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Tendonitis
Tendons are bands of connective tissue that connect muscles to bone. When a muscle contracts, it shortens and pulls on the bone via the tendon. This causes motion across the joint, ie. the wrist, elbow, hip, knee, ankle. All muscles are attached to a bone via a tendon and the three structures are considered a functional unit. In the same way that a car moves by the engine transferring energy through the transmission to the tires, a muscle causes motion by transferring energy through the tendon to the bone it is attached to. The three structures are referred to as the muscle-tendon-bone unit. The tendon is broken down into three areas, the musculo-tendinous junction (where the muscle joins the tendon), the body of the tendon and the osteo-tendinous junction (where the tendon joins the bone). Injury can occur at any of these areas and the symptoms, treatment and recovery course may differ depending on the location of the injury.
Tendonitis occurs when the tendon becomes inflamed from overuse or is injured by overloading the muscle-tendon-bone unit. Tendonitis occurs as the result of sporting and occupational injuries, but may occur due to hobbies, home projects, or even falls. Symptoms may include warmth or redness over the injured area. Pain and tenderness in the injured area may radiate to the bony attachment or up into the muscle belly. Swelling may be present in varying degrees and weakness will be seen in the more severe cases.
Evaluation will include the history and physical examination. Plain x-rays are usually needed to exclude bony injury or tumor as the cause of the pain. In certain circumstances, further testing with an MRI may be necessary.
Treatments include rest, splints and braces, heat/ice therapy, stretching and strengthening exercises, anti-inflammatory medications, topical agents, and physical therapy. Avoidance of the activity felt to have caused the disease is usually necessary to permit healing of the tendon. In rare circumstances, surgery may be necessary in those patients who do not respond to prolonged non-surgical treatments.
If you have been prescribed anti-inflammatory medications, please take the medication daily for maximum benefit. Continue the medication until you are able to do all of your regular activities without pain.
We suggest, as a guideline to returning to your regular activities, that you have complete relief in your pain, normal range of motion of the affected joints, and normal strength of the affected muscles. Remember that the longer symptoms have been present before treatment is begun, the longer it may take for full healing to occur.
APPROACH TO HEALING
- Remember, rest is a key element of the healing process. If you continue to stress the tendon, healing will be slowed or non-existent.
- Heat or ice may be applied 3-5 times daily for 10-20 minutes. Your Physician or Physician Assistant will recommend which to use and when.
- Gentle stretching should occur after the area has been warmed with external heat or aerobic exercise. This allows for increased blood flow to the tissues and reduces the chance for further injury.
- You will be given specific strengthening exercises to begin once the tissues have healed. These are important for return to your regular activities and for prevention of recurrent injury.
- If you find that you are struggling with the recovery program, formal physical therapy may be indicated. Feel free to ask your Physician or Physician Assistant for a referral.
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