Tendinitis and Tenosynovitis

Tendinitis is inflammation of the tendon. Tenosynovitis is inflammation of the lining around the tendon (tendon sheath). These painful conditions often occur at once. Tendons attach muscle to bone. To move a limb, force from the muscle moves through the tendon, to the bone. These conditions often cause increased pain when moving. Tendinitis may be caused by a small or partial tear in the tendon.

SYMPTOMS

  • Pain, tenderness, redness, bruising, or swelling at the injury.

  • Loss of normal joint movement.

  • Pain that gets worse with use of the muscle and joint attached to the tendon.

  • Weakness in the tendon, caused by calcium build up that may occur with tendinitis.

  • Commonly affected tendons:

  • Achilles tendon (calf of leg).

  • Rotator cuff (shoulder joint).

  • Patellar tendon (kneecap to shin).

  • Peroneal tendon (ankle).

  • Posterior tibial tendon (inner ankle).

  • Biceps tendon (in front of shoulder).

CAUSES

  • Sudden strain on a flexed muscle, muscle overuse, sudden increase or change in activity, vigorous activity.

  • Result of a direct hit (less common).

  • Poor muscle action (biomechanics).

RISK INCREASES WITH:

  • Injury (trauma).

  • Too much exercise.

  • Sudden change in athletic activity.

  • Incorrect exercise form or technique.

  • Poor strength and flexibility.

  • Not warming-up properly before activity.

  • Returning to activity before healing is complete.

PREVENTION

  • Warm-up and stretch properly before activity.

  • Maintain physical fitness:

  • Joint flexibility.

  • Muscle strength and endurance.

  • Fitness that increases heart rate.

  • Learn and use proper exercise techniques.

  • Use rehabilitation exercises to strengthen weak muscles and tendons.

  • Ice the tendon after activity, to reduce recurring inflammation.

  • Wear proper fitting protective equipment for specific tendons, when indicated.

PROGNOSIS

When treated properly, can be cured in 6 to 8 weeks. Recovery may take longer, depending on degree of injury.

RELATED COMPLICATIONS

  • Re-injury or recurring symptoms.

  • Permanent weakness or joint stiffness, if injury is severe and recovery is not completed.

  • Delayed healing, if sports are started before healing is complete.

  • Tearing apart (rupture) of the inflamed tendon. Tendinitis means the tendon is injured and must recover.

TREATMENT

Treatment first involves ice, medicine, and rest from aggravating activities. This reduces pain and inflammation. Modifying your activity may be considered to prevent recurring injury. A brace, elastic bandage wrap, splint, cast, or sling may be prescribed to protect the joint for a short period. After that period, strengthening and stretching exercise may help to regain strength and full range of motion. If the condition persists, despite non-surgical treatment, surgery may be recommended to remove the inflamed tendon lining. Corticosteroid injections may be given to reduce inflammation. However, these injections may weaken the tendon and increase your risk for tendon rupture.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often recommended.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers are usually prescribed only after surgery. Use only as directed and only as much as you need.

  • Ointments applied to the skin may be helpful.

  • Corticosteroid injections may be given to reduce inflammation. However, this may increase your risk of a tendon rupture.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve, despite treatment.

  • Pain becomes too much to tolerate.

  • You develop numbness or tingling.

  • Toes become cold, or toenails become blue, gray, or dark colored.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)