Tendinitis is inflammation or irritation of a tendon, the thick, flexible cord of tissue that attaches muscle to bone.  Tendons assist the muscles in moving the bones.  While the inflammation may occur in any of the tendons in the body, tendinitis most commonly occurs around the shoulders, elbows, hands, wrists, knees, or heels.  Tendinitis is often confused with a muscle strain due to similar symptoms such as pain, tenderness, swelling, or decreased strength and flexibility.  However, those who suffer a muscle strain will notice the pain in the muscle itself, whereas in tendinitis, the pain radiates from where the muscle attaches to the bone.

Since the pain of tendinitis occurs near a joint, another common misconception is to assume the presence of arthritis.  Arthritis is a group of painful and degenerative conditions marked by inflammation in the joints that causes stiffness, pain, and limited movement.  Joints are the areas of the body where two or more bones come together.  Arthritis is characterized by a thinning of cartilage, the protective tissue that covers a joint’s surface.  Thinning cartilage leads to friction within the joint causing stiffness, pain, and reduced flexibility when moved.

Tendons are cord-like structures located where a muscle narrows to attach to a bone at the joints.  The tendon is more fibrous and dense than the supple, flexible muscle tissue, and transmits the pull of the muscle to the bone to create movement.  Although tendinitis can be caused by a sudden injury, the condition typically stems from the repetition of a particular movement over time.  The repetition can cause continued stress that overloads the area and results in microtears in the tendons.  The pain may be severe and usually occurs suddenly.  Some forms of tendinitis are named after certain sports such as tennis or golfer’s elbow, pitcher’s shoulder, swimmer’s shoulder, and jumper’s knee.  The healing time for tendinitis is several days to six weeks, depending on whether treatment starts soon after symptoms occur.

Most cases of tendinitis can be successfully treated with the RICE protocol, which stands for rest, ice, compression, and elevation.  Stretching and modification of activities is also recommended.  To reduce pain, avoid the movements that aggravate the injured tendon.  Over-the-counter anti-inflammatory medications may be used to reduce pain and swelling.  Immobilizing the area with a splint, sling, or the use of crutches will assist in avoiding further injury.  Although rest is a key part of treating tendinitis, prolonged inactivity can cause stiffness in the joints.  After a few days of completely resting the injured area, gently move through the full range of motion of the tendon to maintain joint flexibility.

If the pain does not improve after rest, a primary care physician may prescribe physical therapy to increase the flexibility and strength of the involved tendon.  Eccentric strengthening, which emphasizes contraction of a muscle while it is lengthening, has been shown to be an effective treatment for many chronic tendon conditions.  Manual therapy, such as certain types of massage, assist in promoting healing.  Dry needling, a procedure involving making small holes in the tendon with a fine needle, also stimulates healing and can reduce muscle tightness around the involved tendons.  A therapist can also instruct the patient on how to modify the form, posture, and mechanics of the repetitious physical activity to reduce the strain on the tendon.

If deemed necessary, a physician or orthopedic surgeon can administer a local injection of corticosteroids to decrease the pain and inflammation.  Corticosteroids are an anti-inflammatory medication that is chemically similar to cortisol, a natural anti-inflammatory hormone produced by the adrenal glands.  The injections typically reduce pain and inflammation within a few days, although some medications offer relief in a few hours.  The effect usually wears off after a few months.  Side effects from the injection include temporary bruising, infection, thinning of the skin, and puffiness of the face.  Corticosteroids are not recommended for tendinitis lasting over three months as repeated injections may weaken a tendon and increase the risk of rupturing the tendon.

Though the issue may become chronic in some people, tendinitis most often is a short-term condition.  Without proper treatment, tendinitis can increase the risk of experiencing tendon rupture, a much more serious condition that may require surgery.  If tendon irritation persists for several weeks or months, a condition known as tendinosis may develop, a condition that involves degenerative changes in the tendon, along with abnormal new blood vessel growth.  Do not neglect persistent tendinitis.  In addition, consult a specialist in orthopedics or sports medicine to properly diagnose and treat the pain.  Surgical intervention by an experienced orthopedic surgeon may be necessary to avoid ongoing unresponsive symptoms, particularly if a weakened tendon is at risk of tearing or rupture.