Tendinitis (Tendonitis)

Overview

Tendinitis, also spelled tendonitis, is a common condition characterized by inflammation or irritation of a tendon, the thick fibrous cords that attach muscles to bones. This condition causes pain and tenderness just outside a joint, and while it can occur in any tendon, it's most common around shoulders, elbows, wrists, knees, and heels. The condition affects millions of people worldwide and can significantly impact daily activities and quality of life.

Tendinitis typically develops from repetitive minor impact on the affected area or from a sudden more serious injury. Many activities and occupations involve repetitive motions that can lead to tendinitis, from sports like tennis and golf to jobs requiring repetitive movements. The condition is sometimes referred to by common names related to specific sports or activities, such as tennis elbow, golfer's elbow, pitcher's shoulder, swimmer's shoulder, or jumper's knee.

While tendinitis can be painful and limiting, most cases respond well to conservative treatment including rest, ice, and over-the-counter pain medications. Early recognition and treatment are crucial to prevent the condition from becoming chronic or leading to tendon rupture. With proper care and rehabilitation, most people with tendinitis can return to their normal activities without long-term complications.

Symptoms

The symptoms of tendinitis typically develop gradually, though they can appear suddenly following an acute injury. The severity and specific symptoms can vary depending on which tendon is affected and the extent of the inflammation. Most people experience symptoms primarily during and after activity, though severe cases may cause persistent pain even at rest.

Common Symptoms by Location

Shoulder pain

Common in rotator cuff tendinitis, causing difficulty lifting arms overhead

Elbow pain

Tennis elbow (lateral) or golfer's elbow (medial) affecting grip strength

Wrist pain

De Quervain's tendinitis affecting thumb movement and gripping

Knee pain

Patellar tendinitis causing pain below the kneecap during jumping or running

Ankle pain

Achilles tendinitis causing heel and calf pain, especially in morning

Hip pain

Hip flexor tendinitis causing groin pain and difficulty with hip flexion

Additional Common Symptoms

Hand or finger pain

Trigger finger or flexor tendinitis affecting grip and finger movement

Hand or finger swelling

Localized swelling around affected tendons

Arm pain

Biceps or triceps tendinitis affecting arm strength and movement

Leg pain

Hamstring or quadriceps tendinitis affecting walking and running

Foot or toe pain

Posterior tibial or peroneal tendinitis affecting foot stability

General Symptoms

  • Pain described as a dull ache, especially when moving the affected limb or joint
  • Tenderness when touching or pressing on the tendon
  • Mild swelling or thickening of the tendon
  • Stiffness in the morning that improves with gentle movement
  • A sensation of grating or crackling (crepitus) when the tendon moves
  • Weakness in the affected area
  • Warmth or redness over the inflamed tendon

Causes

Tendinitis results from microtrauma to the tendon fibers, leading to inflammation and pain. While the condition can develop from a single acute injury, it more commonly results from repetitive stress over time. Understanding the underlying causes helps in both treatment and prevention of recurrence.

Primary Causes

  • Repetitive motion: The most common cause, involving repeated stress on the tendon from work, sports, or daily activities
  • Sudden increase in activity: Dramatically increasing exercise intensity or duration without proper conditioning
  • Direct trauma: A blow or fall that impacts the tendon directly
  • Poor biomechanics: Incorrect form during activities placing abnormal stress on tendons
  • Muscle imbalances: Weakness or tightness in surrounding muscles increasing tendon strain
  • Inadequate warm-up: Beginning intense activity without properly preparing tissues

Contributing Factors

  • Age-related changes: Tendons become less flexible and more prone to injury with aging
  • Poor circulation: Reduced blood flow to tendons impairs healing and increases vulnerability
  • Metabolic conditions: Diabetes and thyroid disorders affect tendon health
  • Medications: Certain antibiotics (fluoroquinolones) and corticosteroids can weaken tendons
  • Anatomical factors: Bone spurs or abnormal joint structures creating friction
  • Previous injury: Scar tissue from old injuries making tendons more susceptible

Common Activities Leading to Tendinitis

  • Racquet sports (tennis, badminton, squash)
  • Throwing sports (baseball, cricket, javelin)
  • Swimming (especially freestyle and butterfly strokes)
  • Running and jumping activities
  • Weight lifting with poor form
  • Computer work and typing
  • Manual labor and construction work
  • Gardening and household repairs
  • Playing musical instruments

Risk Factors

Several factors can increase the likelihood of developing tendinitis. Understanding these risk factors helps identify individuals who may need to take extra precautions:

Age and Physical Factors

  • Age over 40: Tendons lose elasticity and blood supply decreases with age
  • Previous tendon injuries: History of tendinitis increases risk of recurrence
  • Poor flexibility: Tight muscles place additional stress on tendons
  • Muscle weakness: Inadequate strength to support joint movements
  • Joint hypermobility: Excessive joint flexibility can stress tendons
  • Obesity: Extra weight increases load on weight-bearing tendons

Occupational and Activity-Related Factors

  • Repetitive occupations: Assembly line work, data entry, construction
  • Overhead work: Painting, electrical work, stocking shelves
  • Vibrating tools: Power tools creating additional tendon stress
  • Sports participation: Especially racquet sports, throwing sports, running
  • Weekend warriors: Intense activity after periods of inactivity
  • Poor equipment: Improper shoes, tools, or sports equipment

Medical Conditions

Diagnosis

Diagnosing tendinitis typically begins with a thorough medical history and physical examination. Healthcare providers rely primarily on clinical findings, though imaging tests may be ordered to confirm the diagnosis or rule out other conditions.

Medical History

Your doctor will ask about:

  • Location, duration, and character of pain
  • Activities that worsen or improve symptoms
  • Recent changes in activity level or new activities
  • Previous injuries to the area
  • Occupational and recreational activities
  • Current medications
  • Other medical conditions

Physical Examination

The examination typically includes:

  • Palpation: Feeling for tenderness, swelling, or warmth along the tendon
  • Range of motion testing: Assessing movement limitations and pain patterns
  • Resistance testing: Evaluating strength and pain with specific movements
  • Special tests: Specific maneuvers to stress particular tendons
  • Comparison: Examining the unaffected side for comparison

Imaging Studies

  • X-rays: Show bone abnormalities, calcifications, or arthritis but not soft tissue
  • Ultrasound: Visualizes tendon thickness, tears, and inflammation in real-time
  • MRI: Provides detailed images of tendons and surrounding structures
  • CT scan: Rarely needed but can show bone-tendon interface problems

Differential Diagnosis

Conditions that may mimic tendinitis include:

Treatment Options

Treatment for tendinitis focuses on reducing pain and inflammation while promoting healing. Most cases respond well to conservative treatment, though chronic or severe cases may require more intensive interventions. The key to successful treatment is early intervention and addressing the underlying causes.

Initial Conservative Treatment (R.I.C.E.)

  • Rest: Avoid activities that aggravate symptoms; may require 2-6 weeks
  • Ice: Apply for 15-20 minutes, 3-4 times daily, especially after activity
  • Compression: Elastic bandages or sleeves to reduce swelling
  • Elevation: Raise affected limb above heart level when possible

Medications

  • NSAIDs: Ibuprofen, naproxen for pain and inflammation
  • Acetaminophen: For pain relief without anti-inflammatory effects
  • Topical medications: Anti-inflammatory gels or patches
  • Corticosteroid injections: For severe cases not responding to oral medications
  • Platelet-rich plasma (PRP): Emerging treatment using patient's own blood factors

Physical Therapy

  • Stretching exercises: Improve flexibility and reduce tension
  • Eccentric strengthening: Specialized exercises to remodel tendon fibers
  • Manual therapy: Soft tissue mobilization and joint manipulation
  • Ultrasound therapy: Deep heating to promote healing
  • Electrical stimulation: TENS units for pain relief
  • Dry needling: Technique to release trigger points
  • Activity modification training: Proper biomechanics and ergonomics

Alternative Treatments

  • Acupuncture: May help reduce pain and inflammation
  • Massage therapy: Improves circulation and reduces muscle tension
  • Shockwave therapy: Stimulates healing in chronic cases
  • Cold laser therapy: Low-level laser to promote tissue repair
  • Kinesiology taping: Supportive taping to reduce strain

Surgical Options

Surgery is rarely needed but may be considered for:

  • Failed conservative treatment after 6-12 months
  • Significant tendon tears or ruptures
  • Severe calcific tendinitis
  • Tendon impingement from bone spurs

Surgical procedures may include tendon debridement, repair, or release, often performed arthroscopically for faster recovery.

Prevention

Preventing tendinitis is often easier than treating it. By following proper techniques and maintaining good physical conditioning, many cases can be avoided:

Exercise and Activity Guidelines

  • Proper warm-up: Always warm up before exercise with light activity and dynamic stretching
  • Gradual progression: Increase activity intensity and duration slowly (10% rule)
  • Cross-training: Vary activities to avoid overusing specific tendons
  • Proper technique: Learn correct form for sports and exercises
  • Appropriate equipment: Use properly fitted shoes and ergonomic tools
  • Regular stretching: Maintain flexibility in muscles and tendons
  • Strength training: Build balanced muscle strength around joints

Workplace Ergonomics

  • Adjust workstation height and monitor position
  • Use ergonomic keyboards and mice
  • Take regular breaks from repetitive tasks
  • Alternate tasks when possible
  • Use proper lifting techniques
  • Wear appropriate protective equipment

Lifestyle Modifications

  • Maintain a healthy weight to reduce stress on tendons
  • Stay hydrated to maintain tissue health
  • Get adequate sleep for tissue repair
  • Manage underlying medical conditions
  • Avoid smoking, which impairs healing
  • Listen to your body and rest when experiencing pain

When to See a Doctor

While mild tendinitis often improves with home treatment, certain symptoms warrant medical evaluation:

Seek Immediate Medical Care If:

  • Sudden, severe pain suggesting possible tendon rupture
  • Complete inability to move the affected joint
  • Visible deformity or significant swelling
  • Signs of infection: fever, red streaks, warmth
  • Numbness or tingling suggesting nerve involvement

Schedule an Appointment If:

  • Pain persists despite 2-3 weeks of home treatment
  • Pain interferes with daily activities or sleep
  • Symptoms worsen or spread to other areas
  • Recurrent episodes of tendinitis
  • Weakness that doesn't improve with rest
  • You need guidance on activity modification

References

  1. American College of Rheumatology. Tendinitis and Bursitis. 2023 Guidelines.
  2. Mayo Clinic. Tendinitis: Diagnosis and Treatment. Rochester, MN. 2023.
  3. Maffulli N, et al. Tendinopathy: pathophysiology and clinical management. Nature Reviews Rheumatology. 2023.
  4. American Academy of Orthopaedic Surgeons. Tendinitis: Treatment and Prevention. 2023.
  5. British Journal of Sports Medicine. Evidence-based treatment of tendinopathy. 2023.
  6. Journal of Athletic Training. Current concepts in tendon rehabilitation. 2023.

Medical Disclaimer: This information is for educational purposes only and should not replace professional medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment of medical conditions.