What Is Tendinitis?

s and Tendinitistendon tears. When a tendon is weakened by age or
This report contains general information about bursitisoveruse, trauma can cause it to rupture. These injuries
and tendinitis. It describes what these conditions arecan be so sudden and agonizing that they have been
and how they are diagnosed and treated. At the endknown to bring down charging professional football
is a list of key words to help you understand theplayers in shocking fashion.
medical terms used in this report. If you have furtherHow Are These Conditions Diagnosed?
questions after reading this report, you may wish toDiagnosis of tendinitis and bursitis begins with a medical
discuss them with your doctor.history and physical examination. The patient will
What Is Bursitis and What Is Tendinitis?describe the pain and circumstances in which pain
Bursitis and tendinitis are both common conditions thatoccurs. The location and onset of pain, whether it
involve inflammation of the soft tissue around musclesvaries in severity throughout the day, and the factors
and bones, most often in the shoulder, elbow, wrist, hip,that relieve or aggravate the pain are all important
knee, or ankle.diagnostic clues.
A bursa is a small, fluid-filled sac that acts as a cushionTherapists and physicians will use manual tests called
between a bone and other moving parts: muscles,selective tissue tension tests to determine which
tendons, or skin. Bursae are found throughout the body.tendon is involved, and then will palpate (a form of
Bursitis occurs when a bursa becomes inflamedtouching the tendon) specific areas of the tendon to
(redness and increased fluid in the bursa).pinpoint the area of inflammation. X rays do not show
A tendon is a flexible band of fibrous tissue thattendons or bursae, but may be helpful in ruling out
connects muscles to bones. Tendinitis is inflammationproblems in the bone or arthritis. In the case of a torn
of a tendon. Tendons transmit the pull of the muscle totendon, x rays may help show which tendon is
the bone to cause movement. They are foundaffected.
throughout the body, including the hands, wrists, elbows,In a knee injury, for example, an x ray will show that
shoulders, hips, knees, ankles, and feet. Tendons canthe patella is lower than normal in a quadriceps tendon
be small, like those found in the hand, or large, like thetear and higher than normal in a patellar tendon tear.
Achilles tendon in the heel.The doctor may also use magnetic resonance imaging
What Causes These Conditions?(MRI) to confirm a partial or total tear. MRIs detect
Bursitis is commonly caused by overuse or directboth bone and soft tissues like muscles, tendons and
trauma to a joint. Bursitis may occur at the knee ortheir coverings (sheaths), and bursae.
elbow; for example, from kneeling or leaning on theAn anesthetic-injection test is another way to confirm
elbows longer than usual on a hard surface. Tendinitisa diagnosis of tendinitis. A small amount of anesthetic
is most often the result of a repetitive injury in the(lidocaine hydrochloride) is injected into the affected
affected area. These conditions occur more often witharea. If the pain is temporarily relieved, the diagnosis is
age. Tendons become less flexible with age, andconfirmed.
therefore, more prone to injury.To rule out infection, the doctor may remove and test
People such as carpenters, gardeners, musicians, andfluid from the inflamed area.
athletes who perform activities that require repetitiveWhat Kind of Health Care Professional Treats These
motions or place stress on joints are at higher risk forConditions?
tendinitis and bursitis.A primary care physician or a physical therapist can
An infection, arthritis, gout, thyroid disease, and diabetestreat the common causes of tendinitis and bursitis.
can also bring about inflammation of a bursa or tendon.Complicated cases or those resistant to conservative
What Parts of the Body Are Affected?therapies may require referral to a specialist, such as
Tendinitis causes pain and tenderness just outside aan orthopaedist or rheumatologist.
joint. Some common names for tendinitis identify withHow Are Bursitis and Tendinitis Treated?
the sport or movement that typically increases risk forTreatment focuses on healing the injured bursa or
tendon inflammation. They include tennis elbow,tendon. The first step in treating both of these
golfer’s elbow, pitcher’s shoulder,conditions is to reduce pain and inflammation with rest,
swimmer’s shoulder, and jumper’scompression, elevation, and anti-inflammatory
knee. Some common examples follow.medicines such as aspirin, naproxen (Naprosyn1,
To see a sketch of Tennis Elbow andAleve), or ibuprofen (Advil, Motrin, or Nuprin).
Golfer’s Elbow and many other conditions goIce may also be used in acute injuries, but most cases
to whichvitamins dot org at any timeof bursitis or tendinitis are considered chronic, and ice is
Tennis elbow refers to an injury to the outer elbownot helpful. When ice is needed, an ice pack can be
tendon. Golfer’s elbow is an injury to the innerapplied to the affected area for 15-20 minutes every
tendon of the elbow. These conditions can also occur4-6 hours for 3-5 days. Longer use of ice and a
with any activity that involves repetitive wrist turning orstretching program may be recommended by a health
hand gripping, such as tool use, hand shaking, orcare provider.
twisting movements. Carpenters, gardeners, painters,Activity involving the affected joint is also restricted to
musicians, manicurists, and dentists are at higher riskencourage healing and prevent further injury.
for these forms of tendinitis. Pain occurs near theIn some cases (e.g., in tennis elbow), elbow bands may
elbow, sometimes radiating into the upper arm or downbe used to compress the forearm muscle to provide
to the forearm. Another name for tennis elbow issome pain relief, limiting the pull of the tendon on the
lateral epicondylitis. Golfer’s elbow is alsobone. Other protective devices, such as foot orthoses
called medial epicondylitis.for the ankle and foot or splints for the knee or hand,
To see a sketch of Shoulder Tendinitis, Bursitis, andmay temporarily reduce stress to the affected tendon
Impingement Syndrome and many other conditions goor bursa and facilitate quicker healing times, while
to whichvitamins dot org at any timeallowing general activity levels to continue as usual.
Two types of tendinitis can affect the shoulder. BicepsThe doctor or therapist may use ultrasound (gentle
tendinitis causes pain in the front or side of thesound-wave vibrations) to warm deep tissues and
shoulder and may travel down to the elbow andimprove blood flow. Iontophoresis may also be used.
forearm. Pain may also occur when the arm is raisedThis involves using an electrical current to push a
overhead. The biceps muscle, in the front of the uppercorticosteroid medication through the skin directly over
arm, helps stabilize the upper arm bone (humerus) inthe inflamed bursa or tendon.
the shoulder socket. It also helps accelerate andGentle stretching and strengthening exercises are
decelerate the arm during overhead movement inadded gradually. Massage of the soft tissue may be
activities like tennis or pitching.helpful. These may be preceded or followed by use of
Rotator cuff tendinitis causes shoulder pain at the tipan ice pack. The type of exercises recommended
of the shoulder and the upper, outer arm. The pain canmay vary depending on the location of the affected
be aggravated by reaching, pushing, pulling, lifting, raisingbursa or tendon.
the arm above shoulder level, or lying on the affectedIf there is no improvement, the doctor may inject a
side. The rotator cuff is primarily a group of fourcorticosteroid medicine into the area surrounding the
muscles that attach the arm to the shoulder girdleinflamed bursa or tendon. While corticosteroid injections
shoulder blade. The rotator cuff attaches the arm toare a common treatment, they must be used with
the shoulder joint and allows the arm to rotate andcaution because they may lead to weakening or
elevate.rupture of the tendon (especially weight-bearing
If the rotator cuff and bursa are irritated, inflamed, andtendons such as the Achilles [ankle], posterior tibial
swollen, they may become compressed between the[arch of the foot], and patellar [knee] tendons).
head of the humerus and the acromion, the outer edgeIf there is still no improvement after 6-12 months, the
of the shoulder blade. Repeated motion involving thedoctor may perform either arthroscopic or open
arms, or the aging process involving shoulder motionsurgery to repair damage and relieve pressure on the
over many years, may also irritate and wear down thetendons and bursae.
tendons, muscles, and surrounding structures.If the bursitis is caused by an infection, the doctor will
Squeezing of the rotator cuff is called shoulderprescribe antibiotics. If a tendon is completely torn,
impingement syndrome.surgery may be needed to repair the damage. After
Inflammation caused by rheumatoid arthritis may causesurgery on a quadriceps or patellar tendon, for
rotator cuff tendinitis and bursitis. Sports involvingexample, the patient will wear a cast for 3-6 weeks
overuse of the shoulder and occupations requiringand use crutches. For a partial tear, the doctor might
frequent overhead reaching are other potential causesapply a cast without performing surgery.
of irritation to the rotator cuff or bursa, and may leadRehabilitating a partial or complete tear of a tendon
to inflammation and impingement.requires an exercise program to restore the ability to
To see a sketch of Knee Tendinitis orbend and straighten the knee and to strengthen the leg
Jumper’s Knee and many other conditions goto prevent repeat injury. A rehabilitation program may
to whichvitamins dot org at any timelast 6 months, although the patient can return to many
If a person overuses a tendon during activities such asactivities before then.
dancing, cycling, or running, it may elongate or undergoBrand names included in this report are provided as
microscopic tears and become inflamed. Trying toexamples only, and their inclusion does not mean that
break a fall may also cause the quadriceps muscles tothese products are endorsed by the National Institutes
contract and tear the quadriceps tendon above theof Health or any other Government agency. Also, if a
knee cap (patella) or the patellar tendon below it. Thisparticular brand name is not mentioned, this does not
type of injury is most likely to happen in older peoplemean or imply that the product is unsatisfactory.
whose tendons tend to be weaker and less flexible.Can Bursitis and Tendinitis Be Prevented?
Tendinitis of the patellar tendon is sometimes calledTo help prevent inflammation or reduce the severity of
jumper’s knee because in sports that requireits recurrence:
jumping, such as basketball, the muscle contraction and• Warm up or stretch before physical activity.
force of hitting the ground after a jump strain the• Strengthen muscles around the joint.
tendon. After repeated stress, the tendon may• Take breaks from repetitive tasks often.
become inflamed or tear.• Cushion the affected joint. Use foam for
People with tendinitis of the knee may feel pain duringkneeling or elbow pads.Increase the gripping surface of
running, hurried walking, or jumping. Knee tendinitis cantools with gloves or padding. Apply grip tape or an
increase risk for ruptures or large tears to the tendon.oversized grip to golf clubs.
A complete rupture of the quadriceps or patellar• Use two hands to hold heavy tools; use a
tendon is not only painful, but also makes it difficult fortwo-handed backhand in tennis.
a person to bend, extend, or lift the leg; or to bear• Don’t sit still for long periods.
weight on the involved leg.• Practice good posture and position the body
Achilles Tendinitisproperly when going about daily activities.
Achilles tendon injuries involve an irritation, stretch, or• Begin new activities or exercise regimens
tear to the tendon connecting the calf muscle to theslowly. Gradually increase physical demands following
back of the heel. Achilles tendinitis is a commonseveral well-tolerated exercise sessions.
overuse injury, but can also be caused by tight or• If a history of tendonitis is present, consider
weak calf muscles or any condition that causes theseeking guidance from your doctor or therapist before
tendon to become less flexible and more rigid, such asengaging in new exercises and activities.
reactive arthritis or normal aging.What Are Researchers Learning?
Achilles tendon injuries can happen to anyone whoResearchers supported by the National Institute of
regularly participates in an activity that causes the calfArthritis and Musculoskeletal and Skin Diseases
muscle to contract, like climbing stairs or using a(NIAMS) are studying the role of the immune system in
stair-stepper, but are most common in middle-agedthe inflammation of tendinitis. Their aim is to develop
“weekend warriors” who may notnew strategies to prevent and treat tendinitis
exercise regularly or take time to warm up and stretcheffectively. Others are exploring worksite issues in the
properly before an activity. Among professionaldevelopment of tendinitis and other work-related
athletes, most Achilles injuries seem to occur inmusculoskeletal disorders.
quick-acceleration or jumping sports like football, tennis,I hope you found this report helpful and remember,
and basketball, and almost always end thethere is a complete series available on most ailments
season’s competition for the athlete.and diseases. Contact me if there is a particular
To see a sketch of the Lateral View of the Ankle andailment or disease you would like to read about and
many other conditions go to whichvitamins dot org atmention it in the email.
any timePeter Charalambos
Achilles tendinitis can be a chronic condition. It can also‘What Is’ Mini E-Book Series
cause what appears to be a sudden injury. Tendinitis isThis Mini series of health ailments and condition is put
the most common factor contributing to Achillestogether for and WhichVitamins.