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Symptoms, causes and effective management of tendonitis

The term tendonitis is used to describe a painful and inflamed tendon.

A tendon is the strong cord or band of tissue that attaches the muscle to the bone and assists in the movement of joints and bones when muscles contract. Some of the body’s tendons are covered in a protective sheath that is lined with a membrane containing synovial fluid which aids the tendons movement and reduces friction.

Tendonitis in the knee is one of the most common forms of the condition and many sportsmen and women suffer from this condition on a regular basis. It is normally caused by fissures or small tears in the surrounding tissue, or gradual deterioration of tendons where they connect to the bone. When tendons are damaged in this way the related pain is referred to as tendinopathy. Tendon pain commonly affects the following areas:

  • Finger
  • Wrist
  • Elbow
  • Shoulder
  • Back of heel
  • Knee
  • Thigh

Knee conditions

The tendon joining the shin bone and the kneecap can become red, warm or swollen, causing tendonitis of the knee. This is often called jumper’s knee as it can be caused by sports such as basketball, where there are large amounts of jumping involved.

Diagram of the human knee

Shoulder problems

Patients can suffer from problems with the supraspinatus tendon, which is located at the crown of the shoulder. When you make arm movements, especially when raising it, you will experience pain. This might also be caused at night by lying on the shoulder. Calcific tendonitis is caused by calcium phosphate particles developing within the supraspinatus tendon. This will cause a mild form of pain but long-term, as well as short bursts of severe pain. Problems may spread to the arms or neck and can cause a stiff or weak neck.

Anatomical diagram of the shoulder joint

Problems in the upper arm

Problems may be experienced with the tendon that joins the bicep and shoulder. This will cause upper arm or shoulder pain, particularly when you put your arms above your head.

Anatomy of the elbow joint

Elbow symptoms

Tennis and golfer’s elbow both involve problems with the tendons at either the side or middle of your elbow. The condition means that movement of the tendons will cause pain and you may have a weaker grip or a stiff elbow.

Thumb and finger problems

De Quervain’s tendonitis is when the sheath around the tendons in your thumb thickens and swells. This makes it painful to move. You can also suffer from a trigger thumb or finger, which is where the affected joint remains bent, and it will cause a clicking effect when straightened. The symptoms include the tendon becoming inflamed and thickened.

Diagram showing the bones of the human hand

Achilles heel

With this condition, the tendon joining your calf muscle and heel becomes inflamed. It can be caused by an injury during sports or by ill-fitting shoes. Achilles heel can also be a symptom of rheumatoid arthritis.

Anatomical diagram of the foot and ankle

How to diagnose tendonitis effectively

If you believe you have symptoms of tendonitis and the problems continue, you should consult your GP.

Your GP will often be able to diagnose this painful condition which is caused by the swelling of a tendon. They should also be able to pinpoint a similar condition called tenosynovitis, which results from the swelling of the sheath that surrounds a tendon. Both can cause long-term pain, along with episodes of severe discomfort.

In order to confirm tendonitis, your doctor will ask you about the pain you are suffering; where it is affecting you and assess the level of discomfort. They may also ask you to move around so that they can determine the range of movement in a tendonitis knee or in other areas.

Your GP is likely to ask if you have suffered any recent injury during exercise, or if your job involves you using the affected area repeatedly. It will also be beneficial for the doctor to know if exercising or general movement makes your pain worse. They may even listen to your movements as well as examining you. This is because a thickened tendon sheath will sometimes make a creaking noise when you move it.

The main symptoms of the condition are pain which gets worse when you move, a grating or crackling feeling that can be felt by your doctor when they examine you, weakness in the area, a lump along the tendon, and swelling that may involve redness and heat.

Further investigation

Imaging tests are likely to be used if there is any question about the diagnosis. These include X-rays, which would reveal a broken or fractured bone or calcium deposits gathered around a tendon. Deposits would suggest that you are suffering from calcific tendonitis. This condition often affects the shoulder and may cause mild pain over long periods and shorter bursts of severe pain, which may also spread up to your neck or down your arm. Your shoulder may also become stiff or weak.

Doctor holding up an xray of a knee joint

An MRI (magnetic resonance imaging) scan or an ultrasound may also be used to provide more details about the problem. This could involve singling out the particular tendons causing tendonitis knee problems, for example.

What treatment options are available?

Following a diagnosis it is essential to get the right treatment to ensure you are able to fully recover from the condition. Typically a combination of treatments are offered / suggested to give you the best possible chance of a full and speedy recovery.

Rest, Ice, Compression, Elevation

Self-Care

Once you have confirmed the condition with your GP, you can use the range of treatment techniques below.

Rest

If sport, crouching or typing has caused tendonitis, then stop doing it. Although it’s not always possible to completely avoid the problem activity, especially if you do this for work, it is essential that you rest the tendon as much as possible. This will reduce the risk of further damage and inflammation.

Supporting the problem area will help to relieve the pressure on the tendon and give the inflammation a chance to settle. Specially made supports for commonly affected areas such as wrists, ankles, elbows and knees will provide compression to reduce inflammation, shock absorb and help to prevent overexertion of the area. Splints that can be worn at night provide immobilisation and comfort, keeping the tendon in a pressure free environment to optimise healing.

Ice

Ice packs can help to soothe the swelling associated with tendonitis. It’s recommended that you wrap an ice pack in a towel to avoid direct contact with the skin as this can cause an ice burn. Use a specific, reusable gel ice pack or bag of ice and hold it to the area for 15 to 20 minutes, whenever the heat feels uncomfortable. Following this with compression provided by a support is the best way to relieve inflammation externally.

Painkillers

Non-steroidal anti-inflammatory drugs such as ibuprofen can reduce swelling and provide pain relief in the short term. These are taken in pill form, or there is also a gel that you can apply to the area. Stronger painkillers that contain codeine can be prescribed, but it is not recommended that you take these drugs for long periods of time. Masking the pain can often lead to further injury, so it’s important that the affected area is rested as much as possible in addition to taking drugs.

Physiotherapy

This technique uses massaging and manipulation techniques to encourage the return of movement to the afflicted areas. Methods include direct massage, ultrasound, laser treatment and specific exercises to strengthen and tone the tendon and appropriate muscles.

Physiotherapy can relieve pain and aims to achieve long term improvement. For sufferers of tendonitis knee physiotherapy can begin the strengthening process, to protect vulnerable knees and prevent relapses in this problem area. After physiotherapy, wearing a support that provides compression and comfort is essential to aid the healing process.

Physiotherapist working on a mans ankle

How can be tendonitis be prevented?

If you are an active person who exercises and/or plays sport on a regular basis, you should get into the habit of warming up and cooling down properly. This prepares your body for activity, and helps to prevent injury. A proper set of gentle stretches before and after exercise can be all that is required to avoid unnecessary injury or strain, such as tendonitis knee.

Preventing reoccurrence through exercise

If you have suffered from the condition in the past, you may be able to take steps to prevent is reoccurrence. It may be a matter of changing your equipment, or perhaps working on your technique. If in doubt, always seek the advice of a professional involved in your particular sport or activity.

Working to strengthen the muscles in the area of the affected tendon is also a good way of reducing the risk of the condition returning.

Repetitive movements

Repetitive strain injury (RSI) is a type of this condition. If you are affected, it is extremely important that you try and rest the affected area, avoiding repetitive movements. If this is unrealistic, it is still very important that you try and rest whenever you are able. If your job requires repetitive movements, it is advisable to ask your employer for different duties until the problem passes. If this is not possible you will need and should insist upon structured rest periods. Your company should have access to expert ergonomic advice with regards to the positioning of office equipment - e.g. your computer - that may need reconfiguring to help to avoid a reoccurrence of the injury.