Tendinitis

Tendinitis is inflammation of a tendon.

Tendons are cord-like structures located where a muscle narrows down to attach to a bone, which is why 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.

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 often results from repetitive use (overuse).
 

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!”

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.

To help prevent inflammation or reduce the severity of its recurrence:

  • Begin new activities or exercise regimens slowly.
  • Gradually increase physical demands following several well-tolerated exercise sessions.
  • Exercise regularly.
  • Strengthen muscles around the joint.
  • Take breaks from repetitive tasks often.
  • Stop activities that cause pain.
  • Cushion the affected joint. Use foam for kneeling or elbow pads. Increase the gripping surface of tools with gloves or padding. Apply grip tape or an oversized grip to golf clubs.
  • Use two hands to hold heavy tools; use a two-handed backhand in tennis.
  • Don’t sit still for long periods.
  • Practice good posture and position the body properly when going about daily activities.
  • If a history of tendinitis is present, consider seeking guidance from your doctor or therapist before engaging in new exercises and activities.

Diagnosis of tendinitis and bursitis begins with a medical history and physical examination. The patient will describe the pain and circumstances in which pain occurs. The location and onset of pain, whether it varies in severity throughout the day, and the factors that relieve or aggravate the pain are all important diagnostic clues.

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. 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 it will most likely continue your symptoms. If the problem is in a hip, leg or foot, you may need to stop stressful weightbearing 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.
  • Injections. 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.
  • Supports. 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. If not, you may need custom-made braces and referral to an occupational therapist.
  • 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 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 orthopaedic surgeon. Some patients with an infection or adhesions of the tendon or bursa may need a cortisone injection or an operation.