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What is tendonitis?

Tendonitis (also spelled tendinitis) refers to inflammation of a tendon. It is one of the major sub-types of tendinopathy (tendon disease), along with tendinosis and paratenonitis.

Tendons are thick, fibrous cords of tissue that attach muscles to bones. They are tough, yet flexible, and have evolved to withstand tension. However, they can become injured or strained due to overuse, leading to inflammation.

Common types of tendonitis include:

• Achilles tendonitis – affects the Achilles tendon in the heel.
• Supraspinatus tendinitis – affects the tendon around the top of the shoulder joint.
• Tennis elbow – a.k.a. lateral epicondylitis. Causes pain on the outer elbow, which may radiate down towards the wrist.
• Golfer’s elbow – a.k.a. medial epicondylitis. Causes pain on the inner elbow, which may radiate down to the wrist.
• Tendonitis of the wrist – affects people who make repetitive motions with their wrists, such as badminton players and production line workers.
• Trigger finger – the affected digit becomes fixed in a bent position due to a thickened and inflamed tendon, and will usually click when forced to straighten.
• Calcific tendonitis – calcium deposits build up in the tendon, causing pain. This most commonly occurs in the shoulder, but can occur in any tendon.

Tendonitis is related to, and often goes hand-in-hand with tenosynovitis (inflammation of the sheath around the tendon, such as De Quervain syndrome).

What are the symptoms of tendonitis?

Typical symptoms of tendonitis include:

• Pain – this may worsen during movement.
• Swelling, redness, and heat
• A grating or crackling feeling when the tendon is moving
• The tendon may develop a lump.

Symptoms occur where the tendon connects to the bone. They may last anywhere between a few days and several months. Without proper treatment, the condition can develop into chronic tendinosis and leaves the patient more susceptible to ruptures in the tendon.

What causes tendonitis?

There are two main direct causes of tendonitis:

• Sudden injury
• Repetitive movements over time – these could be anything from movements made during activities like gardening, painting, or cleaning, to sports, such as tennis or golf.

As we age, our tendons lose their elasticity, and become less flexible and easier to injure or tear.

Other risk factors include jobs involving repetitive movements, sport (particularly “weekend warriors”, who are relatively inactive during the week, but push themselves hard at the weekend), and certain health conditions, like diabetes and rheumatoid arthritis, which seem to go hand in hand with a greater likelihood of developing tendonitis.

Bad posture and not warming up properly before exercise can also lead to tendonitis.

Calcific tendonitis is caused by a build-up of calcium deposits in the tendon. Exactly why this occurs is unknown.

How can tendonitis be prevented?

• Exercise – to prevent tendonitis, it is important to keep your muscles and tendons as strong and flexible as possible.
• It is equally important not to push yourself too hard, as overloading the muscles with more than they can handle is a prime cause of tendonitis.
• Stretch before and after exercise to warm up and cool down.
• Avoid repetitive movement.

What is the treatment for tendonitis?

The first line of treatment for mild tendonitis is usually RICE therapy for 2-3 days:

• Rest – avoid exercise or activity with the tendon until the injury improves.
• Ice – apply cold to the tendon for 15-20 minutes.
• Compress – wrap a bandage around it.
• Elevate – keep the injured area raised on a pillow when lying down.

It is recommended that you avoid heat, alcohol and massages for the first few days after injury.

If the injury is severe or lasts longer than a few days, you should see a doctor, who may recommend different treatments, depending on the nature and severity of the tendonitis.

Possible treatments include:

• Painkillers – NSAIDs, such as ibuprofen, are often the first line of treatment, offering pain relief and anti-inflammation.
• Steroid injections
• Shockwave therapy – may speed up healing, or may be used to break down calcium deposits in the case of calcific tendonitis
• Surgery – in very severe cases, the doctor may recommend removing damaged tissue or calcium deposits or repairing a rupture via surgery.