A tendon is a strong band or cord of tissue that attaches muscle to bone and help move bones and joints when muscles contract. Tendonitis is an inflammation of the tendon that typically occurs when tendons are overused, such as in people who perform repetitive tasks like typing or some sport activities.
Tendon overuse and tendonitis is also referred to as a Repetitive Strain Injury (RSI). Some types of arthritis, such as rheumatoid arthritis, can occasionally cause inflammation of both the joints and the sheaths that encase tendons (1). Very occasionally, an infection can also cause tendonitis through germs entering a cut or puncture wound in close proximity to a tendon or tendon sheath (2).
What are the symptoms of tendonitis?
The main symptom of tendonitis is pain in the affected tendon where it attaches to the bone. The pain is often accompanied by stiffness, weakness in the affected area, a lumpiness that develops along the tendon, swelling or a sensation that the tendon is grating or crackling when moving.
Some types of tendonitis are very common and have specific characteristic symptoms. Examples include:
- Lateral epicondylitis, also known as tennis elbow, in which pain usually occurs on the outside of the elbow due to overuse of the forearm muscles
- Medialepicondylitis, also known as Golfer’s elbow, in which pain usually occurs on the insideof the elbow
- Trigger Finger, in which tendonitis prevents the ring finger from being extended and straightening fully
How is tendonitis treated?
Tendonitis is treated in a number of ways, although the most effective treatment remains uncertain due to a relatively small evidence base.
Rest is the most common and often most effective treatment, allowing the tendon to settle. Occasionally a splint, bandage or brace is applied to the affected area to hold it in place and ensure that rest is taken.
Ice packs on the affected areas have also been evidenced to be an effective treatment for any associated pain or swelling that accompanies tendonitis.
Anti-inflammatory painkillers such as ibuprofen are regularly prescribed to help patients reduce both pain and inflammation. Although inflammation may not always be the main issue in tendonitis, anti-inflammatory tablets can still be an effective source of pain relief.
Analgesics. There is evidence to suggest that simple analgesics may work equally as well as anti-inflammatory drugs (3).
Steroid injections have been evidenced to have some impact on short term pain, but longer term studies reveal no significant effect in regards to alleviating the symptoms of tendonitis.
Physiotherapy
New treatment options for persistent tendonitis?
There are some emerging treatments for tendonitis, although the evidence regarding their effectiveness limited due to their relatively new application.
Shock wave Therapy has started to emerge as a treatment for persistent tendonitis, with high energy sound waves passed through the skin to the affected area. As the shock waves can also be painful, this treatment is usually accompanied by the use of a local anaesthetic. Whilst the procedure appears to be safe, there is very little evidence regarding its use in a controlled environment.
Autologous blood injection involves blood being drawn and then injected into the site where tendonitis has occurred. The theory behind this technique is that the blood helps to accelerate the repair of the tendons, and it is also often given in conjunction with an injection of local anaesthetic. The procedure is only generally considered if other treatments have failed, yet as with shock wave therapy there is little evidence regarding how effective this treatment is.
Treatment risk for tendon rupture
There is some evidence to suggest that certain treatments for tendonitis are a risk factor for future Achilles tendon rupture in some patients (5). As such, there is some concern attached to the use of prolonged or high dose systemic corticosteroids for tendonitis, or patients taking courses of quinolone antibiotics (6).
Conservative treatments that involve a period of non-weight bearing rest and a brace appears to be the most popular treatment option for Achilles related tendonitis or rupture, with some studies suggesting that this approach improves long term outcomes when compared to a surgical approach(7). The evidence base for both surgical procedures and conservative treatment is relatively limited and so non-invasive surgery tends to be the most commonly opted for mode of treatment by most doctors.
References
- Naredo E, D’Agostino MA, Wakefield RJ et al (2013) Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis Ann Rheum Dis 72(8):1328-34
- Halla JT, Gould JS, Hardin JG (1979) Chronic tenosynovial hand infection from M.terrae Arthritis Rheum 22(12):1386-90
- Wilson JJ, Best TM (2005) Common overuse tendon problems: A review and recommendations for treatment. Am Fam Physician 1:72 (5):811-8
- Goldman RH, Stason WB, Park SK, et al (2010) Low-dose amitriptyline for treatment of persistent arm pain due to repetitive use Pain 149(1):117-23. doi: 10.1016/j.pain.2010.01.016.
- Vallone G, Vittorio T (2014) Complete Achilles tendon rupture after local infiltration of corticosteroids in the treatment of deep retrocalcaneal bursitis J Ultrasound 29:17(2):165-7
- Sode J, Obel N, Hallas J, et al (2007) Use of fluroquinolone and risk of Achilles tendon rupture: a population-based cohort study. Eur J Clin Pharmacol 63(5):499-503
- Suchak AA, Bostick GP, Beaupre LA, et al (2008) The influence of early weight-bearing compared with non-weight-bearing after surgical repair of the Achilles tendon. J Bone Joint Surg Am Sep;90(9):1876-83
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