What is Tendinitis & How is it Treated?

Tendons are thick cord like structures that connect the muscles to the bones of the body. When these tendons due to some sort of injury or other reason become inflamed or irritated then that condition is termed as Tendinitis.¹ Tendinitis can result in significant pain and restricted range of motion for the affected individual. Tendinitis is usually caused by what we term as repetitive stress injury. Repetitive stress injury are caused by doing activities repetitively which put strain on the tendons and muscles like lifting heavy items, moving heavy items, playing contact sports like football or rugby, playing sports like tennis or badminton, or performing sprinting and other track and field sporting activities. There are also certain medical conditions which can cause Tendinitis like rheumatoid arthritis which is an autoimmune condition. The tendons most prone to develop Tendinitis are the tendons of the shoulder, elbow, heel, and wrist. Some of the other names given to Tendinitis are Swimmer’s Shoulder, Jumper’s Knee or Tennis Elbow.

As stated above, repetitive motions are the main cause of Tendinitis where the tendons are made to move in a similar pattern repetitively for a prolonged period of time.¹

This is seen usually at construction sites lifting and moving heavy objects or playing sports. Some of the possible causes of Tendinitis are:

• Tendon injury is the most likely cause of tendinitis.
• The natural process of aging and degeneration of the tendons and them becoming weak and unable to handle stress
• Conditions like diabetes or rheumatoid arthritis can also cause tendinitis.

People who are at high risk for Tendinitis are sportsmen involved with sporting events like tennis, golf, bowling, or basketball, football, rugby and people who work in construction or carpentry who move or lift heavy items repetitively for prolonged periods of time and in awkward positions.

The classic presenting feature of Tendinitis is pain. The pain from Tendinitis is like a dull ache localized around a particular joint. This pain or dull ache increases with motion of the affected joint. There will be palpable tenderness around the affected joint and there will be increased pain with touching the area. There will also be some swelling due to Tendinitis.

To diagnose Tendinitis, the treating physician will first take a history of the patient. Some of the questions that the physician will ask during history taking may be:

• Any history of previous injuries to the affected area
• Any sporting activities that individual may have been involved with
• Whether the occupation of the individual requires him or her to do heavy lifting or moving of items
• History of any conditions like diabetes or rheumatoid arthritis
• Any medications that the individual may be taking.

Once the history taking is done, the physician will then do a thorough physical examination of the area in question. The physician will look for areas of tenderness and swelling. The physician will palpate the area to observe any increased pain with palpation. The physician will then try to move the affected joint to check for loss of range of motion of the joint. Once Tendinitis is suspected, then the physician will order radiological studies in the form of x-rays, MRI or CT scans to ascertain the extent of damage to the tendons so as to formulate a treatment plan best suited for the patient and also to get an idea of the time it will take to completely recover from the condition and get back to normal activities following treatment for Tendinitis.

Treatment for Tendinitis is basically conservative until the tendon damage is so severe that it completely detaches from the bone. In such cases surgery is required to remove the damaged tendon. Some of the conservative measures done to treat Tendinitis are:

• Resting the affected area for about a week to allow the tendon to heal
• Application of heat for 15-20 minutes two to three times a day
• Use of medications to treat tendinitis involves NSAIDs like Tylenol or ibuprofen to calm down the pain and inflammation
• Use of compression bandage to restrict motion of the affected region and allowing the tendon to heal
• Once the pain associated with tendinitis calms down and the swelling goes down then the patient can start with some stretching and straightening exercises to improve muscle strength and flexibility
• Use of brace and supports also go a long way in helping with the symptoms of Tendinitis.

In cases if the symptoms of Tendinitis do not improve with the above mentioned measures, then the physician may recommend steroid injections for pain relief and to calm down the inflammation but physicians do not recommend repeated injections of steroid as they tend to make the tendons weak.

In cases where Tendinitis is severe and the tendon has completely detached from the bone or muscle then surgery is done to remove the inflammatory tissue.

Tendinitis can be definitively treated if treatment is started early. In case if treatment is delayed then the condition may progress to a stage where the tendon is ruptured and the individual may require surgery to correct the problem which will have its own inherent risks and complications.

Tendinitis is condition that can be easily prevented. Some of the measures to prevent Tendinitis are:

• Stay fit and healthy by doing routine workouts and eat a balanced diet to keep the body in shape
• Warm up before exercising
• Avoid repetitive activities and if you cannot avoid then take frequent breaks for a couple of minutes before resuming your activity
• Use proper posture when working on the computer
• Keep changing posture and do not stay in one posture for a long period of time
• Maintain an ergonomically correct workstation.

For minor cases of Tendinitis with prompt treatment, an individual can get back to normal activities within two weeks. For chronic conditions or if the treatment is delayed it may take up to four to six weeks for resolution of Tendinitis. In case if a surgery is required then the recovery time shoots upwards of three to four months before an individual can get back to normal activities after suffering from Tendinitis.

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