Tendinitis is inflammation or irritation of a tendon — any one of the thick fibrous cords that attaches muscle to bone. The condition causes pain and tenderness just outside a joint.
While tendinitis can occur in any of your body’s tendons, it’s most common around your shoulders, elbows, wrists, knees and heels.
Some common names for various tendinitis problems are:
- Tennis elbow
- Golfer’s elbow
- Pitcher’s shoulder
- Swimmer’s shoulder
- Jumper’s knee
If tendinitis is severe and leads to the rupture of a tendon, you may need surgical repair. But most cases of tendinitis can be successfully treated with rest, physical therapy and medications to reduce pain.
The condition is commonly caused by repetition of a particular movement over time. It can also be caused by a sudden injury. In the majority of cases, tendinitis develops in people whose jobs or hobbies involve repetitive movements; aggravating the tendons.
A tear in the tendon caused by an injury may cause swelling (inflammation)
Tendons transmit the forces of muscle to the skeleton. As such, they are subjected to repeated mechanical loads, which are felt to be a major causative factor in the development of tendinopathy. Pathologic findings include tendon inflammation, mucoid degeneration, and fibrinoid necrosis in tendons. Microtearing and proliferation of fibroblasts have also been reported. However, the exact pathogenesis of tendinopathy is unclear.
Signs and symptoms of tendinitis tend to occur at the point where a tendon attaches to a bone and typically include:
- Pain often described as a dull ache, especially when moving the affected limb or joint
- Mild swelling
Tendinitis can be diagnosed by a GP (general practitioner, primary care physician) based on the patient’s symptoms and a physical examination (as well as tenosynovitis). When attempting to move the tendon a creaky sound may be heard; this is because the tendon sheath has become thicker.
X-ray pictures that show up calcium deposits around the tendon may help confirm a diagnosis.
Imaging tests, such as ultrasound or MRI (magnetic resonance imaging) may reveal swelling of the tendon sheath.
The goals of tendinitis treatment are to relieve your pain and reduce inflammation. Often, taking care of tendinitis on your own — including rest, ice and over-the-counter pain relievers — may be all the treatment that you need.
For tendinitis, your doctor may recommend these medications:
- Pain relievers. Taking aspirin, naproxen sodium (Aleve) or ibuprofen (Advil, Motrin IB, others) may relieve discomfort associated with tendinitis.
Topical creams with anti-inflammatory medication — popular in Europe and becoming increasingly available in the United States —also may be effective in relieving pain without the potential side effects of taking anti-inflammatory medications by mouth.
- Corticosteroids. Sometimes your doctor may inject a corticosteroid medication around a tendon to relieve tendinitis. Injections of cortisone reduce inflammation and can help ease pain.
Corticosteroids are not recommended for chronic tendinitis (lasting over three months), as repeated injections may weaken a tendon and increase your risk of rupturing the tendon.
- Platelet-rich plasma (PRP). PRP treatment involves taking a sample of your own blood and spinning the blood to separate out the platelets and healing factors. The solution is then re-injected into the area of chronic tendon irritation.
Though still under investigation, PRP injection in the region of chronic tendon irritation has been shown to be beneficial for many chronic tendon conditions.
You might benefit from a program of specific exercise designed to stretch and strengthen the affected muscle-tendon unit. For instance, eccentric strengthening — which emphasizes contraction of a muscle while it’s lengthening — has been shown to be effective in treating chronic tendon inflammation.
Surgical and other procedures
Depending on the severity of your tendon injury, surgical repair may be needed, especially if the tendon has torn away from the bone.
For chronic tendon inflammation, focused aspiration of scar tissue (FAST) is a minimally invasive treatment option using ultrasound guidance and very small instruments designed to remove tendon scar tissue without disturbing the surrounding healthy tendon tissue.
FAST achieves the same goal as open surgery but is performed under local anesthesia in a nonsurgical setting. Most people return to normal activities within one to two months.