TENDINITIS

DEFINITION

Tendinitis (pronounced tehn-duh-NI-tiss) is the inflammation of a tendon. Tendons are tough, rope-like tissue that connect muscle to bone.

DESCRIPTION

Tendinitis usually occurs in middle or old age. The condition develops when people have used the same motion over and over again for a long time. When tendinitis occurs in younger people, it is usually caused by performing the same motion very frequently over a short period of time.

A classical example of tendinitis is tennis elbow. Tennis elbow gets its name because it occurs most commonly among tennis players. Tennis players may use the same swing of their arm over and over again many times during a few hours or few days. At the end of many weeks of play, the tendon at the player's elbow may become sore and inflamed.

Tendinitis occurs most commonly in three parts of the body. They are:

• Tendons of the hand
• Tendons of the upper arm that connect with the shoulder
• Tendons that run across the top of the foot and the Achilles tendon. The Achilles tendon connects the muscles in the calf of the leg with the heel bone in the foot

CAUSES

Tendons can be injured in two ways; by sudden stretching or repeated use. In either case, the tendon may be pulled, twisted, torn, or otherwise damaged.

SYMPTOMS

When the body tries to heal injured tendons it increases the blood flow to the injured tissues and sends nutrients to the tissues to help them heal. It also sends chemicals designed to fight possible infection to the damaged area.

These steps all help the tendon to get better. But they may also produce swelling, pain, heat, and redness in the damaged tissue, as well as discomfort in the injured area.

DIAGNOSIS

Tendinitis is usually easy to diagnose. The discomfort described by the patient provides the first clue as to the disorder. The doctor will also ask about the patient's work and recreational experiences. Activities that are repeated over and over again in the injured area also suggest the possibility of tendinitis. Tennis elbow is an example of a condition that can be diagnosed by studying the patient's daily activities. The doctor can usually confirm a diagnosis by applying pressure on an injured area or trying to move a sore joint.

TREATMENT

Tendinitis is best treated by a series of steps known as RICE. The four letters in this acronym stand for:

• R est
• I ce
• C ompression
• E levation

The best way to apply ice is with ice water in a bag. The water insures that the cold will be applied directly to the skin. Chemical ice packs are not advised. They are too cold to use directly on the skin.

An elastic wrap, such as an Ace bandage, can be used to provide compression. Compression is a means of reducing swelling and keeping the joint in its proper position. In some cases, a splint may be used to keep the joint from moving.

Nonsteroidal anti-inflammatory drugs (NSAIDs) can also be used to reduce pain and swelling. Common NSAIDs are aspirin, acetaminophen (trade name Tylenol), and ibuprofen (trade names Advil, Motrin). When these medications are not effective, corticosteroids drugs may be used. Corticosteroids also reduce inflammation and swelling but are usually injected directly into the joint that has been damaged.

In extreme cases, surgery may be necessary. One purpose of surgery is to remove and/or reconstruct the damaged tendon. Another purpose of surgery may be to remove calcium buildups in the joint. Calcium tends to

A classical example of tendinitis is tennis elbow, caused by repetitive swinging of the arm. (© 1994

Jerry Wachter

. Reproduced by permission of

Photo Researchers, Inc.

)

collect in joints that are chronically (continuously) affected with tendinitis and may restrict the joint's ability to move normally.

Alternative Treatment

Hydrotherapy is sometimes effective in treating tendinitis. Warm water helps injured tissue to relax and begin healing. Acupuncture has also been used to treat the disorder. Very gentle forms of massage may also relieve pain and increase mobility in the joint. Finally, increasing the intake of certain foods that are rich in anti-oxidants (such as carrots) may help reduce inflammation.

PROGNOSIS

Injured tendons tend to heal by themselves if given sufficient time and rest. The four elements of RICE treatment can help speed up this process. Healing also occurs sooner if the patient discontinues the activities that caused the problem in the first place.

PREVENTION

Tendinitis can be prevented if a person avoids the kinds of activities that causes injuries to tendons. This instruction is easy to give, but not so easy to follow. An automobile worker, for example, may find it difficult not to perform a particular movement over and over again if that movement is part of his or her regular job. Workers and employers can often work together to arrange conditions so that tendinitis is less likely to occur.

FOR MORE INFORMATION

Books

O'Shea, Kate S. Healing Hip, Joint, and Knee Pain: A Mind-Body Guide to Recovering from Surgery and Injuries. Berkley, CA: North Atlantic Books, 1998.

Pinsky, Mark A. The Carpal Tunnel Syndrome Book: Preventing and Treating CTS, Tendinitis and Related Cumulative Trauma Disorders. New York: Warner Books, 1993.

Scott, W. Norman, Robert S. Gotlin, and Johanna Warshaw. Dr. Scott's Knee Book: Symptoms, Diagnosis, and Treatment of Knee Problems, Including: Torn Cartilage, Ligament Damage, Arthritis, Tendinitis, and Arthritis. New York: Fireside, 1996.

Villar, Richard. Knee Problems: A Patient's Guide to Treatment and Recovery. London: Thorsons Publications, 1996.

Organizations

American College of Rheumatology. 1800 Century Place, Suite 250, Atlanta, GA 30345. (404) 633–3777. http://www.rheumatology.org.

Web sites

American College of Rheumatology. "Tendinitis and Bursitis." HealthTouch Online. [Online] http://www.healthtouch.com/level1/leaflets/ACR/ACR035.htm (accessed on November 5, 1999).

"Tendonitis." [Online] http://www.yourhealth.com/ahl/2109.html (accessed on November 5, 1999).