Something more serious?
That pain you’re feeling right now might be from the yardwork you did this weekend. Or it might be something more serious. Tendinitis is inflammation or irritation of a tendon, a flexible band of tissue that connects muscles to bones. The condition causes pain and tenderness just outside of a joint. While tendinitis can occur in any of your body’s tendons, it’s most common around your shoulders, elbows, wrists and heels. Tendons can be small, like those found in the hand or ankle, or large, like the Achilles tendon in the heel. They help create movement by making the muscles push or pull the bones in different ways. Some common forms of tendinitis are named after the sports that increase their risk. They include tennis elbow, pitcher’s shoulder, and jumper’s knee. A severe case of tendinitis can lead to a ruptured tendon, which usually requires surgery, but most cases can be successfully treated with rest, physical therapy and pain medications.
Although tendinitis can be caused by a sudden injury, the condition is much more likely to stem from the repetition of a particular movement over time. Most people develop tendinitis because their jobs or hobbies involve repetitive motions, which put stress on the tendons needed to perform the tasks. People like carpenters, gardeners, musicians, and athletes often get tendinitis. Using proper technique is especially important when performing repetitive sports movements or job-related activities. Improper technique can overload the tendon, which can occur, for instance, with tennis elbow, and lead to tendinitis. Tendinitis can also occur due to age as the body’s tendons lose their elasticity. It can also be seen in persons with systemic diseases such as rheumatoid arthritis or diabetes. The signs occur at the point where a tendon attaches to a bone and typically include pain, especially when moving the affected joint, tenderness and mild swelling.
Location of pain
A medical history and thorough physical examination are both necessary to correctly diagnose a patient’s tendinitis. The patient will be asked to describe the pain and circumstances in which their pain occurs. The location and onset of the pain, whether it varies in severity throughout the day and the factors that relieve or aggravate it are all important diagnostic clues. A physician will use manual tests called selective tissue tension tests to determine which tendon is involved, and then will touch specific areas of the tendon to pinpoint the area of inflammation. The doctor may also use magnetic resonance imaging, or MRI, to confirm a tear. An anesthetic-injection test is another way to confirm a diagnosis of tendinitis. A small amount of anesthetic is injected into the affected area and if the pain is temporarily relieved, then the diagnosis is confirmed. To rule out a possible infection, the doctor may remove and test fluid drawn from the inflamed area.
If you have tendinitis, you know that relieving the pain and inflammation is a priority in treatment. An injection of a corticosteroid medication around the tendon can do both, but repeated injections can weaken a tendon and increase the risk of rupturing it. An over-the-counter pain reliever such as aspirin or ibuprofen can relieve some of the discomfort associated with tendinitis. Some topical creams with anti-inflammatory medication may also be effective in relieving the pain and these may be recommended by a physician because they don’t have the potential side effects of oral medications. A physical therapist can teach you techniques to stretch the affected tendon, thereby reducing the likelihood of reinjury. The therapist can also assess your body mechanics and teach you better ways to perform the activities that give you trouble. Shoe inserts may be needed to adjust your running form, relieving pressure on your knees and Achilles tendons.
Got tendinitis? Try RICE. No, not the grain. RICE is an acronym for rest, ice, compression and elevation, all of which can help speed your recovery and help prevent further problems. Avoid activities that increase the pain or swelling and don’t try to work or play through the pain. Rest is essential to healing but it doesn’t mean complete bed rest. You can do other activities that don’t stress the injured tendon. Prolonged inactivity can cause stiffness in your joints so after a few days of completely resting the injured area, gently move it through its full range of motion to maintain joint flexibility. To decrease pain, muscle spasm and swelling, apply ice to the injured area for up to 20 minutes, several times a day. Because swelling can result in loss of motion in an injured joint, compress the area with wraps or elastic bandages until the swelling has ceased. And if tendinitis affects your knee, raise the affected leg above the level of your heart to reduce swelling.
Trusted by thousands of listeners every week, T. Glenn Pait, M.D., began offering expert advice as the host of UAMS’ “Here’s to Your Health” program in 1996. Dr. Pait began working at UAMS in 1994 and has been practicing medicine for over 20 years.