Tendons are complex, versatile, fibrous bands of tissue that link muscles to bones. When tendons become swollen, irritated, or suffer tiny tears, the condition is called tendonitis. Tendons can be small, like the fragile little bands in the hands, or large, like the heavy, ropelike cables that anchor the calf or thigh muscles. Most of the times, the cause of tendonitis is unknown; when a cause can be identified, the condition normally occurs for one of two factors:
Overuse: A particular body motion is repeated too often.
Overload-- The level of a specific activity, such as weight-lifting, is increased too quickly.
Rarely, tendonitis is caused by an infection, such as gonorrhea. Tendonitis is most common in the shoulder, elbow, knee, wrist and heel, although it can take place anywhere that tendons are discovered in the body. For uncertain reasons, tendonitis is also typical in people with diabetes. In recent years, a rare reason for tendonitis (or other tendon disease, consisting of rupture) has actually been acknowledged: using specific antibiotics, consisting of ciprofloxacin or levofloxacin. Why this occurs is unidentified.
Tendonitis in the shoulder-- The most typical kind of tendonitis in the shoulder is rotator cuff tendonitis. Less commonly, the tendon of the infraspinatus muscle or other tendons of the rotator cuff is impacted. The average patient is a male laborer older than 40, and the shoulder discomfort is on the exact same side as his dominant hand (for example, right shoulder pain in a right-handed person).
Tendonitis in the elbow-- Two kinds of tendonitis commonly include the elbow: lateral epicondylitis and medial epicondylitis. Both are extremely common overuse injuries amongst athletes associated with golf or throwing and racquet sports.
Lateral epicondylitis (tennis elbow) triggers pain on the external side of the elbow joint. This condition most likely affects 40% to 50% of all adult athletes who play racquet sports. It also can be brought on by any activity that consistently twists and flexes the wrist, such as pulling weeds, utilizing a screwdriver or even carrying a briefcase.
Medial epicondylitis (golf enthusiast's elbow) causes pain on the inner side of the elbow. It is a less typical injury than tennis elbow and, regardless of its name, it is most likely to be a related profession that needs repeated elbow motions (such as construction work) than to sports. When it does occur as a sports injury, medial epicondylitis can be set off by repeatedly swinging a golf club or tossing a baseball.
Tendonitis in the knee-- Jumper's knee, the most common form of knee tendonitis, involves either the patellar tendon at the lower edge of the kneecap or the quadriceps tendon at the upper edge of the kneecap. It is a common overuse injury, especially in basketball gamers and distance runners.
Tendonitis in the wrist-- In the wrist, tendonitis typically appears in the form of de Quervain's disease, a condition that causes discomfort in the back of the wrist at the base of the thumb. Although de Quervain's illness usually happens in people who consistently grasp or pinch with the thumb, it in some cases establishes during pregnancy or for no recognized factor.
Achilles tendonitis-- This type of tendonitis impacts the Achilles tendon, the big ropelike tendon attached to the heel bone at the back of the foot. Achilles tendonitis likewise might be related to malfunctioning running strategy or to improperly fitting shoes, if the back of the shoe digs into the Achilles tendon above the heel.
Symptoms
In general, tendonitis causes pain in the tissues surrounding a joint, specifically after the joint is utilized excessively throughout play or work. In some cases, the joint may feel weak, and the area might be red, inflamed and warm to the touch.
When tendonitis is brought on by an infection such as gonorrhea, there might be other symptoms, including rash, fever, or a discharge from the vagina or penis.
Other symptoms differ according to which tendon is affected:
- Rotator cuff tendonitis-- Usually dull, aching shoulder discomfort that can't be connected to one location. It often radiates into the arm towards the chest. The discomfort is typically worse in the evening and may disrupt sleep.
- Tennis elbow-- Pain in the outer side of the elbow. In many cases, the painful area extends down to the lower arm and wrist
- Golf enthusiast's elbow-- Pain in the inner side of the elbow
- Jumper's knee-- Pain below the kneecap and, in some cases, above it
- De Quervain's illness-- Pain at the back of the wrist, near the base of the thumb
- Achilles tendonitis-- Pain at the back of the heel or 2 to 4 inches above the heel
Diagnosis
After evaluating your case history, including any previous joint injuries, your medical professional will ask you specific concerns about your discomfort:
- What does your discomfort seem like (sharp, dull, burning)?
- Where is your discomfort found? Is it limited to one location or does it spread away from the joint to include a broader location on your hand, leg or arm?
- Do you have tingling, tingling or weak point?
- When did your discomfort begin? Did it begin after an abrupt boost in your work activities or exercise? Might it be related to any new sport or exercise that you've recently attempted?
- What makes it feel better, and what makes it even worse?
- Does the pain vanish when you rest the location, or is it present even at rest?
- Have you had unprotected sex?
During the physical exam, your physician will try to find inflammation, swelling, inflammation, muscle weakness and minimal movement in the location of the sore tendon. Your medical professional also might ask you to move specific ways, such as raising your arm above your head or bending your wrist. These moves may harm, but they are extremely important to assist your medical professional figure out which tendon is impacted. For the most part, the diagnosis can be made based upon your case history and symptoms, together with your occupational and sports history and the outcomes of your physical exam.
Some people may need blood tests to try to find other reasons for swelling around the joints, such as gout or rheumatoid arthritis. X-rays also might be required to confirm that there is no dislocation, bone or fracture illness. In people with Achilles tendonitis or rotator cuff tendonitis, ultrasound or magnetic resonance imaging (MRI) scans might be utilized to assist assess the extent of tendon damage.
Expected Duration
Depending on the area and seriousness of tendonitis, signs might last for a few days or for a number of weeks. Pain might continue and worsen for several months if there is continued overuse or irritation of the injured site.
Prevention
In many cases, tendonitis can be prevented by taking a couple of simple preventative measures. Some valuable methods include:
- Constantly warm up prior to starting exhausting exercise.
- If you want to heighten your exercise level, do it slowly.
- Take care about the "no pain, no gain" method. It can be hard to distinguish between a pain that shows you're constructing strength and a pain that indicates you injured a tendon.
- Prevent activities that need extended durations of reaching over your head, such as painting the ceiling. If you should do this type of work, take regular breaks.
- Use shoes that fit appropriately, particularly if you take part in a sport that requires a lot of running, such as track, cross-country or basketball.
- If you are active in arranged sports or exercise frequently, focus on your technique. Ask your coach or trainer for guidance. A medical professional who specializes in sports medicine may be valuable as well if you're having exercise-related tendonitis.
- For individuals with median or lateral epicondylitis connected to racquet sports, changing to a racquet with a bigger head may help to prevent re-injury, as long as the brand-new racquet is not much heavier than the original. Some experts think that this type of racquet reduces the transmission of vibrations to the arm.
- Tendonitis triggered by gonorrhea can be avoided by abstinence or by practicing safe sex.
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Treatment
The quicker your tendonitis is dealt with, the quicker you'll recuperate complete strength and flexibility. To eliminate pain and swelling, your medical professional might suggest that you take ibuprofen (Advil, Motrin and others), aspirin or another non prescription anti-inflammatory medication, for up to numerous weeks. If an infection is triggering the tendonitis, an antibiotic is suggested.
Depending upon the location and intensity of tendonitis, you might require short-term splinting, bracing or a sling (for tendonitis in the upper extremity). However, it is essential to gently and frequently move the joint to prevent getting a stiff, or "frozen," joint. This is especially essential for tendonitis involving the shoulder.
For more serious cases of noninfectious tendonitis, your doctor may inject a corticosteroid drug or local anesthetic into the impacted tendon. He or she also may refer you to a physical therapist for more specialized regional treatments, such as deep heat treatments utilizing ultrasound, friction massage or water therapy to enhance joint movement. The physical therapist likewise will assist you through a rehabilitation program that will assist you to regain strength, function and movement. The length of time for rehabilitation differs depending upon the type and intensity of tendonitis. Achilles tendonitis and epicondylitis might need numerous months to deal with.
Surgery is rarely required to treat tendonitis. When there is substantial tendon damage that is unlikely to enhance with any other treatment, it is booked for cases that do not respond to other types of treatment or.
When To Call a Professional
Call your medical professional whenever you have a substantial joint issue, such as extreme discomfort, redness or swelling or loss of joint function. Also, call your doctor if less-severe joint discomfort is consistent.
Prognosis
With proper treatment, the affected tendon normally recovers totally. Insufficient rehab or a hasty return to activity can slow the healing procedure or lead to re-injury.
