Tendinitis

Content

Introduction

Tendonitis is an inflammatory process of tendons, sturdy structures that connect muscle to bone and are made up of a type of tissue called connective, with a high content of a protein called collagen and a more elastic one called elastin. Tendons are essential structures for movement because they are able to transform the force generated by the contraction of muscles into displacement.

Over time, following continuous stresses, trauma and / or modifications, the fibers that make up the tendons can be damaged with the consequent appearance of tendonitis. This inflammatory process mainly affects the knees, elbows and shoulders but, at times, it can also affect other parts of the human body such as ankles, hands and wrists.

In cases where in addition to the degeneration / inflammation of the tendon there is also the involvement of the synovial membrane, the normal lining of the tendons, we speak of tenosynovites.

Tendonitis manifests itself with localized pains in the site where the damaged tendon is located and occurs during movement and on palpation. It can be caused by:

• severe trauma
• aging
• overweight
• overexertion
• repeated microtrauma
• incorrect posture (posture is the position of the human body in space and the relative relationship between its body segments)
• Sedentary life
• flat foot and valgus knee, conditions present at birth (congenital)
• exercise that overloads some joints, like the elbow in tennis players

The risk of tendonitis can increase in the presence of:

• illnesses, such as rheumatoid arthritis, hypercholesterolemia, gout and diabetes
• taking quinolone antibiotics
• frequent infiltrations with corticosteroids

To ascertain (diagnose) tendonitis, in addition to the medical examination and the collection of information on the person's health over time (anamnesis), and a clinical examination of the patient, we use magnetic resonance and ultrasound, important techniques that allow the doctor to evaluate the possible damage to the tendon.

The treatment differs depending on the location of the tendons affected by the inflammation. Absolute rest and the application of ice packs on the affected area are generally recommended. However, if the pain is very severe, the doctor may recommend taking anti-inflammatory drugs, corticosteroids and analgesics (pain relievers).

Symptoms

The main disorders (symptoms) caused by tendonitis are:

• swelling, pain and swelling, of varying extent according to the severity of the inflammatory process
• decrease in the strength of the muscles connected to the inflamed tendons
• limitation in "performing movements with the joint involved

These disorders are localized in the site where the damaged tendon is located, for example:

• knees, in case of patellar tendonitis, quadriceps tendonitis (tendon of the anterior thigh muscle), popliteal tendonitis (tendon of the muscle located at the back of the knee)
• elbows, tennis elbow
• shoulders, rotator cuff tendonitis, muscle-tendon structures of the shoulder
• ankles, Achilles tendonitis, a large tendon found in the back of the leg from the heel to mid-calf
• hiptendonitis of the gluteus medius or piriformis muscle (muscle located in the gluteus region that compresses or irritates the sciatic nerve)
• hands, feet, wrists, heels and arms

Sometimes, tendonitis can be associated with cysts and nodules as occurs in wrist tendonitis.

Causes

Tendonitis is usually caused by continuous and excessive stress on the tendons which, in the long run, can cause damage and injury to the fibers that compose them, resulting in inflammation.

Triggers of tendonitis are:

• trauma
• excessive strains
• intense efforts
• bruises
• sprains

Some sports or activities that require repetitive and intense movements, capable of causing damage to specific joints, can also cause tendonitis. I am an example:

• tennis
• I swim
• golf
• basketball
• race
• football
• dance
• playing string instruments or piano / keyboard

For example, playing tennis can cause painful inflammation of the tendons that connect the muscles in the forearm to the outside of the elbow. This condition is called tennis elbow. In people who practice running, however, the Achilles tendon can become inflamed.

Additional causes of tendonitis are:

• aging
• sudden resumption of training after a long period of rest
• inadequate footwear, while running on uneven ground
• lack or insufficient heating period, before a physical exercise
• incorrect body position
• local infiltration of corticosteroids

Furthermore, tendonitis can result from factors already present at birth (congenital) which, in the long run, can cause inflammation of the tendons. An example of this is the abnormal curvature of the spine and the faulty support of the foot on the ground.

Diagnosis

As with all diseases, being able to ascertain (diagnose) tendonitis in the early stages is essential to immediately start the most appropriate treatment. The doctor, to assess the actual presence of tendonitis, carries out a medical examination and checks the person's present and past health status (anamnesis), inquiring about his lifestyle, work and sporting activities and about "possible use of drugs.

To establish the localization of the inflamed tendon, a medical examination and verification of the disorders may sometimes be sufficient. In most cases, however, specific instrumental investigations such as ultrasound and magnetic resonance are required.

Ultrasound is a non-invasive technique useful for excluding soft tissue diseases, confirming the presence of tendonitis and assessing the extent of damage. Greater precision can be obtained with magnetic resonance imaging, a diagnostic imaging technique that allows you to assess both the extent and extent of the damage suffered.

Therapy

Treatment of tendonitis varies according to the location of the inflamed tendon and the disorders present. The initial treatment, common to all types of tendonitis, consists of:

• ice packs, to be applied for 15 minutes 4-5 times a day for 3 consecutive days. The ice must be placed on the painful area, not in direct contact with the skin to avoid injury (wrap it in a cloth or use the ice pack). The application of ice has a strong anti-inflammatory power
• rest of the painful joint, it is advisable not to overload the joint and related structures in the acute phase of the disease. Efforts can increase pain associated with inflammation and can lead to complications of varying severity, such as tendon rupture
• analgesics (pain relievers) and anti-inflammatories, to be taken for immediate pain relief

At the end of the acute phase of the disease it is necessary to proceed with rehabilitation under the guidance of qualified personnel who will decide the most appropriate exercises to perform. Normally the following are recommended:

• specific massages, to stretch and strengthen the surrounding tendons and muscles
• stretching exercises (stretching)
• Physiotherapy, such as TENS (Transcutaneous Electrical Nervous Stimulation), ultrasound, iontophoresis, TECAR (Capacitive and Resistive Energy Transfer) and laser

Furthermore, to facilitate healing, support braces or elastic bands can be used. In the case of tendonitis in the lower limbs, the use of orthotics and shoes suitable for different circumstances may be useful.

In the event that rehabilitation does not improve the state of the tendons and the disease becomes chronic (persistence over time), it may be appropriate to intervene with other forms of physiotherapy such as, for example, shock waves (high acoustic waves energy that perform a mechanical action, subjecting the structures they pass through to high pressure levels).

In case of complete rupture of the tendons, or in particular persistent (chronic) forms, it is necessary to resort to orthopedic surgical treatment.

Prevention

The prevention of tendonitis is essential for the well-being of the person and can be implemented by following some precautions and exercises.

Those who practice sports should start and end each workout with warm-up and muscle stretching exercises.

Heating initial allows the muscles to gradually adapt to the effort and avoid trauma.

Stretching it is important to stretch the muscles because if the muscle is contracted the chances of tendon rupture / inflammation are greater.

The equipment plays an important role in the prevention of tendonitis and must be suitable for the type of activity performed. People who practice running must pay particular attention to the choice of footwear, taking care that they adapt to the support of the foot and the weight of the person and that they do not have a too low and rigid sole.

An important precaution after a long break from sporting activity is to resume training gradually. It is advisable to be aware that any pain can be the alarm bell of a serious problem. In case of pain, it is necessary to stop the activity, respect an adequate period of rest and if it does not pass, contact your doctor.

Bibliography

MedlinePlus. Tendinitis (English)

Mayo Clinic. Tendinitis (English)

NHS. Tendonitis (English)

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