Tendinopathy (commonly called tendinitis) is a painful condition of the tendon that is characterized by deterioration of or loss of function in a tendon. Tendinopathy is often the result of overuse, but sometimes no cause can be determined.
The cause is not always known.
Tendons are painful, particularly when moved, and sometimes swollen.
The diagnosis is usually based on symptoms and results of a physical examination.
Using a splint, applying heat or cold, and taking nonsteroidal anti-inflammatory drugs can help.
Tendons are fibrous cords of tough tissue that connect muscles to bones. Some tendons are surrounded by tendon sheaths. (See also Introduction to Muscle, Bursa, and Tendon Disorders.)
The cause of tendinopathy is often unknown. Tendinopathy usually occurs during middle or older age, as the tendons weaken and become more susceptible to injury. (This weakening of the tendon usually results from changes in many factors, including collagen production, blood supply to the tendons, and even the structure and life cycle of the cells in surrounding tissues. Affected tendons may gradually or suddenly tear completely, and the body's normal healing response may fail.) Tendinopathy also occurs in younger people who exercise vigorously (who may develop rotator cuff tendinitis—see also Rotator Cuff Injury/Subacromial Bursitis) and in people who do repetitive tasks.
Certain tendons are particularly susceptible to tendinopathy:
Tendons of the shoulder (rotator cuff): Injuries to these tendons are the most common cause of shoulder pain (see Rotator Cuff Injury/Subacromial Bursitis).
The 2 tendons that extend the thumb away from the hand: When these tendons are affected, it is called De Quervain syndrome.
The flexor tendons that clench the fingers: These tendons get caught in their sheaths, resulting in a popping feeling (trigger finger).
The tendon above the biceps muscle in the upper arm (bicipital tendon): Pain can occur when the elbow is bent or the arm is elevated or rotated.
The tendons in the forearm that attach to the medial and lateral epicondyles: These common sports injuries are called, respectively, lateral epicondylitis (tennis elbow) and medial epicondylitis (golfer's elbow)
Achilles tendon in the heel: Pain occurs at the back of the heel (Achilles tendinitis).
A tendon that runs over the side of the knee (popliteus tendon): Pain occurs on the outer part of the knee.
Tendons near the hip bone (trochanter): Because bursae may also be affected, the term trochanteric bursitis is often used to include these tendons.
Some antibiotics, such as fluoroquinolones, may increase the risk of tendinopathy (weakening of the tendon) and rupture of the tendon.
Certain joint diseases, such as rheumatoid arthritis, systemic sclerosis, gout, diabetes, and reactive arthritis, can increase the risk of tenosynovitis (inflammation of the thin layer of tissue surrounding the tendon). In people with gonorrhea, especially women, gonococcal bacteria can cause tenosynovitis, usually affecting the tissues of the shoulders, wrists, fingers, hips, ankles, or feet.
Symptoms of Tendinopathy
The inflamed tendons are usually painful when moved or when pressed. Moving the joints near the tendon, even a little, may cause pain, depending on how severe the tendinitis is. Occasionally, the tendons or their sheaths swell and feel warm.
If tendinitis lasts a long time, calcium may become deposited. The area around the shoulder joint is often affected. In addition to being painful, the shoulder may feel stiff and weak. It may snap or catch when moved.
Diagnosis of Tendinopathy
A doctor's evaluation
Sometimes imaging tests
Doctors can usually diagnose tendinitis based on the symptoms and results of a physical examination.
Sometimes magnetic resonance imaging (MRI) or ultrasound imaging is helpful.
Treatment of Tendinopathy
Activity modification and exercise
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Sometimes injections of steroids (often called corticosteroids or glucocorticoids)
Therapy for tendinopathy includes modifying activity as needed; resting more frequently than usual; and exercising early, with an emphasis on eccentric loading (testing the tendon's ability to withstand direct stress as well as stress during bending). Taking NSAIDs for 7 to 10 days can reduce the pain and increase range of motion, but they do not address the underlying cause of tendinopathy. After symptoms are controlled, exercises to increase the range of motion should be done several times a day.
Sometimes steroids (such as betamethasone, methylprednisolone, or triamcinolone) and anesthetics (such as lidocaine) are injected into the tendon sheath. While steroids can provide short-term pain relief, they do not help with long-term symptoms and may increase the risk of tendon rupture. Rarely, the injection causes pain hours later because the steroid temporarily forms crystals inside the joint or sheath. This pain lasts less than 24 hours and can be treated with cold compresses and pain relievers.Sometimes steroids (such as betamethasone, methylprednisolone, or triamcinolone) and anesthetics (such as lidocaine) are injected into the tendon sheath. While steroids can provide short-term pain relief, they do not help with long-term symptoms and may increase the risk of tendon rupture. Rarely, the injection causes pain hours later because the steroid temporarily forms crystals inside the joint or sheath. This pain lasts less than 24 hours and can be treated with cold compresses and pain relievers.
Other medications may be used, depending on the cause. For example, if gout is the cause, indomethacin or colchicine may be used.is the cause, indomethacin or colchicine may be used.
Rotator Cuff Tendinopathy
Tendinopathy may develop in the tendons of the muscles that help move, rotate, and hold the shoulder in place (rotator cuff).
Rotator cuff tendinopathy (see also Rotator Cuff Injury/Subacromial Bursitis) is the most common cause of shoulder pain. It causes pain when the arm is raised (particularly between 40° and 120°) or when people dress. People often have pain during the night, especially when they lie on the affected arm.
Symptoms of rotator cuff tendinitis may occur suddenly and be severe, especially after physical activity, or they may develop more slowly and be milder.
Doctors may do x-rays to look for calcium deposits in the tendon. Sometimes magnetic resonance imaging (MRI) or ultrasound imaging is helpful to confirm there is not a complete tendon tear.
Range-of-motion exercises, nonsteroidal anti-inflammatory drugs (NSAIDs), and sometimes a steroid injection can be used for treatment. Rarely, surgery is done to remove calcium deposits or repair the tendon if is completely torn. Physical therapy to increase range of motion and rehabilitate muscles and tendons is required after surgery.
