Tendons are bands of connective tissue that connect muscles to bones. They vary in length and thickness depending on where they are situated anatomically. When tendons become inflamed, irritated, and damaged, the condition is called tendonitis.
Tendonitis is caused by repetitive, overuse of a tendon or tendons. It often starts with microscopic tears and progresses over time. It can also be caused by overloading and stressing the tendon quickly as in weightlifting or other sports. There are multiple sports commonly associated with the development of tendonitis such as swimming, golf, tennis, and running to name a few. “Tennis elbow” is a form of tendinitis. Musicians such as guitarists, pianists, and drummers may also develop tendonitis in the parts of the body used most often. Other causes include trauma and labor-intensive work. Medical conditions associated with tendonitis as one of their symptoms include diabetes, lupus, rheumatoid arthritis, psoriatic arthritis, and thyroid disorders.
A detailed history taken by your physician can help establish the diagnosis of tendonitis. The doctors may ask you to describe the nature of your pain, is it sharp, dull, or burning? Where is the pain located? What is the extent of the pain? Is the pain also associated with tingling, numbness, and weakness? When did the pain begin and was it associated with certain activities? What makes the pain better? What makes the pain worse? Is it relieved with rest?
During the physical exam, the physician will look for tenderness, red discoloration, swelling, weakness, and a restricted range of motion. Depending on the nature of the suspected tendonitis, you may be asked to perform certain voluntary motions that may reproduce the pain.
Diagnostic imaging can include X-rays which are used to rule out fractures, dislocations, and bone disease. An ultrasound or MRI can be used to visualize tendon damage. Blood tests are performed to look for the presence of medical conditions that may be causing tendinitis such as gout or inflammatory arthritis.
Conservative measures should be tried at first for mild cases of tendonitis. These include rest, elevation, heat or ice, and over-the-counter pain medications such as Tylenol, Advil, and Aleve. Compression bandages can help reduce swelling. Stretching and exercising can help strengthen the muscles in the area and improve mobility. For more advanced cases, splints, braces, and other assistive devices can help with recovery. Physical therapy is an important part of a multimodal approach to treating tendinitis. If pain persists with these measures, a steroid injection by an appropriately trained and qualified physician can help reduce inflammation. The goal with tendinitis is to start managing it early to improve the chances of recovery and healing. Behavior modification in the form of avoiding the activities that led to tendinitis can help prevent recurrences. For cases that do not respond well to standard treatment and for cases of tendon rupture, surgery is a viable option.