A tendon is the end part of a muscle that attaches the muscle to the bone. The normally very elastic and soft muscle tapers off at the end to form the much more dense and stiff tendon. While this density makes the tendons stronger, the lack of elasticity of the tendon and the constant pulling on its attachment to the bone with movement, makes it much more susceptible to a low level of tearing at a microscopic level. This tearing will produce the inflammation and irritation known as tendinitis. Often spelled tendonitis, either spelling is correct for this condition. Tendinitis is usually seen after excessive repetitive movement with which the tendon gradually becomes tighter until the fibers start to tear. For example, a person who plays tennis may over-use the muscles of the elbow through hitting the ball repetitively and cause tendonitis to the area.

The most common tendon areas that become inflamed are the elbow, wrist, biceps, shoulder (including rotator cuff attachments), leg, knee (patellar), ankle, hip, and Achilles. Of course, tendonitis can will vary with each person, as it strikes the areas you use most.

Symptoms can vary from an achy pain and stiffness to the local area of the tendon, to a burning that surrounds the whole joint around the inflamed tendon. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiffer the following day.

Tendonitis Treatment Candidates

Tendonitis is almost always diagnosed on physical examination. Findings consistent with tendonitis include:

• Tenderness directly over the tendon
• Pain with movement of muscles and tendons
• Swelling of the tendon

Studies such as x-rays and MRIs are not usually needed to make the diagnosis of tendonitis. While they are not needed for diagnosis of tendonitis, x-rays may be performed to ensure there is no other problem, such as a fracture, that could be causing the symptoms of pain and swelling. X-rays may show evidence of swelling around the tendon.

MRIs are also good tests identify swelling, and will show evidence of tendonitis. However, these tests are not usually needed to confirm the diagnosis; MRIs are usually only performed if there is a suspicion of another problem that could be causing the symptoms.

Once the diagnosis of tendonitis is confirmed, the next step is to proceed with appropriate treatment. Treatment depends on the specific type of tendonitis.

Tendonitis Treatment Alternatives

Below is some advice for tendonitis treatment and avoiding recurrences of this problem. As with any treatment program, talk with your doctor before you begin tendonitis treatment! In order to aid healing you should:

Rest and Protect The Area

Tendonitis treatment must begin by avoiding aggravating movements. This may mean taking a break from a favorite activity for a period of time, but this is a necessary step to allow the inflamed tendon to heal. It is also recommended in tendonitis treatment to try alternative activities; for example, if you are a runner who is experiencing knee pain due to tendonitis, try incorporating swimming into your workout schedule. Often a splint or brace will be prescribed to help protect the area.

Apply an Ice Pack

Icing the area of inflammation is an important aspect of tendonitis treatment. The ice will help to control the inflammation and decrease swelling. By minimizing inflammation and swelling, the tendon can return to its usual state and perform its usual function.

Take Anti-Inflammatory Medications

Nonsteroidal anti-inflammatory medications (NSAIDs) include a long list of possibilities such as Ibuprofen, Motrin, Naprosyn, Celebrex, and many others.

Tendonitis treatment can be improved by these medications that will decrease pain and swelling. Be sure to talk to your doctor before starting these medications.

Cortisone Injections

If the symptoms of tendonitis are persistent, an injection of cortisone may be considered. Cortisone is a powerful anti-inflammatory medication, but instead of being given by mouth, it is injected directly to the site of inflammation. This can be extremely helpful for situations that are not improved with rest.

Not all types of tendonitis can be addressed with cortisone injections! For example, Achilles tendonitis is rarely injected with cortisone because of concerns about possible rupture of the tendon.

Tendonitis Treatment Outcome & Benifits

A total ankle replacement will last about 10 years. While it restores some range of motion to the joint, it doesn't totally restore it. Total ankle replacements tend to be less successful than hip or knee replacements. People who have total ankle arthroplasty are more likely to develop infections from the artificial joint or to require follow-up surgery due to complications.

Prepare for Tendonitis Treatment

Tendonitis or tenosynovitis can be diagnosed by your GP or a specialist based on your symptoms and an examination.

Sometimes, the tendon sheath becomes thickened and a creaky sound may be heard when you attempt to move the tendon.

If there is any doubt about the diagnosis, an X-ray can be done, which may show calcium deposits around a tendon. An ultrasound or magnetic resonance imaging (MRI) scan may show inflammation (swelling) of the tendon sheath.

Examples of tendonitis and tenosynovitis:

Achilles tendonitis

Achilles tendonitis is inflammation of the tendon between the heel and the calf muscle. It is commonly caused by a sports injury. It may also be caused by wearing shoes that do not fit or support the foot properly, causing you to walk awkwardly, or may be associated with rheumatoid arthritis.

Suprastinatus tendonitis

Suprastinatus tendonitis is inflammation of the tendon around the top of the shoulder joint.

It causes pain when you move the arm, particularly if you lift it high.

The pain may also occur when lying on the shoulder at night. It is often part of a condition called 'rotator cuff syndrome', where other tendons in the same area are also affected.

Tennis Elbow and Golfer's Elbow

Tennis elbow (lateral epicondylitis) is pain in the side of the elbow. Golfer's elbow (medial epicondylitis) is pain in the middle of the elbow.

These conditions cause pain when you move the elbow, particularly when you lift it against a force. The pain is usually around the elbow but may spread down towards the wrist.

DeQuervain's Stenosing Tenosynovitis

DeQuervain's stenosing tenosynovitis is inflammation of the sheath that surrounds the thumb tendons, which run between the wrist and the thumb. There is obvious swelling and thickening of the sheath and it becomes very painful to move the thumb.

Trigger Finger and Trigger Thumb

Trigger finger or thumb is where the finger or thumb become fixed in a bent position and there is a clicking sensation when it is straightened out. This is because of thickening and inflammation of the tendon sheath in the palm of the hand. It may also be caused by a small nodule forming along the tendon.

Tendonitis Treatment Overview

Tendons are bands or cords that connect a muscle to a bone.
Tendons are very smooth and strong, but through repetitive overuse, or with advancing age, they can become worn and weak. When a tendon becomes inflamed the medical name given to the condition is tendonitis.

Tendonitis can be caused by three things: over-use of a tendon, injury or ageing. In a small number of cases, it can be associated with other inflammatory diseases that attack the bones and joints in the body, such as rheumatoid arthritis or lupus.

One of the most common forms of tendonitis among people who engage in high-impact sports is Achilles tendonitis, which is inflammation of the tendon connecting the calf muscle to the heel bone.

The main symptoms of tendonitis are pain and stiffness. Symptoms may be more acute at night, or after vigorous exercise. There may also be swelling and tenderness in the affected area.

Tendonitis is usually diagnosed on the basis of the history and physical signs. An MRI scan can reveal any weakening of the tendon itself or changes in the tendon sheath or covering.

Although anti-inflammatory drugs may be administered to reduce swelling and inflammation, the most important form of treatment for tendonitis is: rest, ice, immobilize and elevate. Tendonitis will get worse with continued use of the inflamed tendon, so rest is vital. Temporary use of a splint may also help to rest the tendon.

For those engaged in sport, it may be useful to get some form of physical therapy such as massage or ultrasound for the affected area. Exercises which stretch and strengthen the muscles are also helpful.

Tendonitis can recur with a return to physical activity, and prolonged bouts of this painful condition can lead to rupture of the tendon itself. Those who suffer from tendonitis on a regular basis should avoid taking part in any form of exercise, which is based on excessive repetitive motions. This would include high-impact aerobics, stepping, skipping or running on a hard surface.

In repeated cases of chronic tendonitis, surgery may be considered.

Shoulder Tendons

The injured shoulder should be rested from the activities that caused the problem and from activities that cause pain. Ice packs applied to the shoulder and non-steroidal anti-inflammatory drugs will help reduce inflammation and pain.

Physical therapy to strengthen the muscles of the rotator cuff should be started. If the pain persists or if therapy is not possible because of severe pain, a steroid injection may reduce pain and inflammation enough to allow effective therapy.

If a patient does not respond to conservative (non-surgical) measures, surgery is discussed and the risks and benefits are carefully reviewed. Arthroscopic visualization is a procedure which can remove an acromial spur or improve a thickened acromion. This procedure is performed on an outpatient basis with repair of minor damage and fraying to the rotator cuff tendon. If there is scarred bursal tissue, this can also be removed at the same time. This procedure often cures impingement and prevents further rotator cuff injury.

If the rotator cuff is already torn and symptoms persist, the tendon will most likely need to be repaired surgically. Arthroscopic surgery allows a surgeon to visualize the interior of the joint to trim and remove fragments of torn cuff tendon and biceps tendon. The arthroscope can also be used when grinding or cutting away an acromial spur or thickened acromion.

If there is a small rotator cuff tear it may be repaired with arthroscopy. If it is a larger tear a mini-open procedure is often performed. When a rotator cuff tear has pulled off the bone a suture (stitch) may be needed. After locating and visualizing the tear with the arthroscope, a two-inch incision can be made directly over the tear so that stitches can connect the tendon back to the bone. Small suture screw anchors may also be used if a tear is slightly retracted.

The program after surgery depends greatly on the severity of the injury. A sling is typically worn immediately following surgery for at least a day to allow healing of the soft tissues. Range of motion exercises follow this, and then strengthening, particularly of the rotator cuff. For a completely torn rotator cuff that was treated surgically, it may take at least six months for the muscles to regain their function and for full range of motion to be restored. The pain itself is usually relieved much sooner that this, however, and normal activities of daily living are often achieved within 2-3 months even for completely torn rotator cuffs.

Each patient has the option of choosing surgery or not. The factors weighing the choice are the age of the patient, health of the patient, and severity of symptoms. If a patient is young and working, or leads an aggressive lifestyle in terms of activities, surgery will be suggested. If an older individual does not require the ability to lift overhead and the pain is not too severe, conservative treatment may be elected. If disability and ongoing pain are significant factors for any age patient, surgery should be considered to repair the rotator cuff.

Proximal Biceps Tendon Rupture. Rupture is usually transverse and either within the shoulder joint or within the proximal part of intertubercular groove. The biceps muscle bunches up in the distal arm. There is minimal loss of function.

Patients can be treated conservatively as most will become asymptomatic after 4-6 weeks. Operative treatment may be indicated for cosmetic reasons or if shoulder reconstruction is required for other reasons.

Distal Biceps Tendon Rupture. Usually caused by a single traumatic event involving flexion against resistance, with the elbow at a right angle. Most often occurs in a 50-60 year old active male. A sudden sharp tearing sensation results in a painful swollen elbow with weakness of flexion and supination. In a partial rupture, the biceps tendon will still be palpable in the antecubital fossa.

Surgery must be performed early in order to avoid scarring of biceps.

Elbow Tendons

Refractory cases of lateral epicondylitis- meaning cases where the patient has not responded to exercise, physical therapy, splinting, anti-inflammatory medicines, and steroid injections will generally undergo surgery.

Wrist and Hand Tendons

The goal is to relieve the pain caused by the irritation and swelling. Swelling around the flexor tendon and tendon sheath must be reduced to allow smooth gliding of the tendon. In some cases, your doctor may recommend resting the finger and wrist by wearing a splint. Anti-inflammatory medication taken by mouth or injected into that tendon compartment may help reduce the swelling and relieve the pain. In some cases, simply not doing the activities that cause pain and swelling may allow the symptoms to go away on their own. Treatment may also include changing activities to reduce swelling.

When symptoms are severe or do not improve, surgery may be recommended. The surgery opens the compartment (covering) to make more room for the irritated tendons . Normal use of the hand can usually be resumed once comfort and strength have returned. Your hand surgeon can advise you on the best treatment for your situation.

Knee Tendons

Patellar Tendon Rupture. Usually unilateral and due to a sports injury in patients younger than 40 years. Bilateral ruptures, with more minor trauma can occur in patients with systemic conditions such as inflammatory disease, diabetes mellitus, or chronic renal failure. There is an immediate onset of pain with a tearing sensation. Diffuse tender swelling with bruising develops in the anterior knee. A defect at the level of the rupture may be palpable. Active extension may be completely lost and the patient unable to maintain the passively extended knee against gravity.

Immediate surgical repair of the ruptured patella tendon is recommended for optimal return of function.

Quadriceps Tendon Rupture. Relatively infrequent and usually occurs in patients older than 40 years. Are most often unilateral and bilateral ruptures usually result from systemic disease and prior degenerative changes. Patients typically present with acute knee pain, swelling, and functional loss following a stumble, fall, or a giving way of the knee. There may be no history of prior knee pain. Supra-patellar swelling, bruising and tenderness are present. There is also variable loss of knee extension.

Early surgical repair yields the best results for complete quadriceps tendon ruptures. Partial tears can be treated conservatively.

Ankle and Foot Tendons

Achilles tendonitis. The best treatment of Achilles tendonitis is prevention. Stretching the Achilles tendon before exercise, even at the start of the day, will help to maintain flexibility in the ankle joint. Problems with foot mechanics can also be treated with devices inserted into the shoes. Products such as heel cups, arch supports, and custom orthotics can be used to correct for abnormalities such as overpronation and help prevent Achilles tendonitis.

Other conservative measures used to treat Achilles tendonitis include icing the injury, anti-inflammatory medications, and physical therapy.

Resting the painful Achilles tendon will allow the inflammation to be minimized and allow for healing. Therefore, cross-training is an important aspect of recovery. Steroid injections are not used in the case of Achilles tendonitis because studies have shown an increase in incidence of Achilles tendon rupture after steroid injections.

Achilles tendon rupture is generally treated surgically to reattach the tendon to its normal position. In some individuals, generally people who live sedentary lifestyles, surgery may be avoided by casting the Achilles tendon rupture for several months. However, the rate of re-rupture is much higher in the non-surgical patients. In patients who have surgery for an Achilles tendon rupture, less than 3% experience a re-rupture of the tendon.

The surgery to treat an Achilles tendon rupture involves an incision along the back of the ankle. Usually the incision is made just to the side of midline so shoes will not rub on the site of the scar. The most common and worrisome complication following an Achilles tendon repair is problems with wound healing. The skin over the Achilles tendon sometimes does not heal well. Therefore, careful wound management is of utmost important following surgical repair of an Achilles tendon rupture.

Usually patients are placed in a cast following the surgery for a period of 4-8 weeks. After the cast is removed, a walking boot can be used. Often the cast will be placed with the toes pointing slightly downwards--this eases the tension on the Achilles tendon to allow healing. There are many variations and particular physician preferences regarding how long to cast, use crutches, etc. Talk with your doctor about rehab from surgery to treat an Achilles tendon rupture as each case must be treated and rehab must take place individually.

Posterior Tibial Tendon Rupture. The posterior tibial tendon maintains the arch of the foot and rupture is one of the most common causes of acquired flat foot in adults. The foot may become so deformed that severe ankle arthritis develops. Pain frequently begins just behind the medial malleolus. The foot rolls inwards and becomes flat. Treatment of posterior tibial tendonitis begins with a good supportive arch support. The arch support is useful because it supports the arch and takes some of the stress off the tendon. You may need to decrease your activity, mainly the time up on your feet to rest the tendon. Anti-inflammatory medications, such as ibuprofen or aspirin, may be prescribed by your doctor. Cortisone injection in this condition is usually not indicated, due to the increased risk of rupture of the tendon following injection. Some physicians recommend a slightly different cortisone treatment (rather than injection) called ionophoresis. Ionophoresis is a treatment that uses electric current to increase the absorption of a cortisone cream through the skin and down around the tendon where the inflammation is occurring. There is much less of a risk of rupture of the tendon when this method is used.

If this fails to resolve the process, surgery may be required to remove the thickened tissue around the tendon. This is done to try and decrease the symptoms of pain and to prevent rupture of the tendon.

If the tendon has ruptured, surgery may be required to either repair the ruptured tendon - or to replace it with a tendon graft. Most tears will not simply be repairable, unless they only recently occurred. Usually, another tendon in the foot, such as the tendon that flexes the four lesser toes (bends them down) is used as a tendon graft to replace the function of the posterior tibial tendon.

Finally, in cases which have been neglected, and a fixed flatfoot deformity is present, a fusion (or arthrodesis) of the foot may be required. A fusion is an operation where a joint between two bones is removed and the two bones on either side of the joint are allowed to grow together - or fuse. This type of operation is used to stop pain from joints that are worn out and can be used to realign the bones when the normal mechanisms for maintaining normal alignment are lost - such as when the tendons and ligaments no longer work properly. Usually, several joints must be fused to control the flatfoot deformity occurring after posterior tibial tendon rupture.

Following surgery, you will most likely be placed in some sort of brace or cast if the tendon has been repaired or grafted. You will probably be in a cast for 6-8 weeks if a fusion has been performed.

Peroneal Tendon Rupture. Most ruptures are longitudinal tears of the peroneus brevis tendon and this usually occurs as the result of a lateral ankle sprain. The longer the injury takes to heal, the greater the suspicion of a tendon rupture. Many cases of peroneal tears are too small to find with any test other than exploratory surgery.

Most peroneal brevis tendon ruptures do not heal and require surgical repair.

However, a newer treatment for tendonitis may be more effective and prevent the need for surgery with many cases of chronic tendonitis. Percutaneous needle tenotomy is a technique where a small gauge needle is introduced using local anesthetic and ultrasound guidance. The needle is used to poke several small holes in the fascia. This procedure is called "tenotomy." Tenotomy induces an acute inflammatory response. Then, platelet rich plasma, obtained from a sample of the patient's whole blood is injected into the area where tenotomy has been performed. Platelets are cells that contain multiple healing and growth factors. The result? Normal good quality fascial tissue is stimulated to grow with natural healing.

Tendonitis Treatment Recovery

A successful ankle replacement will get rid of your pain and allow you to move your ankle to up and down. Usually, total ankle replacements last 10 or more years. How long yours lasts will depend on your activity level, overall health, and the amount of damage to your ankle joint before surgery.

After surgery, you will need to stay in the hospital for up to 4 days. When your surgery is complete, your leg will be elevated and your ankle immobilized in a splint.

A small tube that helps drain blood from the ankle joint will be left in your ankle for 1 or 2 days. To keep swelling down, you can keep your foot raised higher than your heart while you are sleeping or resting.

Your doctor may recommend physical therapy to learn exercises that will help with ankle motion.

Tendonitis Treatment After Care

Stop doing the activity that caused the condition, such as sport or typing, or at least reduce it. This will help prevent any further inflammation or damage.

It is important to rest the affected area. This will allow the inflammation to settle. Some form of support, such as a bandage, splint or brace, may be helpful as this will reduce movement.

Severe cases of tendonitis may respond to complete rest in a plaster.

You can ease the pain and swelling by applying an ice pack or warm towel to the affected area. Do not use ice directly on your skin as this may cause a cold burn. Wrap it in a towel or put a towel over the injured area, before applying ice.

Tenosynovitis may be treated with mild non-steroidal anti-inflammatory painkillers (NSAIDs), such as ibuprofen. These should not be used for long periods of time and are not recommended for people with asthma or kidney or liver disease.

Ordinary painkillers such as paracetamol will also help to ease the pain.

Some Tendonitis Expert Tips to Help:

• Once the incisions have sealed, start Ice Dipping your forearms and hands.
• Increase your Protein intake. You need the extra building blocks to heal.
• Keep your wrist moving just a little bit, as constantly as you can. The more it moves, the better it heals.

Tendinitis Possible Risks

The most common causes of tendinitis are injury, overuse, infection of the tendon sheath or disease (tendinitis is evident in rheumatoid arthritis, gout and psoriatic arthritis). More often than not, the cause of tendinitis is unknown.