What is tendonitis?
Tendonitis is a term used to describe inflammation of a tendon. (A tendon is a cord or band of fibrous connective tissue that attaches muscles, usually to bones.) When the lining of the sheath surrounding the tendon is also inflamed, the condition is called tenosynovitis. These two conditions usually occur together and the collective term generally used is tendonitis.
Tendonitis and bursitis are often used interchangeably since bursae are often located near tendons. A bursa is a small sac of fibrous tissue lined with membrane (synovial membrane) and filled with lubricating fluid (synovial fluid). Bursae usually occur where tendons near joints move over each other, and help to reduce friction.
What causes tendonitis?
The exact cause is not known, but the condition seems to be associated with repeated use of tendons, leading to strain. It is common in people who suddenly indulge in excessive exercise when they are not used to it.
It is also more common in older people, probably because blood supply to the tendons decreases, and they may also have suffered small injuries repetitively over the years.
The tendon sheaths may also be affected in diseases which involve other parts of the body as well, such as rheumatoid arthritis and gout.
The most common areas of the body where tendonitis occurs are the shoulder capsule and its associated tendons, the tendons around the wrist and hand, the hip area, the hamstrings (in the thigh) and the Achilles tendon (heel tendon). The latter is a very common area of inflammation in sportspeople, particularly runners and cyclists.
A specific form of tendonitis called De Quervain’s disease affects the tendons associated with the thumb.
Symptoms and signs of tendonitis
The main symptom is pain in the area of the inflamed tendons – particularly on moving the joint or area. The tendon sheaths may be visibly swollen, particularly around the wrist, because of the accumulation of inflammatory fluid.
They can also be inflamed and dry. In this case, you can feel roughness as the tendon moves through its sheath, and this can be heard as a friction rub with a stethoscope.
The affected tendon is often very painful to the touch and when specific movements of the joint are elicited by the doctor, extreme pain is felt.
In long-standing cases, calcium deposits, which can be seen on X-ray, may form in the areas of inflammation.
Can tendonitis be prevented?
Since tendonitis is often associated with overuse of a tendon, it can be avoided by grading exercise to prevent overuse. Avoid repetitive movements, which cause strains that could result in inflammation.
Sportspeople should make sure that they warm up adequately before events and training sessions to avoid tendon injuries.
How is tendonitis treated?
Resting the affected area is the mainstay of treatment. In severe cases a splint or even a cast may be used to immobilise the joint firmly.
In the early stages of the inflammation, applying heat packs is helpful.
Pain-killers can be used as required and non-steroidal anti-inflammatory medications are useful to reduce the inflammation.
Once the acute inflammation is controlled, the joint can be moved in a programme of regulated exercise, preferably prescribed by a physiotherapist.
In severe and intractable cases, injecting the inflamed tendon sheath with cortisone may be helpful. This sometimes results in a temporary increase in pain for about 24 hours after the injection. Cold compresses and pain-killers can help relieve the pain.
What is the outcome of tendonitis?
In some severe cases, injections and pain-killers may be needed every two to three weeks for one or two months before the tendonitis resolves.
In intractable cases, which will not respond to other treatment, surgery may be needed to remove inflamed or calcified deposits. This is followed by physiotherapy and graded exercises.
When to call the doctor
If you have a painful joint or tendon that does not respond to rest and pain-killers, then your doctor may be able to offer further treatment.
(Reviewed by Dr Sirk Loots, orthopaedic surgeon)