Tendonitis

Page last reviewed: 13/07/2011

Tendonitis is inflammation (swelling) of a tendon, which can cause pain in the affected area. It can affect tendons around the shoulder, elbow, wrist, finger, thigh, knee or back of the heel.

Tendonitis is caused by overusing a tendon or injuring it, for example during sport (see Causes, above).

Tendonitis is quite common and can affect anyone, but particularly adults who do a lot of sports. Also, tendons lose their elasticity and become weaker over time, making tendonitis more likely in the elderly.

What are tendons?

Tendons are the tough, rubbery cords that link muscles to bones. They help move the bones and joints when the muscles contract.

For example, the tendons you can see on the back of your hands move your fingers and are joined to the muscles in the forearm.

Some tendons are covered with a protective sheath of tissue called synovium. Between the synovium and the tendon is a small amount of greasy fluid that helps the tendon move easily and prevents friction.

What is tenosynovitis?

If the sheath surrounding the tendon (rather than the tendon itself) becomes inflamed, the condition is called tenosynovitis. Tendonitis and tenosynovitis can occur at the same time.

Experts use the term 'tendinopathies' to describe tendon injuries collectively.

Can it be treated?

Usually, painkillers and an ice pack will relieve symptoms until the tendonitis goes away after a few days. It is important to stop doing the activity that caused it.

More persistent cases may need physiotherapy or shock wave therapy (see Treatment, above).

Glossary

Tissues
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.  
Joints
Joints are the connection point between two bones that allow movement.
Inflammation
Inflammation is the body's response to infection, irritation or injury. It causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Page last reviewed: 13/07/2011

Symptoms of tendonitis include:

  • pain that becomes worse if 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 (because of the pain), and
  • a lump that develops along the tendon.

If symptoms persist, the tendon may rupture (split) and a gap may be felt in the line of the tendon. Movement of that area will become more difficult.

Glossary

Pain
Pain is an unpleasant physical or emotional feeling and your body's way of warning you it has been damaged.
Inflammation 
Inflammation is the body's response to infection, irritation or injury. It causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Page last reviewed: 13/07/2011

Tendonitis is caused by overuse of a tendon or injury. It may be the result of:

  • a sports-related injury, or
  • a repetitive strain injury (repeated overuse of muscles), which can occur in the workplace.

A tear in the tendon because of injury may cause inflammation (swelling).

Medical conditions

For reasons that are not known, tendonitis tends to occur more commonly in people with diabetes than in the general population.

Also, tenosynovitis (inflammation of the sheath surrounding the tendon) is sometimes associated with rheumatoid arthritis.

For more information on these conditions, see Useful links.

Page last reviewed: 13/07/2011

Tendonitis or tenosynovitis can be diagnosed by your GP or a specialist based on your symptoms and an examination.

Sometimes, the tendon sheath becomes thickened and a creaky sound may be heard when you attempt to move the tendon.

If there is any doubt about the diagnosis, an X-ray can be done, which may show calcium deposits around a tendon. An ultrasound or magnetic resonance imaging (MRI) scan may show inflammation (swelling) of the tendon sheath.

Examples of tendonitis and tenosynovitis

Achilles tendonitis

Achilles tendonitis is inflammation of the tendon between the heel and the calf muscle. It is commonly caused by a sports injury. It may also be caused by wearing shoes that do not fit or support the foot properly, causing you to walk awkwardly, or may be associated with rheumatoid arthritis.

Supraspinatus tendonitis

Suprastinatus tendonitis is inflammation of the tendon around the top of the shoulder joint.

It causes pain when you move the arm, particularly if you lift it high.

The pain may also occur when lying on the shoulder at night. It is often part of a condition called 'rotator cuff syndrome', where other tendons in the same area are also affected.

Tennis elbow and golfer's elbow

Tennis elbow (lateral epicondylitis) is pain in the side of the elbow. Golfer's elbow (medial epicondylitis) is pain in the middle of the elbow. 

These conditions cause pain when you move the elbow, particularly when you lift it against a force. The pain is usually around the elbow but may spread down towards the wrist.

DeQuervain's stenosing tenosynovitis

DeQuervain's stenosing tenosynovitis is inflammation of the sheath that surrounds the thumb tendons, which run between the wrist and the thumb. There is obvious swelling and thickening of the sheath and it becomes very painful to move the thumb.

Trigger finger/thumb

Trigger finger or thumb is where the finger or thumb become fixed in a bent position and there is a clicking sensation when it is straightened out. This is because of thickening and inflammation of the tendon sheath in the palm of the hand. It may also be caused by a small nodule forming along the tendon. For more information, see Useful links.

Glossary

Ultrasound
Ultrasound scans are a way of producing pictures of inside the body using sound waves.
Pain
Pain is an unpleasant physical or emotional feeling and your body's way of warning you it has been damaged.
X-ray
An X-ray is a painless way of producing pictures of inside the body using radiation.
Joint
Joints are the connection points between two bones and allow movement.
MRI
MRI stands for magnetic resonance imaging. It is the use of magnets and radio waves to take detailed pictures of inside the body.
Inflammation
Inflammation is the body's response to infection, irritation or injury. It causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Page last reviewed: 13/07/2011

An episode of tendonitis may last for only a few days but it can become more persistent and last for several weeks or months.

Self-care

Resting the tendon

Stop doing the activity that caused the condition, such as sport or typing, or at least reduce it. This will help prevent any further inflammation or damage.

It is important to rest the affected area. This will allow the inflammation to settle. Some form of support, such as a bandage, splint or brace, may be helpful as this will reduce movement.

Severe cases of tendonitis may respond to complete rest in a plaster.

Heat and ice

You can ease the pain and swelling by applying an ice pack or warm towel to the affected area. Do not use ice directly on your skin as this may cause a cold burn. Wrap it in a towel or put a towel over the injured area, before applying ice.

Painkillers

Tenosynovitis may be treated with mild non-steroidal anti-inflammatory painkillers (NSAIDs), such as ibuprofen. These should not be used for long periods of time and are not recommended for people with asthma or kidney or liver disease. 

Ordinary painkillers such as paracetamol will also help to ease the pain.

Injections and therapies

Steroid injections

If there is swelling and evidence of inflammation, a steroid injection around the affected tendon or into the tendon sheath may be effective. 

Physiotherapy

Physiotherapy, which involves manipulation and massage of the affected area, can be helpful. For more information on physiotherapy, see Useful links.

Extracorporeal shock wave therapy

If there are calcium deposits around the tendon (calcific tendonitis), they can either be surgically removed or, if the condition is persistent, treated with a procedure called extracorporeal shock wave therapy (ESWT).

ESWT involves passing shock waves through the skin to the affected areas to break up the calcium deposits.   

The National Institute for Health and Clinical Excellence (NICE) has produced guidelines on the use of ESWT for calcific tendonitis and for treating heel pain and tennis elbow (see Useful links).

Glossary

Antibiotics
Antibiotics are medicines used to treat infections caused by micro-organisms, usually bacteria or fungi. Examples of antibiotics include amoxicillin, streptomycin and erythromycin.
Pain
Pain is an unpleasant physical or emotional feeling and your body's way of warning you it has been damaged.
Ultrasound
Ultrasound scans are a way of producing pictures of inside the body using sound waves.
Corticosteroid
Corticosteroid is a naturally occurring hormone produced by the adrenal gland or a synthetic hormone with similar properties. It is used to treat inflammation, reducing swelling and pain.
Inflammation 
Inflammation is the body's response to infection, irritation or injury. It causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Physiotherapy
Physiotherapy uses physical movements, massage and exercise to relieve illness or injury.
Liver
The liver is the largest organ in the body. Its main jobs are to secrete bile (to help digestion), detoxify the blood and change food into energy.
Analgesics
Analgesics are medicines that relieve pain. Examples include paracetamol, aspirin and ibuprofen.
Kidney
Kidneys are a pair of bean-shaped organs at the back of the abdomen. They remove waste and extra fluid from blood and pass them out of the body as urine.
Anti-inflammatory
Anti-inflammatory medicines reduce swelling and inflammation.

Page last reviewed: 13/07/2011

Exercises

Exercising the affected area will strengthen the muscles around the tendon and prevent a further episode. Visit a physiotherapist for advice on the best stretching and strengthening exercises to do.

If you play sport or exercise a lot, the best way to prevent tendonitis is to warm up and stretch properly before starting, and to do exercises and stretches to cool down when you finish.

Physiotherapists and occupational therapists can give useful advice on joint protection.

Avoiding repetitive movements

Avoid repetitive movements of the affected area. If this is not possible, it is very important to take regular rests.

If you have tendonitis and your job means you have no choice but to use repetitive movements, discuss it with your employer so they can provide rest periods and different duties for you.   

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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