effective for treating tendonitis
and may be employed by a variety of practitioners, including chiropractors, massage
therapists, physical therapists, and osteopaths. One of the most common methods of soft
tissue treatment for tendonitis is a vigorous friction massage to the damaged tendon. This
friction massage will stimulate the healing of tissue in the area. It is also thought to
help produce a healthy and strong scar-tissue repair of the damaged tendon fibers.
Practitioners of manual therapy are also likely to advocate a regular stretching program
to help decrease tension in those muscles that may be pulling excessively on the tendon.
Acupuncture and traditional Chinese medicine are quite effective in treating
tendonitis. Acupuncture may be used in the immediate vicinity of the tendonitis to help
address muscular dysfunction. Acupuncture treatment may also use more distant points along
the energy meridians to help address pain and reduce inflammation. Acupuncture may also
have significant benefits in creating an optimum environment for healing of the tendon
fiber to take place.
Topical liniments and herbal preparations are often used to treat tendonitis. They have
anti-inflammatory properties and will help heal the torn tendon fibers. If a condition is
chronic, treatment with moxibustion (burning a small amount of mugwort near the skin) may
hasten the healing process. Some oral herbal preparations may also be used in order to
create the optimal healing environment for the tendon and address any underlying problems.
Practitioners of traditional Chinese medicine may also use a special form of acupressure
massage called Tui-Na.
Pain and anti-inflammatory medications (aspirin, naproxen, and ibuprofen) will help and
are often used to treat tendonitis along with ice, compression wraps, and activity
modification, as mentioned earlier. Sometimes the inflammation lingers and requires
additional treatment. Injections of anti-inflammatory medication, such as cortisone, often
relieve chronic tendonitis, but they should be used with caution. Research has indicated
that cortisone may have detrimental effects on the healing of connective tissues and may,
in fact, weaken them in the long run. This would make the person susceptible to a greater
injury in the future.
If tendonitis is persistent and unresponsive to nonsurgical treatment, the afflicted
portion of tendon can be removed through surgery. Surgery is also performed to remove the
calcium buildup that comes with persistent tendonitis.
Generally, tendonitis will heal if the activity that provokes it is stopped. Various
kinds of treatments may accelerate the healing process. Some tendonitis complaints may
last for a long time because they are not given adequate healing time before the
individual returns to a vigorous level of activity.
If given enough time, tendons will strengthen to meet the demands placed on them. The
blood supply to tendons is poor, so tendons grow slowly. Therefore, adequate time is
required for good conditioning. Stretching the muscles that are associated with
problematic tendon will also help decrease overuse on the tendon.