Tendinitis (Tendonitis)

Tendinitis (also spelled tendonitis) is the inflammation, irritation, or microscopic tearing of a tendon — the strong, flexible band of fibrous connective tissue that connects muscle to bone. Tendons transmit the force generated by muscles to move bones. **Understanding Tendon Problems:** - **Tendinitis:** Acute inflammation of the tendon (early stage, typically under 6 weeks) - **Tendinosis:** Chronic degeneration without significant inflammation (ongoing damage, failed healing) - **Tendinopathy:** Umbrella term covering both conditions **Common Types by Location:** | Type | Location | Common Names | |------|----------|-------------| | Rotator Cuff Tendinitis | Shoulder | Swimmer's shoulder, pitcher's shoulder | | Lateral Epicondylitis | Outer elbow | Tennis elbow | | Medial Epicondylitis | Inner elbow | Golfer's elbow | | De Quervain's Tenosynovitis | Thumb/wrist | Texting thumb, mommy thumb | | [Carpal Tunnel](/condition/carpal-tunnel-syndrome) related | Wrist | Wrist tendinitis | | Patellar Tendinitis | Knee | Jumper's knee | | Achilles Tendinitis | Heel/ankle | Runner's heel | | [Plantar Fasciitis](/condition/plantar-fasciitis) | Foot bottom | Related but affects fascia, not tendon | | Hip Flexor Tendinitis | Hip/groin | Dancer's hip | **How Tendinitis Develops:** 1. **Overuse/repetitive stress** causes micro-tears in the tendon 2. **Inflammatory response** brings blood flow and repair cells 3. **If rest is adequate:** tendon heals stronger (adaptation) 4. **If overuse continues:** damage outpaces repair, leading to chronic tendinopathy 5. **Degeneration phase:** tendon structure breaks down, becoming weak and prone to rupture

Tendinitis develops from a combination of mechanical, biological, and lifestyle factors: **Overuse & Repetitive Stress (Most Common Cause):** - Repetitive motions in sports (throwing, swinging, running) - Work-related repetitive tasks (typing, assembly line, construction) - Sudden increase in activity intensity or duration - Inadequate recovery time between activities - Related to [carpal tunnel syndrome](/condition/carpal-tunnel-syndrome) in repetitive hand/wrist work **Age-Related Changes:** - Tendons lose elasticity and water content after age 30 - Blood supply to tendons decreases with age - Healing capacity slows significantly - Degenerative changes accumulate — related to [osteoarthritis](/condition/osteoarthritis) development **Biomechanical Factors:** - Poor posture or technique in sports/work - Muscle imbalance or weakness - Joint instability or hypermobility - Flat feet or high arches affecting leg tendons - [Scoliosis](/condition/scoliosis) causing compensatory strain **Medical Conditions:** - [Rheumatoid arthritis](/condition/rheumatoid-arthritis) — systemic inflammation affects tendons - [Type 2 diabetes](/condition/type-2-diabetes) — impairs tendon healing and structure - [Hypothyroidism](/condition/hypothyroidism) — affects connective tissue health - [Gout](/condition/gout) — crystal deposits can irritate tendons - [Obesity](/condition/type-2-diabetes) — excess load on weight-bearing tendons - [Psoriatic arthritis](/condition/psoriatic-arthritis) — can cause enthesitis (tendon inflammation at bone attachment) **Medications That Increase Risk:** - Fluoroquinolone antibiotics (ciprofloxacin, levofloxacin) — significant tendon rupture risk - Statins (cholesterol medications) — can cause tendon pain - Aromatase inhibitors — used in breast cancer treatment - Long-term corticosteroid use — weakens tendons over time **Lifestyle Factors:** - Sedentary lifestyle with sudden activity bursts ("weekend warrior") - Inadequate warm-up before exercise - Poor ergonomic setup at work - Dehydration and poor nutrition - Smoking — reduces blood flow to tendons

Treatment follows a progressive approach: **Immediate Management (RICE/PEACE & LOVE Protocol):** - **P**rotection: Avoid activities that worsen pain - **E**levation: Keep the area elevated when possible - **A**void anti-inflammatories: In the first 48 hours (they may impair initial healing) - **C**ompression: Gentle compression to reduce swelling - **E**ducation: Understanding the condition promotes better outcomes After 48 hours: - **L**oad: Gradually reintroduce gentle movement - **O**ptimism: Positive outlook improves recovery - **V**ascularization: Pain-free cardiovascular exercise promotes blood flow - **E**xercise: Active approach to recovery **Physical Therapy (First-Line Treatment):** - **Eccentric exercises:** Loading the tendon while it lengthens (most evidence-based) - **Isometric exercises:** Static holds for pain relief (immediate analgesic effect) - Progressive loading programs tailored to the specific tendon - Manual therapy and soft tissue mobilization - Stretching and flexibility work - Correction of biomechanical issues - Similar rehabilitation approach used for [back pain](/condition/back-pain) **Medications:** - NSAIDs (ibuprofen, naproxen) for short-term pain relief - Topical anti-inflammatory gels (diclofenac) - Acetaminophen for pain management - Avoid prolonged oral NSAID use (may impair tendon healing) **Advanced Treatments:** - **Corticosteroid injections:** Effective short-term relief but may weaken tendons; limit to 2-3 per site - **Platelet-Rich Plasma (PRP):** Uses patient's own blood growth factors to promote healing - **Shockwave therapy (ESWT):** Sound waves stimulate tendon healing - **Dry needling:** Fine needles into the tendon to stimulate healing response - **Nitroglycerin patches:** Topical nitric oxide promotes tendon healing - **Ultrasound-guided procedures:** Precise treatment delivery **Bracing & Support:** - Tennis elbow straps (counterforce braces) - Wrist splints for [carpal tunnel](/condition/carpal-tunnel-syndrome) and wrist tendinitis - Patellar tendon straps for jumper's knee - Night splints for Achilles tendinitis - Shoe insoles or orthotics for lower extremity tendinitis **Surgery (Last Resort — After 6-12 Months of Failed Conservative Treatment):** - Tendon debridement (removing damaged tissue) - Tendon repair or reattachment - Arthroscopic procedures for shoulder tendinitis - Recovery: 3-6 months depending on location and procedure **Prevention Strategies:** - Gradual progression of activity (no more than 10% increase per week) - Proper warm-up and cool-down - Cross-training to avoid repetitive strain - Ergonomic workspace setup - Regular stretching and strengthening - Adequate hydration and nutrition (vitamin C, collagen)