Tendonitis pain relief



by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit




Tendonitis is inflammation involving a tendon (the fibrous structure that joins muscle to bone).

Some tendons move inside a lubricated sheath. Either from injury or repetitive movement, the tendon sheath becomes inflamed. As the sheath becomes more inflamed, it tightens on the tendon, causing pain.

Other tendons don't have a sheath. The term "tendonitis" is probably a misnomer when discussing tendon damage with these types of tendons since inflammation is minimal. The primary problem is tendon degeneration. The proper term to use is "tendinosis." Tendon problems can occur as a result of injury, overuse, or with aging as the tendon loses some of its elasticity.

They can also be seen in systemic diseases such as rheumatoid arthritis. Tendonitis can occur in any tendon, but some commonly affected sites are the shoulder, the wrist, the heel (Achilles tendon), the knee, the hand, and the elbow.


Symptoms:

• pain and tenderness around a joint (hip pain, knee pain, shoulder pain, elbow pain, wrist pain, or pain in other joints) aggravated by movement
• pain is worse with activity
• pain at night


Examples:

Shoulder: Rotator cuff tendonosis or bicipital tendonitis occurs from repetitive motion
Elbow: Repetitive motion or strain leading to tendonosis of the extensor or flexor tendon bundles (lateral and medial epicondylitis)
Wrist: Repetitive motion leading to Dequervain’s tenosynovitis, a painful tendonitis involving the thumb. Rheumatoid arthritis can cause tendonitis in the wrist and hand. When the fingers are involved, trigger finger may result. The finger catches and there is swelling and pain involving the tendon sheath.
Hip; Tendonosis in the hip usually occurs as a result of repetitive motion.
Knee: Tendonosis involving the patellar tendon results from jumping or running
Ankle and foot: The large Achilles tendon can undergo degeneration and microtears. The danger here is that it may also rupture. Rheumatoid arthritis may affect the tendons in the ankle and foot.



Physical exam will show tenderness along the affected tendon and pain when the muscle to which the tendon is attached is used against resistance. The tendon can be inflamed and boggy and the overlying skin may be warm and red.

The goal of treatment is to relieve pain and reduce inflammation. Restoration of normal function is also important.

Rest or immobilization of the affected tendons is helpful for recovery. This may be achieved using a splint, or a removable brace. The application of heat or cold to the affected area will reduce the pain and inflammation.

Non-steroidal anti-inflammatory medications (NSAIDs) help to relieve pain in addition to reducing inflammation. Physical therapy modalities such as ultrasound may be helpful. Steroid injections into the tendon sheath can be very helpful in controlling pain and allowing physical therapy to start. Care must be taken to avoid injecting the tendon itself because this can cause damage.

A more physiologic approach is to use ultrasound-guided injection of platelet-rich plasma (PRP). This is an ultraconcentrate of your own blood that contains a large number of platelets. Platelets are cells that contain many growth and healing factors.

Rarely, surgery is needed to physically remove the inflammatory tissue from around the tendon.

After recovery, strengthening exercises for the muscles surrounding the affected tendon may prevent recurrence of the injury.

Symptoms improve with treatment and rest. If the injury is caused by overuse, a change in work habits may be indicated to prevent recurrence of the problem.


Complications:

• recurrence of tendonitis
• tendon rupture


Prevention:

• avoid repetitive motion and overuse of an extremity
• warm up by stretching first, then exercising at a relaxed pace before engaging in vigorous activity
• keep all muscles strong and flexible
• alternate repetitive movements with other movements helps reduce the risk. Spend a few minutes rotating joints in the opposite direction to the repetitive movement.

For more information about tendonitis, visit our sister site:
Tendonitis TendonitisandPRP.com provides reliable, accurate, and useful information on tendonitis treatment written by a board-certified rheumatologist. Learn more about how to get tendonitis relief using the most up-to-date methods.





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