| #ffffff;" /> | | | | Dequervain’s tendonitis, is felt on the outside of |
| So, you’ve been diagnosed with tendonitis and | | | | the thumb. |
| you’ve gone through the usual types of | | | | Tendonitis in this area is managed with glucorticoid |
| treatment programs like physical therapy, | | | | injections and immobilization with a splint. Physical |
| anti-inflammatory drugs, and even cortisone shots. | | | | therapy modalities may be helpful. Rarely, if ever, is |
| What else is available? | | | | surgery required. Tendonitis in the fingers can lead to |
| Before we discuss the exciting new ways of | | | | catching of the fingers. This is termed “trigger |
| managing chronic tendonitis, let’s talk about | | | | finger.” Trigger finger usually responds to |
| what tendonitis is… and what it isn’t. | | | | injection. |
| Tendons are thick cords of fibrous tissue that connect | | | | Tendonitis in the knee may affect the patellar tendon. |
| muscles to bones. It is this connection that allows joint | | | | This is the tendon that connects the knee cap to the |
| motion. When muscles contract, they pull on the | | | | tibia (lower leg bone). Patellar tendonitis usually occurs |
| tendons which cause the bones to move. | | | | because of excessive jumping and is actually called |
| In order for tendons to glide they move inside a | | | | “jumpers knee.” This is treated with rest, |
| lubricated sheath of tissue that is lined with synovial | | | | anti-inflammatory medications, and physical therapy. |
| tissue. This synovial tissue is the same type of tissue | | | | Tendonitis in the ankle can occur along the outside of |
| that lines the inside of joints. Tendonitis occurs when | | | | the ankle (peroneal tendonitis), the inside of the ankle |
| the sheath through which a tendon glides becomes | | | | (posterior tibial tendonitis), or at the back of the ankle |
| inflamed. This leads to severe pain. The pain usually | | | | (Achilles tendonitis). The tendonitis that occurs along |
| gets worse with use of the affected joint. However, | | | | the outside or inside of the ankle can occur because |
| when tendonitis becomes severe, there may be pain | | | | of trauma or because of mechanical instability. Another |
| at rest, particularly at night. | | | | potential cause is an underlying arthritis condition. |
| Since muscles and tendons surround most joints, | | | | Achilles tendonitis often occurs as a result of |
| tendonitis is rather common. The diagnosis of tendonitis | | | | excessive stress and loading of the tendon as well as |
| is relatively simple for the experienced clinician. | | | | repetitive motion. The Achilles tendon is the thick cord |
| Generally, the diagnosis is made by history and | | | | at the back of the ankle that connects the heel bone |
| physical examination. In difficult diagnostic cases, | | | | to the calf muscle. Treatment involves rest, elevation |
| diagnostic ultrasound or magnetic resonance imaging is | | | | of the heel to take the tension off the Achilles tendon, |
| helpful in confirming the diagnosis. | | | | and physical therapy. Glucocorticoid injection should be |
| Some of the more common types of tendonitis are: | | | | avoided because of the danger of Achilles tendon |
| Shoulder tendonitis. The tendons in the shoulder that | | | | rupture. Anti-inflammatory medication may be helpful. |
| are most often affected are the rotator cuff and | | | | So what can be done to treat chronic tendonitis? |
| biceps tendons. | | | | What can you do if you’ve tried all of the |
| The rotator cuff consists of four tendons that sit on | | | | above treatments and still have a problem? |
| top of the upper arm bone. They are the | | | | The first new approach, particularly with tendons that |
| supraspinatus, infraspinatus, subscapularis, and teres | | | | are balky is to use hydrodissection. This is a form of |
| minor tendons. The location of these tendons and the | | | | treatment where a small gauge needle is introduced |
| muscles they attach to are what give the shoulder | | | | into the tendon sheath and a large volume of saline, |
| such a great range of motion. | | | | glucocorticoid, and lidocaine are used to dissect the |
| Rotator cuff tendonitis may occur as a result of | | | | sheath away from the tendon. Often chronic |
| repetitive activity or tendon degeneration. Pain is felt | | | | inflammation causes the sheath and tendon to stick |
| with most movements and is usually located on the | | | | together and this can cause pain as well as loss of |
| outside part of the shoulder. Certain movements such | | | | function. This type of therapy is particularly effective |
| as reaching behind or to the side may be | | | | for the small tendons in the hand. |
| uncomfortable. | | | | Another new form of therapy called tenotomy is now |
| The biceps tendon permits the arm to be flexed at the | | | | being used. This almost always negates the need for |
| elbow. Biceps tendonitis also occurs due to repetitive | | | | an open surgical procedure. With tenotomy, a small |
| activity and pain is felt in the front of the shoulder. | | | | gauge needle is introduced with local anesthetic and |
| Shoulder tendonitis can sometimes be treated | | | | used to “irritate” the insertion of the |
| successfully with anti-inflammatory medication, physical | | | | tendon where the site of inflammation is located. The |
| therapy, and occasionally glucocorticoid (cortisone) | | | | needle is inserted using direct ultrasound visualization. |
| injection. These methods are most useful for acute | | | | After the needling, injection of a small amount of |
| tendonitis. | | | | platelet rich plasma (PRP) is performed at the site of |
| Tendonitis in the elbow is usually located either on the | | | | needling, again using direct ultrasound visualization. PRP |
| outside and is called lateral epicondylitis or tennis elbow. | | | | is rich in growth factors that stimulate healing. The |
| It may also occur along the inside part of the elbow- | | | | process of healing takes only a few days to weeks |
| medial epicondylitis. This is called golfer’s elbow. | | | | as opposed to the several weeks to months that an |
| Treatment for this condition consists of physical | | | | open surgical procedure takes. |
| therapy, stretching and strengthening exercises, splints, | | | | Tenotomy can be performed at almost any site |
| and injections. While surgery is sometimes | | | | where there is chronic tendon inflammation. Results |
| recommended for chronic case, I will discuss why that | | | | are usually excellent. |
| is inadvisable. | | | | Both of these procedures are excellent for the aging |
| Tendonitis in the wrist arises because of repetitive | | | | athlete who wants to keep going. |
| motion. A peculiar form of tendonitis, called | | | | |