31/7-2014 
 
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Muscles and Tendons

Tendinitis – Tendon inflammation

Definition and causes of tendinitis

The tendons connect the muscles to the bones. The tendons are strong, flexible but inelastic. Tendons around arms and legs might be long and are used by the muscles as a roping device to move the limbs. There may be a stress or irritation condition in a tendon, and this is called tendonitis or tendon inflammation without bacteria.

This condition usually stems from some form of injury or overuse with too many repetitive movements for example in connection with work. It can also occur from strenuous muscular activity overloading a tendon. Incorrect use of equipment or inappropriate equipment (shoes, rackets, and golf clubs) can also trigger tendinitis.

Tendinitis can occur in any tendon, but is most often seen in the tendons around the shoulders, elbows, wrists, knees and feet. Inflammation of the tendon attached to the outside of the elbow is called a "tennis elbow", as this tendon is often overloaded in tennis. On the inside of the elbow are tendon attachments, which can be overloaded by golfers resulting in a so-called “golf elbow”. However, one can easily incur these conditions without entertaining either of the two sports.

The inflammation may also affect the surrounding tendon sheaths and fascia. (See Tenosynovitis and Tenovaginitis).

The tendons get stiffer with age and this probably explains why the incidence of tendonitis increases with age.

Some diseases such as arthritis and Bechterews disease increase the risk of tendinitis. Some people may be hereditary predisposed to tendon disorders.
 

Symptoms of tendinitis

There will be pain when using the muscle connected with the tendon. The area around the tendon will swell and movement may be reduced. There will be redness over the area. In severe cases there may be pain even during rest. Continued use of the tendon will aggravate the inflammation and result in scar tissue and calcification in the tendon and cartilage leading to reduced tendon function.
 

Prevention and diagnosis of tendinitis

It is important to pay attention to warning signals from the body. In case of pain in a tendon it is important to give the tendon rest to heal before resuming the activity which caused the pain. If the patient's work involves many repetitive movements such as certain forms of office or PC work or painting it is important not to continue with the same work after the arrival of the described symptoms.

When resuming a sport it is important to start slowly and only gradually increase the psychical load. This also prevents the risk of other injuries such as pulled muscles, tendon injuries and tendon rupture. (see Pulled Muscle – Tendon injuriessports injury) If the inflammation is caused by wrong training practice or faulty equipment this of course has to be addressed.

The diagnosis made by the physician based on nature of the condition and the typical symptoms. Imaging examination is usually not necessary, but an inflamed tendon will show on an ultrasound scan.
 

Treatment of tendinitis.

The most important treatment is to give the tendon complete rest and thus time to heal. A supporting bandage or a sling might be helpful. If the symptoms do not subside with rest a doctor should be consulted.

The doctor may prescribe a so-called non-steroidal anti-inflammatory drug (NSAID) to relieve the pain and reduce the swelling. In severe cases, it may be necessary to treat with adrenal cortical hormones injected into tissue around the tendon. Usually this is a quick and effective treatment.

In rare cases, irritating calcification in the tendon may be removed surgically to make better room for the swollen tendon. It is important to start training movement of the joint as soon as the symptoms disappear to avoid stiffness in the joint. Physiotherapeutic treatment, with strengthening and stretching exercises can be good help. Ultrasound treatment can reduce both pain and inflammation.
 

Outlook of tendinitis

The vast majority of cases of tendinitis will subside and disappear by giving the tendon complete rest. With continued use of an inflamed tendon one may develop a chronic inflammatory condition that can take a very long time to get rid of and result in lasting damage. It is important subsequently to avoid situations, which may overload the tendon and trigger a recurrence of the condition.

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