Tendonitis: Causes, Symptoms, and Treatment

Welcome to our comprehensive guide on tendonitis. In this article, we will explore what tendonitis is, its causes, common symptoms, and various treatment options available to help you manage this condition effectively.

The tendon, in simple terms, is a tough band of collagen-rich connective tissue. Its function is to connect muscles to bones, transmit the energy produced by the muscles, and facilitate body movement.

What is tendonitis?

Tendonitis is an inflammatory condition characterized by pain, swelling, increased temperature in the affected area, and redness at the tendon insertions/sites that have been affected.

The term “tendinosis” refers to histopathological findings of a degenerated tendon.

The term “tendinopathy” is a general term used to describe a common clinical condition that affects tendons and causes pain, swelling, and reduced functionality.

It is a fact that in most cases of tendon injury, pain is not actually accompanied by inflammation. Therefore, the term “tendinopathy” may be more accurate than the term “tendonitis.” Additionally, there are cases where inflammation affects the tendon sheath, which is called tenosynovitis. If you are experiencing tendon-related issues, consulting a specialist such as hand surgeon Singapore can help you receive proper care and treatment for optimal recovery.

Symptoms

Generally, the symptoms vary depending on the specific area affected. Therefore, it is crucial for the therapist or specialist to have the theoretical knowledge and clinical experience to evaluate and recognize the underlying pathological condition and recommend a rehabilitation program.

Common Types of Tendonitis:

a. Upper Extremities:

• Rotator Cuff Tendonitis
• Long Head of Biceps Tendonitis
• Tennis Elbow (Lateral Epicondylitis)
• Golfer’s Elbow (Medial Epicondylitis)
• De Quervain’s Tenosynovitis

b. Lower Extremities:

• Patellar Tendonitis (Jumper’s Knee)
• Achilles Tendonitis

The causes of tendonitis can vary, but the most common ones include:

• Overuse (due to work, sports, and/or lack of rest).
• Middle-aged individuals are more susceptible because tendons gradually lose their elasticity.
• Anatomical factors such as imbalance, functional or anatomical scoliosis, kyphosis, or lordosis can lead to poor load distribution, causing certain muscle groups and their tendons to be overworked. Additionally, anatomical factors such as reduced subacromial space can result in impingement at the rotator cuff.
• Some tendons are naturally ischemic (receive less blood supply), making them more vulnerable.
• Chronic conditions such as rheumatoid arthritis.
• Poor posture.
• Incorrect technique.
• Poor-quality footwear or equipment, such as an unsuitable tennis racket.
• Excess weight can burden the joints and, consequently, the muscles and tendons, especially in the lower extremities.

Prevention

Prevention is achieved through educating the individual on proper techniques for their sport or daily activities. This includes wearing appropriate footwear, engaging in proper strength training, and allowing for adequate muscle rest. Additionally, weight reduction is important for individuals carrying excess weight to avoid tendonitis, especially in the lower extremities.

Specifically, if engaging in aerial acrobatics and pole dance:

1. Most common tendonitis in aerial activities and pole dance:
   • Upper Extremities:
     • Rotator Cuff Tendonitis
     • Golfer’s Elbow (Medial Epicondylitis)
   • Lower Extremities:
     • Patellar Tendonitis (Jumper’s Knee)
     • Achilles Tendonitis
2. Causes:
   • The causes of tendonitis in individuals involved in aerial acrobatics or pole dance are the same as mentioned above. However, it can be more specifically stated that poor physical conditioning preparation and repeated improper technique often lead to pathological compression of the supraspinatus tendon (and sometimes other tendons of the rotator cuff) between the acromion, coracoacromial ligament, and acromioclavicular joint while under load and in an extended position.
   • Additionally, prolonged contraction of the flexor muscles of the wrist and fingers can cause minor strains on the corresponding tendons, leading to the development of medial epicondylitis. Less common tendon conditions encountered include patellar tendonitis and Achilles tendonitis, usually resulting from prolonged landings with incorrect foot placement, decreased tendon elasticity, and delayed neuromuscular response.
3. Prevention:
   • Prevention for athletes and practitioners of pole dance and aerial acrobatics follows the same logic. However, it is crucial that each training session begins with proper warm-up, strength training, correct technique instruction, and appropriate preparatory exercises, and ends with proper cool-down and a period of rest.

Therapeutic Approach:

The goal of therapy is to reduce pain and restore the individual to their daily activities.

Non-pharmacological approach:

• Immobilization of the affected limb or reduction of activities (there is no specific duration of rest, and it is at the discretion of the specialist for each individual case. However, patients should avoid activities that cause pain).
• Proper positioning of the limb, if feasible.
• Ice therapy for the first 24-48 hours, 15 to 20 minutes, 3 to 4 times a day. Ice therapy is also recommended after intense activities.
• Bandaging or application of a brace to reduce mobility in the affected area.
• Application of heat packs only in cases where there is no inflammation and when symptoms are reduced.
• Hydrotherapy.
• Strengthening and flexibility exercises should be performed once the pain has subsided. Plyometric strengthening exercises, in particular, have shown good results in cases of tendonitis.
• Various massage techniques can promote blood flow to the area and improve lubrication, reducing friction between the tendon and its sheath.

Pharmacological approach: The goal of pharmacological treatment is to reduce pain and inflammation.

• Non-steroidal anti-inflammatory drugs (NSAIDs) are effective for tendonitis pain and can be administered topically or orally. However, since the majority of tendonitis cases are non-inflammatory, it is unclear if NSAIDs are more effective than other analgesic medications.
• In patients with tendonitis who have failed conservative treatment with rest, immobilization, and anti-inflammatory approaches, injectable corticosteroids may be beneficial. Corticosteroid injections (e.g., triamcinolone) are typically combined with a local anaesthetic (e.g., lidocaine) to provide immediate pain relief. Pain relief confirms the diagnosis and proper placement of the corticosteroids.
• The effectiveness of local corticosteroid injections is still under discussion. A systematic review concluded that corticosteroid injections offer short-term pain relief but may not have long-term efficacy. The response to injection therapy can vary depending on the anatomical location of the tendonitis.
• A randomized, controlled study in 165 patients with unilateral shoulder pain lasting over 6 weeks showed that although corticosteroid injections showed favourable results at 4 weeks, the percentage of patients with significant improvement or complete recovery at 1 year was lower with corticosteroid injections compared to a placebo injection (83% versus 96%). One-year recurrence was also higher with corticosteroid injections compared to the placebo (54% versus 12%).
• It should be noted that corticosteroid injections should not be administered in the Achilles tendon due to reported cases of tendon rupture following injection. Additionally, repeated corticosteroid injections in any area, as well as direct injection into a tendon, should be avoided due to the risk of tendon rupture.

Surgical approach: The surgical approach is considered for patients who have failed conservative treatment.

Complications and prognosis: Complications of tendonitis can include chronic dysfunction, calcification, and/or tendon rupture. In cases where the shoulder is affected, adhesive capsulitis (frozen shoulder) may develop. However, in most cases, rest and conservative treatment provide excellent results.

If you are experiencing any issues and have concerns, it is advisable to consult with a specialist for your safety and better outcomes.

Epilogue

If you are experiencing symptoms of tendonitis or have concerns about your tendon health, it is important to consult with a specialist for proper diagnosis and personalized treatment. Remember, early intervention and appropriate care can make a significant difference in your recovery from tendonitis.

References:

1. Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. Nov 20 2010;376(9754):1751-67
2. Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA. Feb 6 2013;309(5):461-9.

We value your thoughts and experiences. Feel free to leave a comment below and share your journey with tendonitis or any questions you may have. Your insights can help others seeking support and information.