What is tendonitis?
Tendonitis is a term often used to describe an inflamed and painful tendon.
Tendons are strong bands or cords of tissue that attach muscle to bone. They help move the bones and joints when the muscles contract.
Some tendons are covered by a protective sheath. The sheath is lined with a membrane that contains synovial fluid, which helps the tendon to move easily and minimises friction.
Tendon pain can be caused by small tears in the surrounding tissue, or the gradual deterioration of a tendon where it connects to the bone. This type of tendon pain is often known as 'tendinopathy'.
Tendon pain can affect tendons in the:
- back of the heel
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What causes tendonitis?
Tendonitis is commonly caused by:
- a tendon injury - for example, while playing sports that involve throwing, or using a racquet, such as tennis
- overusing a tendon - for example, using a computer mouse may cause tendonitis in your wrist due to (RSI)
Tendonitis tends to be more common in people with. The reasons for this are not fully understood.
Tenosynovitis (inflammation of the sheath that surrounds the tendon) is sometimes associated with.
A painful tendon will often get better after a few days. Rest the affected area and stop doing the exercise or activity that has caused your symptoms.
Using painkillers, such asand , and applying an ice pack wrapped in a towel to the affected area (a bag of frozen vegetables wrapped in a towel works well), may also help relieve tendonitis.
For more persistent cases of tendonitis, treatments such as, or shock wave therapy may be recommended.
In some cases, surgery may be recommended to treat long-term tendon pain, such as Achilles tendinopathy or, which has not improved following treatment.
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When to see your doctor
You should go to see your doctor if your painful symptoms persist despite resting the affected area and using treatment at home.
Your doctor will usually be able to diagnose tendonitis by examining the affected area. If there is any doubt, anmay be recommended.
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If you play sport or exercise regularly, you should always warm up properly before you start. This will prepare your body for more vigorous activity and help you avoid injury. You should cool down and stretch after you finish.
Read about [how to warm up before exercising] and how to stretch after exercising.
If you have had tendonitis in the past from exercising or playing sport, you may be able to make changes to prevent it reoccurring. For example, you may need to use different equipment or seek the advice of a coach about altering or improving your technique.
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The main symptoms of tendonitis are pain and inflammation in the affected tendon.
If you have tendonitis you may have:
- pain that is worse when you move the affected area
- a sensation that the tendon is grating or crackling as it moves (this may be felt on examination)
- swelling, sometimes with heat or redness
- weakness in the affected area
- a lump that develops along the tendon
If your symptoms persist, the tendon may rupture (split) and a gap may be felt in the line of the tendon. Movement in that area will also become more difficult.
Types of tendonitis and tenosynovitis
Tendonitis can occur in many different parts of the body. If the sheath surrounding the tendon, rather than the tendon itself, becomes inflamed, the condition is known as tenosynovitis.
Supraspinatus tendonitis (shoulder)
Supraspinatus tendonitis is inflammation of the tendon at the top of the shoulder joint. It causes pain when moving your arm, particularly if you lift it up high.
The pain may also occur when you are lying on your shoulder at night. Supraspinatus tendonitis is often part of a condition called rotator cuff syndrome, where other tendons in the same area are also affected.
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Calcific tendonitis (shoulder)
In calcific tendonitis, calcium phosphate crystals form in the supraspinatus tendon in your shoulder. It can cause long-term mild pain, plus short episodes of more severe pain. The pain can spread down your arm or up into your neck.
Calcific tendonitis may also cause your shoulder to become weak or stiff. It is a similar condition to supraspinatus tendonitis, but the calcium crystals will be visible on an.
Biceps tendonitis (upper arm)
Biceps tendonitis affects the tendon that attaches the muscle on the front of your upper arm (bicep) to your shoulder. This can cause pain in your shoulder and upper arm, which may be worse if you lift or reach overhead.
Tennis elbow and golfer's elbowis pain in the side of the elbow. Golfer's elbow is pain in the middle of the elbow.
These conditions cause pain when you move your elbow, particularly when you lift it against a force. The pain is usually around the elbow joint, but may spread down your forearm towards the wrist. You may have less grip strength due to the pain and your elbow may feel stiff.
De Quervain's tenosynovitis (thumb)
De Quervain's tenosynovitis is inflammation of the sheath surrounding the thumb tendons, which run between the wrist and the thumb. There is obvious swelling and thickening of the sheath and moving your thumb will be very painful.
Trigger finger or thumbor thumb causes the finger or thumb to become fixed in a bent position which gives a clicking sensation when it is straightened out.
This is due to thickening and inflammation of the tendon sheath in the palm of the hand. It may also be caused by a small lump forming along the tendon.
Achilles tendonitis (heel)
Achilles tendonitis is inflammation of the tendon between the heel and the calf muscle.
It is often the result of a, but may also be caused by wearing poorly fitting shoes that make you walk awkwardly. It can also be associated with .
Tendonitis or tenosynovitis (inflammation of the sheath surrounding the tendon) can often be diagnosed by your doctor.
Your doctor will ask you:
- where the pain is and how severe it is
- whether you have recently injured yourself while exercising, or whether your work involves repeated use of the affected area
- whether movement or exercise makes the pain worse
You may also be asked to move the affected area to look at your range of movement.
Sometimes, the tendon sheath becomes thickened and a creaky sound can be heard when you attempt to move the tendon.
If there is any doubt about the diagnosis, imaging tests can be carried out to provide more information about your injury. For example:
- an may show calcium deposits around a tendon, indicating calcific tendonitis, or it may reveal that you have a fractured or broken bone
- an or can provide a more detailed image - for example, if it is not clear which tendon in your elbow is injured
Treatment for tendonitis
An episode of tendonitis may only last for a few days. However, sometimes it can be more persistent and last for several weeks or months.
There are a number of different treatment options, although what's best for you may depend on which tendon you have injured.
You can treat tendonitis yourself at home using the self care techniques described below.
Rest the tendon
Stop doing the activity that caused tendonitis, such as sport or typing, or at least reduce the amount you do. This will help prevent any further inflammation or damage.
It's important to rest the affected area to allow the inflammation to settle. Some form of support, such as a bandage, splint or brace, may help by reducing movement.
How long you need to rest for may depend on which tendon is affected and how severely it is damaged. For example, if you have golfer's elbow, which causes pain in the middle of your elbow, you may need to rest your elbow for at least six weeks.
Applying an ice pack to the affected area may help ease the pain and swelling. Do not put ice directly on your skin because it may cause a cold burn. Instead, wrap it in a towel or put a towel over the injured area before applying the ice pack. A bag of ice cubes or frozen vegetables wrapped in a towel works just as well.
Hold the ice pack on the affected area for around 15-20 minutes several times a day. You can also use an ice pack after exercise to try to prevent symptoms occurring.
Tendonitis can be treated with mild(NSAIDs), such as .
NSAIDs provide short-term pain relief and help reduce inflammation. They are available as a medicine that you swallow or as a gel that you apply directly to the affected area.
NSAIDs should not be used for long periods and are not recommended for people with, kidney disease or liver disease.
Other painkillers, such as, will also help ease the pain. For more severe pain, a stronger painkiller, such as codeine, can be prescribed.
Some people have reported that theirimproved after taking dietary supplements, such as amino acids. However, as yet, there is no scientific evidence to show that these supplements have any benefits.
Therapies and injections
Physiotherapy(physio), uses massage and manipulation to help recover movement and function in the affected areas. There are many different physiotherapy techniques including:
- special exercises to stretch and strengthen the tendon and surrounding muscles
- massaging the affected area
- using high-frequency sound waves (ultrasound)
- using narrow beams of light (lasers)
Physiotherapy can be used to relieve pain and may result in more long-term improvement than corticosteroid injections (see below).
Corticosteroids are medicines that contain steroids (a type of hormone) and can be used to reduce inflammation. If there is inflammation, corticosteroids can be injected around the affected tendon or into the tendon sheath.
Although corticosteroid injections can relieve pain, they do not have a long-term effect and the pain often returns. You can have another injection, but you will need to wait at least six weeks. It is not possible to have more than three injections into the same area in a year because it can increase the risk of the tendon rupturing (splitting).
Thinning and lightening of the skin are two possible side effects of corticosteroid injections.
Local anaesthetic injectionsis often used during minor surgical procedures to numb a specific area of the body. In some types of tendonitis, local anaesthetic can be injected into the affected area as well as corticosteroids.
Extracorporeal shock wave therapy
Extracorporeal shock wave therapy (ESWT) is a treatment option for tendonitis that has not responded to other treatments.
ESWT involves passing shock waves through your skin to the affected area. This may be carried out over one or more sessions and local anaesthetic may be used to numb the area first.
ESWT may help relieve the pain caused byor Achilles tendonitis, but it is not clear whether it is better than other treatment options. If you are considering this treatment, you may be asked to take part in a (medical research) to look at how effective the treatment is over time. There are also possible risks, such as:
- the tendon rupturing - in one study, this happened to 2 out of 49 people who had ESWT for Achilles tendonitis
- temporary redness or swelling
- pain during the treatment
- feeling sick
Surgery may be a possible option for some types of tendonitis. However, most cases of tendonitis improve with time so surgery is not usually necessary. You may want to try other treatments for up to a year before considering surgery.
Several different surgical techniques have been used for tennis elbow including:
- removing a damaged part of muscle from the elbow
- removing part of a ligament in your elbow (ligaments are tough bands of tissue that link two bones together at a joint)
- damaging a nerve in your elbow so that you no longer feel pain there
The benefits of surgery for tennis elbow have yet to be proven. Your symptoms may improve but this could be because the condition was getting better anyway, or it may be due to the placebo effect (when you feel better after having a 'dummy' treatment rather than a 'real' treatment).
After surgery, you should be able to start playing sport again within 4-6 months.
Surgery can be used to remove calcium deposits that have formed in the tendon in your shoulder. This can be carried out using a technique called an.
An arthroscopy is a type of keyhole surgery that can be used to look inside a joint and repair any damage. Only a very small cut needs to be made in your body.
Biceps tendonitis affects the tendon that attaches the muscle on the front of your upper arm (bicep) to your shoulder.
Surgery can be used to reattach the end of the tendon to the bone in your upper arm (humerus). This may be an option if you are in severe pain or you have torn the tendon.
Resting the affected area can stop tendonitis getting worse. Strengthening the muscles around the tendon can help prevent it reoccurring.
Avoid repetitive movements of the affected area. If this is not possible, at least make sure that you rest regularly.
If you have tendonitis and your job involves repetitive movements, ask your employer to provide rest periods and different duties for you.
It may be possible to move your computer keyboard or mouse into a more comfortable position to avoid(RSI).
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Exercising the affected area will strengthen the muscles around the tendon and help prevent further problems.
A physiotherapist (a healthcare professional who practises) will be able to advise you about the best stretching and strengthening exercises to do.
If you play a lot of sport or you exercise regularly, you can try to prevent tendonitis by warming up and cooling down properly before and afterwards.
If a particular sporting activity has caused tendonitis in the past, you may be able to make changes to prevent it occurring in the future. For example, you may need to use different equipment or ask a coach for advice about altering your technique.
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