Tendinitis

Author/s: J. Ricker Polsdorfer

Definition
Tendinitis is the inflammation of a tendon, a tough rope-like tissue that connects muscle to bone.

Description
Tendinitis usually occurs in individuals in middle or old age because it is often the result of overuse over a long period of time. Tendinitis 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.

Diagnosis
Some tendon injuries are superficial and easy to identify. These include "tennis elbow" (extensor tendinitis) over the outside of the elbow, and Achilles' tendinitis 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 tendinitis.

Treatment
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 tendinitis 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 tendinitis.

Alternative treatment
An osteopathic soft-tissue treatment on the tendon may relieve pain and increase mobility. Increasing intake of antioxidant-rich foods and lowering intake of animal fats may help reduce the inflammation. Acupuncture has also been used to combat tendinitis. Hydrotherapies, such as whirlpool baths, help relax the surrounding muscles.

Prognosis
Generally, tendonitis will heal if the provoking activity is stopped.

Prevention
If given enough time, tendons will strengthen to meet the demands placed on them. They grow slowly because of their poor blood supply, so adequate time is required for good conditioning.

Key Terms

Biceps
The muscle in the front of the upper arm.

Infraspinatus
A muscle at the middle of the shoulder blade.

Supraspinatus
A muscle at the top of the shoulder blade.

Further Reading
For Your Information
Books
Boulware, Dennis W. "The Painful Shoulder." In Cecil Textbook of Medicine, edited by J. Claude Bennett and Fred Plum. Philadelphia: W. B. Saunders, 1996.
Gilliland, Bruce C. "Relapsing Polychondritis and Other Arthritides." In Harrison's Principles of Internal Medicine, edited by Anthony S. Fauci, et al. New York: McGraw-Hill, 1998.