Tendinitis
(Tendonitis)
In this condition factsheet:
The Facts on Tendinitis
Tendons are cords of tissue that anchor muscles to bones. They slide back and forth as our muscles contract and our joints flex. To prevent chafing and to keep them in position, the tendons are enclosed in special coverings (sheaths) that are lubricated. When something goes wrong that prevents the tendon from moving smoothly, pain and stiffness result.
When tendons are damaged and inflamed, the condition is commonly known as tendinitis. If the problem is in the lining of the tendon's sheath, it's called tenosynovitis.
Tendinitis is most common in athletes who play golf, tennis, bowling, or baseball, and in people who have repetitive motions or tasks at their job.
Causes of Tendinitis
The most common causes of tendinitis are strain, overexertion, injury, repetitive movements, and sudden or unaccustomed movements. Tendinitis is most common in seniors and middle-aged people, since the tendons of older individuals lack the elasticity of younger people and have sustained hundreds of microscopic tears due to wear and tear over the years.
There are certain diseases that can cause tendinitis, such as rheumatoid arthritis, gout, Reiter's syndrome, lupus, and diabetes. Sometimes, people with gout have uric acid crystals that appear in the tendon sheath that cause friction and tearing. Very high blood cholesterol levels may also be linked with this condition. Quinolone antibiotics (e.g., ciprofloxacin, levofloxacin, moxifloxacin)* and aromatase inhibitors (e.g., anastrozole, letrozole) may increase the risk of tendon rupture.
Some common types of tendinitis include the following:
Rotator cuff tendinitis affects tennis players, swimmers, and anyone who frequently lifts their arms above the head and in a forward motion. This causes several shoulder tendons to rub together. Inflammation can set in and, if severe and untreated, may start to erode the tendons. Rotator cuff tendons hold the upper arm bone in the shoulder socket.
Achilles tendinitis involves the strongest tendon in the body, the one that connects the heel to the leg muscles. It's usually caused by running uphill or downhill, jumping, or engaging in sports that require sudden stopping and starting. Wearing shoes with either very soft-padded heels or very stiff soles, especially for someone whose ankles roll in, may also contribute to Achilles tendinitis. Achilles tendinitis requires special care, as the Achilles tendon must handle great force from the upper body. Special caution is especially warranted if the inflammation is due to the quinolone medications mentioned above.
Flexor digital tenosynovitis (trigger finger) may be seen in people with rheumatoid arthritis and diabetes. A protrusion or thickening of the tendon catches in the tendon sheath, causing the finger to bend and stick.
De Quervain's tenosynovitis (De Quervain's syndrome) affects the tendon sheaths extending from above the wrist to the thumb. The most common cause is excessive wringing of the wrist or other repetitive movements. In some cases, rheumatoid arthritis may be involved.
Tennis elbow is medically known as epicondylitis, since inflammation occurs at the part of the elbow where the tendon inserts. Of course, it has many other triggers besides tennis.
Symptoms and Complications of Tendinitis
The primary symptom of most types of tendinitis is pain. Usually, this is a dull ache and tightness around the affected joint with increasing pain during motion. Some positions or movements can cause a greater degree of pain than others. You may also feel the lack of smoothness in the movement of the affected muscle. Sometimes, the tendon sheath fills with liquid and becomes inflamed. In other cases, it's dry and causes obvious friction when you move. In severe cases, tendons can rupture, causing increased pain and swelling and possibly permanent change in function of the related muscle and joint.
Serious complications of tendinitis and tenosynovitis include contractures (or tightening) of the tendon, scarring (called adhesions), muscle wasting, and disability. The shoulder is the most vulnerable joint since it can freeze up, a condition called "frozen shoulder." What may start out as tendinitis becomes frozen shoulder when adhesions (scars) limit the motion and cause pain when stretching. People do not notice the difference. Keeping inflamed joints flexible through their whole range of motion helps prevent contractures and adhesions. In serious cases, the rotator cuff tendons can tear, which may lead to prolonged weakness and pain in the shoulder.
