What Is Tendinitis?
Tendinitis (also called tendonitis) is an inflammation or irritation of a tendon, a thick cord that attaches bone to muscle.
What Causes Tendinitis?
Tendinitis is most often caused by repetitive, minor impact on the affected area, or from a sudden more serious injury.
There are many activities that can cause tendinitis, including:
- Overuse doing massage
- Throwing and pitching
Incorrect posture at work or home or poor stretching or conditioning before exercise or playing sports also increases a person’s risk.
Who Gets Tendinitis?
Anyone can get tendonitis, but it is more common in adults, especially those over 40 years of age. As tendons age, they tolerate less stress, are less elastic and are easier to tear.
Where Does Tendinitis Occur?
Tendinitis can occur in almost any area of the body where a tendon connects a bone to a muscle. The most common places are:
The base of the thumb
De Quervain’s tendinosis occurs when the tendons around the base of the thumb are irritated or constricted. The word “tendinosis” refers to a swelling of the tendons. Swelling of the tendons, and the tendon sheath, can cause pain and tenderness along the thumb side of the wrist.
To diagnose de Quervain’s tenosynovitis, your doctor will examine your hand to see if you feel pain when pressure is applied on the thumb side of the wrist.
Your doctor will also perform a Finkelstein test, in which you bend your thumb across the palm of your hand and bend your fingers down over your thumb. Then you bend your wrist toward your little finger. If this causes pain on the thumb side of your wrist, you likely have de Quervain’s tenosynovitis.
Imaging tests, such as X-rays, generally aren’t needed to diagnose de Quervain’s tenosynovitis.
- Immobilizing your thumb and wrist, keeping them straight with a splint or brace to help rest your tendons.
- Avoiding repetitive thumb movements as much as possible.
- Avoiding pinching with your thumb when moving your wrist from side to side.
Massage or Massage Therapy for Tendonitis
How Massage Therapy Can Help Tendinitis and Tendinosis
Clients frequently come to me suffering from joint pains they believe are tendinitis or bursitis, and that they hope are not due to arthritis. With simple assessment techniques, I can evaluate which tissues are injured or causing pain and which treatment approaches can help.
Tendinitis and tendinosis are dysfunctions of tendons, which are the crucial structures in our bodies that connect our muscles to our bones. Tendons must be tough enough to withstand our strongest muscle contractions, and flexible enough to allow the myriad of movements we make every day. Tendons stay strong and elastic with good circulation, nutrition, hydration, exercise, and rest.
A healthy tendon can tear in extreme situations when a sudden force overpowers it. Anyone can suffer trauma like this in the course of their daily life. In this case, the tear causes inflammation and pain, known as tendinitis, and scar tissue forms as the healing process continue.
In contrast, tendinosis is the result of a much more common scenario when repetitive strain and chronic overuse cause a breakdown within the integrity of the tendon on a molecular level. This derangement of the tendon tends to occur without inflammation (Lowe, 2006, p. 10 and Hendrickson, 2009, p.20), and thus without the healing process that inflammation brings. The science and art of orthopedic massage come together to initiate a renewed healing process in your body for both tendinitis and tendinosis.
An effective orthopedic massage will have five crucial elements in it:
1. Skilled orthopedic testing to identify and locate the injured or deranged tissue
2. Skilled Cyriax friction of the precise location revealed by the testing
3. Release of tension in adjacent muscles that have had to work harder to compensate for the injured tendon
4. Opening of constricted areas due to postural patterns that may be contributing to the strain at the injured site
5. Instructions for client self-care between sessions (including simple targeted stretches and rehabilitative exercises; good food, water, and rest; stress-reduction strategies)
The first goal of effective orthopedic massage is to accurately identify the compromised tissue using skilled orthopedic evaluation. If orthopedic tests reveal either tendinitis or tendinosis, my treatment will include Cyriax friction on the exact place discovered to be injured. This orthopedic massage technique stimulates a mild local inflammatory healing response, which will enable the scar tissue to remodel. Treatment is most effective when combined with targeted stretches (creating elasticity in the healing tissue) and rehabilitative exercises (creating strength in the healing tissues). A strong elastic scar or remodeled tendon will be much more functional, and much less likely to be re-injured.
Friction is performed for only a few minutes per massage session. The rest of the session relieves the tension caused by injury overcompensation, postural and other patterns that contribute to the problem.
The final key to optimal healing of tendinitis or tendinosis is the self-care the client offers themselves between massage sessions. Besides properly directed exercises for the specific site of injury, we must take care to eat, hydrate, and rest well. We also need to look at any areas of our life that are causing stress. All stress, whether physical, chemical, emotional, and mechanical, is perceived by our body’s chemistry similarly, raising the stress hormones. This, in turn, affects our immune system and our ability to heal. When dealing with tendinosis or tendinitis, your body is experiencing a stressor. You may be emotionally stressed from the pain. Orthopedic treatment of the injuries through therapeutic massage can reduce the stress of the injury site. The remaining time in an hour massage session, caring for areas of tension will further reduce the stress felt in your body.
Lowe, Orthopedic Assessment in Massage Therapy, p. 10, 2006
Hendrickson, Massage and Manual Therapy for Orthopedic Conditions, p. 20, 2009
What Are the Symptoms of Tendinitis?
The symptoms of tendinitis include:
- Pain at the site of the tendon and surrounding area. Pain may gradually build up or be sudden and severe, especially if calcium deposits are present.
- Loss of motion in the shoulder, called “adhesive capsulitis” or frozen shoulder.
How Can I Avoid Tendinitis?
To avoid tendinitis, try these tips when performing activities:
- Take it slow at first. Gradually build up your activity level.
- Use limited force and limited repetitions.
- Stop if unusual pain occurs. Do something else. Try again later and if pain recurs, stop that activity for the day
What is the Achilles tendon?
The Achilles tendon connects the calf muscle to the heel bone. It is the biggest tendon in the human body and allows you to rise up on your toes and push off while walking or running.
What are the common Achilles tendon problems?
The two main problems found in the Achilles tendon are:
- Achilles tendinopathy. Achilles tendinopathy refers to one of two conditions:
- Achilles tendon tear or rupture. An Achilles tendon can partially tear or completely tear (rupture). While a partial tear may cause mild or no symptoms, a complete rupture causes pain and sudden loss of strength and movement.
- An abnormal or poorly placed bone or joint (such as length differences in your legs or arthritis in a joint) that stresses soft-tissue structures.
- Stresses from other conditions, such as rheumatoid arthritis, gout, psoriatic arthritis, thyroid disorders, or unusual medication reactions.
- Overuse or doing too much too soon when the tendons are not used to a movement or to the task taken on. Tendinitis is common in “weekend warriors,” people that play and exercise hard only on weekends.
- Occasionally an infection can cause tendinitis, especially infection from a cat or dog bite to the hand or a finger.
From Wikipedia, the free encyclopedia
- Tendinitis (also tendonitis), meaning inflammation of a tendon, is a type of tendinopathy often confused with the more common tendinosis, which has similar symptoms but requires different treatment. (The suffix -itis denotes diseases characterized by inflammation.) The term tendinitis should be reserved for tendon injuries that involve larger-scale acute injuries accompanied by inflammation. Generally, tendinitis is referred to by the body part involved, such as Achilles tendinitis (affecting the Achilles tendon), or patellar tendinitis (jumper’s knee, affecting the patellar tendon).
Tendinitis injuries are common in the upper and lower limbs (including the rotator cuff attachments), and are less common in the hips and torso. Individual variation in frequency and severity of tendinitis will vary depending on the type, frequency, and severity of exercise or use; for example, rock climbers tend to develop tendinitis in their fingers or elbows, swimmers in their shoulders. Achilles tendinitis is a common injury, particularly in sports that involve lunging and jumping, while Patellar tendinitis is common among basketball and volleyball players owing to the amount of jumping and landing. A veterinary equivalent to Achilles tendinitis is the bowed tendon, tendinitis of the superficial digital tendon of the horse.
Symptoms can vary from aches or pains and local joint stiffness to a burning that surrounds the whole joint around the inflamed tendon. In some cases, swelling occurs along with heat and redness, and there may be visible knots surrounding the joint. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiff the following day as muscles tighten from the movement of the tendon. Many patients report stressful situations in their life in correlation with the beginnings of pain which may contribute to the symptoms. If the symptoms of tendinitis last for several months or longer it is probably tendinosis.
Treatment of tendon injuries is largely conservative. Use of non-steroidal anti-inflammatory drugs (NSAIDs), rest, and a gradual return to exercise is a common therapy. Resting assists in the prevention of further damage to the tendon. Ice, compression, and elevation are also frequently recommended. Physical therapy, Occupational therapy, orthotics, or braces may also be useful. Initial recovery is typically within 2 to 3 days and full recovery is within 4 to 6 weeks. Tendinosis occurs as the acute phase of healing has ended (6–8 weeks) but has left the area insufficiently healed; Treatment of tendinitis helps reduce some of the risks of developing tendinosis, which takes longer to heal.
Steroid injections have not been shown to have long term benefits but have been shown to be more effective than NSAIDs in the short term.
In chronic tendinitis or tendinosis, laser therapy has been found to be better than conservative treatment at reducing pain; however, no other outcomes were assessed. Both Prolotherapy and PRP injections are being used more frequently with good clinical short and long-term outcomes in tendonosis – research has been only slightly positive for these treatment modalities due to the poor design of many of the completed studies.
Information About Diagnosis and Treatment of Tendonitis
Updated May 20, 2014
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A tendon is a tough yet flexible band of fibrous tissue. The tendon is the structure in your body that connects your muscles to the bones. The skeletal muscles in your body are responsible for moving your bones, thus enabling you to walk, jump, lift, and move in many ways. When a muscle contracts it pulls on a bone to cause movements. The structure that transmits the force of the muscle contraction to the bone is called a tendon.Tendons come in many shapes and sizes. Some are very small, like the ones that cause movements of your fingers, and some are much larger, such as your Achilles tendon in your heel. When functioning normally, these tendons glide easily and smoothly as the muscle contracts.
Sometimes the tendons become inflamed for a variety of reasons, and the action of pulling the muscle becomes irritating. If the normal smooth gliding motion of your tendon is impaired, the tendon will become inflamed and movement will become painful. This is called tendonitis, and literally means inflammation of the tendon.
Causes of Tendonitis
There are hundreds of tendons scattered throughout our body, but it tends to be a small handful of specific tendons that cause problems. These tendons usually have an area of poor blood supply that leads to tissue damage and poor healing response. This area of a tendon that is prone to injury is called a “watershed zone,” an area when the blood supply to the tendon is weakest. In these watershed zones, the body has a hard time delivering oxygen and nutrients necessary for tendon healing–that’s why we see common tendon problems in the same parts of the body. Tendonitis is most often an overuse injury. Often people begin a new activity or exercise that causes the tendon to become irritated. Tendon problems are most common in the 40-60-year-old age range. Tendons are not as elastic and forgiving as in younger individuals, yet bodies are still exerting with the same force.
Occasionally, there is an anatomical cause for tendonitis. If the tendon does not have a smooth path to glide along, it will be more likely to become irritated and inflamed. In these unusual situations, surgical treatment may be necessary to realign the tendon.
Symptoms of Tendonitis
Tendonitis is almost always diagnosed on physical examination. Findings consistent with tendonitis include:
- Tenderness directly over the tendon
- Pain with movement of muscles and tendons
- Swelling of the tendon
X-rays & MRIs: Are They Necessary?
Studies such as x-rays and MRIs are not usually needed to make the diagnosis of tendonitis. While they are not needed for diagnosis of tendonitis, x-rays may be performed to ensure there is no other problem, such as a fracture, that could be causing the symptoms of pain and swelling. X-rays may show evidence of swelling around the tendon.
MRIs are also good tests to identify swelling and will show evidence of tendonitis. However, these tests are not usually needed to confirm the diagnosis; MRIs are usually only performed if there is a suspicion of another problem that could be causing the symptoms.
Once the diagnosis of tendonitis is confirmed, the next step is to proceed with appropriate treatment. Treatment depends on the specific type of tendonitis. Once the specific diagnosis is confirmed, the appropriate treatment of tendonitis can be initiated.
- Tendonitis can occur in any tendon in the body but tends to occur in one of a small handful of the hundreds of tendons scattered throughout our body. The reason these tendons are prone to injury is the result of problems with the blood supply to the area of concern. In these situations, poor blood supply within the so-called “watershed zone” of the tendon leads to a tendency for problems. Some of the types of tendonitis that are seen most frequently include:
- Wrist Tendonitis
Wrist tendonitis is a common problem that can cause pain and swell around the wrist. Wrist tendonitis is due to inflammation of the tendon sheath. Treatment of wrist tendonitis usually does not require surgery.
- Achilles Tendonitis
Achilles tendonitis causes pain and swelling in the back of the heel. Understanding this common problem can help with treatment and help to avoid serious complications such as Achilles tendon rupture.
- Posterior Tibial Tendonitis Tendonitis
Occurring near Achilles tendonitis, posterior tibial tendonitis is less common, but should be considered in people with symptoms on the inner side of the ankle. Left untreated, posterior tibial tendonitis can result in a flat foot.
- Patellar (Kneecap) Tendonitis
Patellar tendonitis, or inflammation of the patellar tendon, is a condition often called Jumper’s Knee. Treatment of patellar tendonitis usually consists of rest and anti-inflammatory medication.
- Rotator Cuff Tendonitis
Many patients who have pain are told by their doctor they have shoulder bursitis or rotator cuff tendonitis; learn more about rotator cuff tendonitis and available treatments.
- Tennis Elbow (Lateral Epicondylitis)
Tennis elbow is actually a type of tendonitis that causes pain over the outside of the elbow. Commonly associated with people who play tennis, lateral epicondylitis can occur in people who perform other sports or repetitive activities of the wrist and elbow.
Below is some advice for tendonitis treatment and avoiding recurrences of this problem. As with any treatment program, talk with your doctor before you begin tendonitis treatment! In order to aid healing you should:
- Rest and Protect The Area
Tendonitis treatment must begin by avoiding aggravating movements. This may mean taking a break from a favorite activity for a period of time, but this is a necessary step to allow the inflamed tendon to heal. It is also recommended in tendonitis treatment to try alternative activities; for example, if you are a runner who is experiencing knee pain due to tendonitis, try incorporating swimming into your workout schedule. Often a splint or brace will be prescribed to help protect the area.
- Apply an Ice Pack
Icing the area of inflammation is an important aspect of tendonitis treatment. The ice will help to control the inflammation and decrease swelling. By minimizing inflammation and swelling, the tendon can return to its usual state and perform its usual function.
- Take Anti-Inflammatory Medications
Nonsteroidal anti-inflammatory medications (NSAIDs) include a long list of possibilities such as Ibuprofen, Motrin, Naprosyn, Celebrex, and many others. Tendonitis treatment can be improved by these medications that will decrease pain and swelling. Be sure to talk to your doctor before starting these medications.
- Cortisone Injections
If the symptoms of tendonitis are persistent, an injection of cortisone may be considered. Cortisone is a powerful anti-inflammatory medication, but instead of being given by mouth, it is injected directly into the site of inflammation. This can be extremely helpful for situations that are not improved with rest. Not all types of tendonitis can be addressed with cortisone injections! For example, Achilles tendonitis is rarely injected with cortisone because of concerns about a possible rupture of the tendon.
To prevent the return of tendonitis symptoms:
- Strengthening and Physical Therapy
Proper strengthening techniques can help you avoid tendonitis by using your muscles in a safe, more efficient manner. For example, patients with rotator cuff tendonitis can learn ways to move the shoulder that will not cause inflammation. Do not begin exercises until the inflammation of tendonitis has resolved!
- Take Breaks
Alternate repetitive tasks with breaks to relieve stress on the tendons. Don’t perform one activity continuously for hours at a time. For those with exercise-related tendonitis, try to vary your workouts to relieve the repetitive stress of one exercise activity.
- Protect the Tendons
Some patients who have chronic tendonitis will find relief by protecting the affected area when performing certain activities. For example, wrist splints can be worn while gardening or Chopat straps (patellar tendonitis) can be worn while playing sports.
The steps listed above are usually adequate tendonitis treatment, and most patients have a resolution of their symptoms. Learning to avoid activities that may cause a tendonitis flare-up can also be important.
Tendonitis due to underlying conditions such as arthritis and gout are more difficult to treat and recur more frequently. The best management in these situations is to do your best to avoid flare-ups of gouty attacks or arthritic episodes and to avoid activities that you have learned cause tendonitis.
Almekinders, LC. “Tendinitis and other chronic tendinopathies” J. Am. Acad. Ortho. Surg., May 1998; 6: 157 – 164.
- Wrist Tendonitis
Tendinitis often results from repetitive use (overuse). Though the problem can recur or be chronic (long term) in some people, it is most often short term, mainly if treated early. Tendinitis or bursitis often involves the shoulder, elbow, wrist, hip, knee, and ankle. The pain it causes may be quite severe and often occurs suddenly. As in arthritis, the pain is worse during movement. Unlike arthritis, the pain is often in parts of the body far from a joint.
- Tendinitis and bursitis are inflammation or degeneration (breakdown) of the soft tissue around muscles and bones.
- Immediate treatment includes RICE: Rest, Ice, Compression, and Elevation.
- Danger signs include rapid worsening of pain, redness, and swelling, or sudden inability to move a joint.
What is tendinitis?
Tendons are cord-like structures located where a muscle narrows down to attach to a bone. The tendon is more fibrous and dense than the elastic, fleshy muscle. A tendon transmits the pull of the muscle to the bone to cause movement. Tendinitis is often very tender to the touch.
What is bursitis?
Bursitis is inflammation of a bursa. This small sac acts as a cushion between moving structures (bones, muscles, tendons, or skin). If a muscle or tendon is pulling around a corner of a bone, or over a bone, a healthy bursa protects it from fraying and stress. When a bursa is inflamed, it becomes very painful, even during rest.
What causes tendinitis and bursitis?
Tendinitis can occur from a sudden intense injury. Most often, though, it results from a repeated, minor injury of that tendon. Doctors call this repetitive stress or overuse. For example:
- Painting a ceiling for four hours or more, typing long hours, improper body position while using a keyboard, chopping, cutting, or sawing may result in tendinitis or bursitis hours or days later.
- Tight clenching while using hand tools or while driving a long time.
- Using a backhand, mainly single-handed, in an early-season game of tennis (“tennis elbow”).
- Wearing improper running shoes or not getting proper training before sports.
To prevent these overuse injuries, follow the tips in the Joint Protection Table.
Persons with gout, pseudogout, or blood or kidney diseases often develop bursitis as part of that disease. Older persons are more prone to get tendinitis and bursitis.
Rarely, some drugs can cause tendinitis and tendon rupture (spontaneous tear). These include fluoroquinolone antibiotics and statins (drugs that lower cholesterol). The green part of the image illustrates the anserine bursa of the knee, which becomes inflamed in bursitis. Tendons (white) connect the muscles (red) to insert onto the bone, above the bursa.
How are tendinitis and bursitis diagnosed?
To determine the cause of these problems, a health care provider asks about your medical history and does a careful physical exam. Tenderness along the tendon or its sheath (outer covering), or at one specific point in the tendon, suggests tendinitis. Pain occurs when the muscle to which the tendon is attached is worked against resistance as part of the exam.
Most patients at first do not need imaging tests like X-rays, magnetic resonance imaging (often referred to as MRI), or ultrasound scans. Imaging and blood tests are done only if the problem recurs or does not go away. A blood test also can help detect an infection. Signs of an infection include redness, warmth, and swelling. If the bursitis is the result of infection, the fluid must be drained from the bursa at once and promptly studied.
How are tendinitis and bursitis treated?
Treatment depends on the cause. In overuse or injury, you must reduce the causing force or stress. If tendinitis is job-related, the doctor or physical therapist should review proper ergonomics, so you can work safely. Some patients may need joint protection advice and support of the involved region. There is little proof that therapeutic ultrasound helps these problems, and most doctors do not recommend it.
Treatment can consist of any of the following.
Rest. You should rest the injured limb or joint, at least for a short time. Failure to rest will most likely continue your symptoms. If the problem is in a hip, leg, or foot, you may need to stop stressful weight-bearing activities for a short time. This lets the inflammation lessen.
Ice. Ice may help reduce inflammation and pain. Ice the area for 10–15 minutes once or twice a day.
Medicine. If your pain persists, you may need nonsteroidal anti-inflammatory drugs—often referred to as NSAIDs—such as aspirin, ibuprofen or naproxen. Topical (applied to the skin) forms of NSAIDs are now available and may reduce pain and inflammation without stomach upset. Acetaminophen (Tylenol) also can help relieve pain.
Corticosteroid injections may provide short-term benefit in certain forms of tendinitis and may be considered if you are unable to take NSAIDs.
If an infection is present, you most often will need a proper antibiotic. (Daily drainage of fluid with a needle also may be needed.)
If crystals of gout are found in joint fluid, there is a medicine that controls the disease.
Supports. The use of a cane in the opposite hand can help a painful hip. Splints or braces for the affected body part help rest and reduce stress on the body. Off-the-shelf supports may be enough. If not, you may need custom-made braces and a referral to an occupational therapist.
For ankle tendinitis, you may need orthotics to reduce the stress at the ankle or in the foot. An orthotic is a device that goes inside the shoe, which changes the support and the angle of the foot. This improves foot mechanics and relieves pain or pressure. They can be custom made or off the shelf.
Physical therapy. Some tendon problems do not go away despite standard treatment. If tendinitis lasts beyond a few weeks, you may need a referral to a physical therapist or a rheumatologist. The doctor or therapist can give you exercises to do that will maintain strength and function. If the tendinitis or bursitis has begun to limit joint movement, or already restricts movement, seeing a physical therapist is wise. For instance, if the pain in a shoulder has gone away, but you can no longer raise your arm as high as your healthy arm, a “frozen shoulder” or other rotator cuff problems are developing. You can prevent this problem with early treatment.
Surgery. If, after a few months of treatment, tendinitis still limits an essential activity, you may want to consider surgery. Ask your doctor to refer you to an experienced orthopedic surgeon.
Some patients with an infection or adhesions of the tendon or bursa may need a cortisone injection or an operation.
A possibly serious complication of tendinitis is the rupture of a tendon. The most common rupture is a tear of the Achilles tendon in the lower calf. It most often needs surgery.
There are ways you can prevent these problems from occurring. These tips apply to all joints:
- Before strenuous exercise, warm-up, and stretch.
- Properly train for a new activity. Slowly increase the intensity of your workout.
- Engage in exercise and sports daily or near-daily rather than just on weekends.
- Learn and maintain proper posture and body mechanics.
- Make sure sports equipment is the right size and fit for you, and designed for the sport you are doing.
- Avoid staying in one position for too long. Take rest breaks or change positions every 20–40 minutes.
- Stop any activity that causes pain.
- Avoid compulsive behavior, like “I’m going to finish this job even if it kills me!”
The Table shows how to protect certain joints.
Table: Joint Protection
|Elbow and wrist||
|Knee and ankle||
WHAT IS THE BROADER HEALTH IMPACTS OF TENDINITIS AND BURSITIS?
Tendinitis or bursitis in the shoulder can become a greater problem if the shoulder becomes stiff. It is important to do a range of motion exercises, such as stretching, each day. This preserves movement in the shoulder joint.
LIVING WITH tendinitis OR BURSITIS
Tendinitis or bursitis can be painful. Seek medical attention early to prevent joint stiffness and chronic problems that may follow. It also is important to rest the limb or the joint, at least until movement is free of pain. Failure to rest it most often delays full healing.
Points to remember
- Rest the painful tendon. Avoid heavy activity or any activity that causes pain.
- Ice the area for 10–15 minutes once or twice a day.
- Seek medical help at once if pain worsens, if redness and swelling appear or if the problem does not improve in 3–6 weeks.
- Avoid overuse of any part of the body, such as doing the same motion over and over.
- Warm-up by exercising at a relaxed pace before doing more strenuous activity.
Other good links:
*Disclaimer: This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider.
Please consult your healthcare provider with any questions or concerns you may have regarding your condition.
The information provided is for educational purposes only and is not intended as diagnosis, treatment, or prescription of any kind. The decision to use, or not to use, any information is the sole responsibility of the reader. These statements are not expressions of legal opinion relative to the scope of practice, medical diagnosis, or medical advice, nor do they represent an endorsement of any product, company, or specific massage therapy technique, modality, or approach. All trademarks, registered trademarks, brand names, registered brand names, logos, and company logos referenced in this post are the property of their owners.