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Tendonitis

  • What is tendonitis?

    Tendonitis

    Tendonitis is an inflammatory (swelling) disease of the tendons. Tendons are tough but flexible bands of fibrous tissue that connect the muscles to the bones. If the tendon becomes swollen, it will become irritated by the action of the muscles and movement will be painful.

    Types of tendonitis

    Tendon inflammation can occur in any tendon in the body, especially in the ankle (Achilles or posterior tibia tendon), wrist, kneecap, elbow or shoulder. Here are the most common types of tendonitis:

    • Achilles tendonitis – Common in runners, Achilles tendonitis is often caused by overuse of the tendon that connects the calf muscles to the heel bone. Symptoms of this condition include heel pain and heel tenderness.
    • Peroneal tendonitis – Inflammation of the peroneal tendons is usually caused by repetitive ankle motion. Common symptoms of peroneal tendonitis include pain at the back of your ankle, pain that worsens during activity and lessens during rest, pain when rotating the foot, swelling at the back of the ankle, and unstable ankle when carrying objects
    • Patellar tendonitis – Also known as jumper's knee, this condition refers to the inflammation of the patellar tendon, which connects the patella or kneecap to the tibia or shin bone. This is caused by overuse of the knee joint. Repeated stress can cause the tendons to be inflamed. Symptoms include pain and tenderness around the patellar tendon, swelling, pain when jumping, running, walking, bending or straightening the leg.
    • Posterior tibial tendonitis – This condition affects the tendon that connects the back of the shinbone to the bones of your foot. Common symptoms of posterior tibial tendonitis are pain on your foot, difficulty in pointing toes inward, tendon swelling, and the inability to stand on tiptoes. If left untreated, this can lead to flatfoot in the long run.
    • Rotator cuff tendonitis – This affects the tendons that help move the shoulder joint. This can result from engaging in activities that involve repetitive lifting of the arm over your head. Rotator cuff tendonitis can also occur when you keep your shoulder in one position for a long period or when you frequently sleep on your shoulder at night.
    • Tennis elbow – This tendon inflammation causes pain around the outside of the elbow. It is often a result of overuse of the forearm muscles and tendons.
    • Wrist tendonitis – The inflammation of one or more tendons in the wrist causes symptoms like stiffness, pain, swelling or warmth in the wrist. The wrist tendon can be inflamed due to small tears that resulted from sudden or repetitive injury.
  • Tendonitis is usually caused by an injury, eg. sports injury or an overuse injury when running. Other causes include:

    • Reactive arthritis (formerly called Reiter’s syndrome) – This condition is triggered by an infection in another part of the body like the intestines, genitals or urinary tract, but it results in joint pain and swelling. Reactive arthritis typically affects the knees and the joints of the ankles and feet, which may cause tendonitis.
    • Rheumatoid arthritis – This autoimmune and inflammatory disease attacks the immune system and healthy cells in the body by mistake. This can cause inflammation in certain parts of the body, specifically the joints, and may cause tendonitis.

    Risks factors for tendonitis

    Factors that increase a person's risk of developing tendonitis include:

    • Age – Tendon problems are most common in middle-aged people (40 – 60 years). At this age, the tendons are not as elastic as in a young person and are more likely to become injured.
    • Occupation – People whose jobs require repetitive movements, forceful exertion and inconvenient positions are at a higher risk of developing tendonitis.
    • Hobbies – Being active in sports that require repetitive motions may increase your risk of developing tendonitis. Without using proper techniques, tendonitis may occur when engaging in sports like running, tennis, golf, baseball, basketball, bowling, and swimming.
  • All forms of tendonitis cause pain, swelling and tenderness in the area of the affected tendon. The onset may be rapid, such as with a sports injury.

    • Achilles tendonitis causes pain and swelling in the back of the heel.
    • Patellar (kneecap) tendonitis, also called jumper’s knee, causes the tendon in the knee to be inflamed and painful.
    • Posterior tibia tendonitis occurs near the Achilles tendon but is less common – symptoms are felt on the inner side of the ankle.
    • Rotator cuff tendonitis causes pain in the shoulder.
    • Tennis elbow causes pain on the outside of the elbow. Although it is commonly linked to people who play tennis, it can occur in people who perform other sports or repetitive activities using the wrist and elbow.
    • Wrist tendonitis can cause pain and swelling at the wrist.
  • If you are experiencing tendonitis symptoms, your doctor will recommend that you undergo the following diagnostic procedures:

    • Physical exam and medical history –  Your doctor will check the area where the pain is concentrated and will ask about any injuries you've experienced and details about your past or current physical activities, any previously diagnosed medical conditions, prescription drugs, over-the-counter medications, and herbal supplements you take
    • X-ray – This common type of imaging test can help the doctor have a clear view of your tendons. The X-ray result can help diagnose and monitor your condition.
    • Muscoskeletal ultrasound – Using sound waves, this safe and non-invasive procedure will produce pictures of muscles and tendons to help diagnose your condition.
    • Magnetic Resonance Imagery (MRI) – MRI is another tendon imaging procedure. It provides images for both the ligament injury and the related intra-articular damage.
  • To relieve your symptoms, your doctor may recommend a combination of tendonitis treatments depending on the severity of your condition. Treatment for tendonitis usually involves:

    • Home remedies – Resting the area, raising the affected limb and applying ice to reduce the swelling are often enough to treat tendonitis. In the case of severe swelling, a plaster cast may be applied to the affected part of the body.
    • Medication – Non-steroidal anti-inflammatory drugs may be given to ease the pain and reduce the swelling.
    • Therapy – Physical therapy sessions will help to stretch and strengthen the affected tendon through a program of exercises.
    • Dry needling – This tendonitis treatment involves insertion of needles into the affected tendon.
    • Ultrasonic treatment – In this minimally invasive procedure, a small incision will be made to reach and remove the tendon scar tissue using ultrasonic sound waves.
    • Surgery – Depending on the severity of your tendonitis, surgery may be a necessary treatment. Your doctor may recommend surgical procedure especially if the tendon has torn away from your bone.

    At Parkway East Hospital, our experienced orthopaedic consultants and surgeons are supported by a comprehensive team of nurses and physiotherapists to provide you with the suitable treatment options for tendonitis.

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  • Generally, tendonitis symptoms improve with consistent treatment. However, there is still a risk of developing complications. Likewise, tendonitis can lead to more serious conditions if left untreated. Complications of tendonitis include:

    • Tendinosis – This refers to the degeneration of the tendon's collagen due to chronic overuse.
    • Contractures – Tendonitis can lead to contractures, a condition wherein the tendon or tendon sheath stiffens and has limited flexibility and joint movement.
    • Scarring or adhesions
    • Formation of nodules
    • Tendon rupture – If left untreated, tendon inflammation can lead to rupture, a partial or complete tear of the tendon.
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