Not every type of tendonitis responds to the same treatments, and knowing the exact source of your discomfort can help to address the problem. Listed below, you'll find some of the most common types of tendonitis, along with links to information about treatments that may be effective for each type.
Achilles tendonitis causes pain and swelling in the back of the heel. People with this condition often complain of pain and stiffness and feel a lump behind the ankle joint.
Achilles pain often loosens up with some gentle activity but tends to worsen as activities are increased. Understanding this common problem can help with treatment and help to avoid serious complications such as Achilles tendon rupture. Occurring not far from the location of Achilles tendonitis, posterior tibial tendonitis is less common, but should be considered in people with symptoms of pain on the inner side of the ankle.
Posterior tibial tendonitis typically causes pain with walking and can make it almost impossible to stand up on your toes.
Left untreated, posterior tibial tendonitis can result in a flat foot. Changes in footwear, such as supportive shoes and orthotics, can be helpful for initial symptoms. Patellar tendonitis , or inflammation of the patellar tendon, is a condition often called jumper's knee.
This condition causes pain and swelling directly under the kneecap and is a common problem in basketball players and other athletes who perform repeated jumping activities. Treatment of patellar tendonitis usually consists of rest and anti-inflammatory medication. The most challenging part for many athletes is avoiding activities that specifically re-aggravate this condition. Recent studies have investigated the use of newer treatments such as PRP injections for this condition.
Many patients who have pain in their shoulder are told by their doctor they have shoulder bursitis or rotator cuff tendonitis. This common cause of shoulder pain is the result of irritation to the tendons that help to lift the arm away from your side, as well as inflammation of the bursa that surrounds those tendons. Treatment of rotator cuff tendonitis can almost always be accomplished with non-surgical treatments, although in some rare situations surgery may become necessary.
Tennis elbow is a common cause of elbow pain due to irritation of the tendons over the outside of the elbow joint. Commonly associated with people who play tennis, lateral epicondylitis can occur in people who perform other sports or repetitive activities of the wrist and elbow.
Injections for tennis elbow are controversial, but often used for treatment. Wrist tendonitis is a common problem that can cause pain and swelling around the wrist joint. Wrist tendonitis is due to inflammation of the tendons and often involves fluid accumulation in the tendon sheath.
One of the most important aspects is to identify the tendon or tendons that are causing the problem so that treatment can be targeted. Splinting will not be effective if the problematic tendons are not being rested. Treatment of wrist tendonitis usually does not require surgery.
Once the type of tendonitis is identified, a more targeted approach to treatment can be pursued. The good news is that tendonitis symptoms can almost always be resolved with non-invasive treatments, and only in rare circumstances do they become more persistent and difficult to manage. Tendonitis is among the most common orthopedic conditions for which people seek treatment. There are hundreds of tendons throughout your body, any of which can become inflamed.
That said, certain tendons are much more prone to developing problems related to this inflammation. Try out PMC Labs and tell us what you think.
Learn More. Think tendinitis and you think pain and burning in the affected area, decreased strength and flexibility, and pain caused by everyday activities. As it turns out, tendinosis is far more often responsible for these symptoms than tendinitis 1 , 2 , 3. It is important for health care practitioners to distinguish between these disorders in order to apply the most appropriate treatment.
Tendinitis is still a very common diagnosis, though research increasingly documents that what is thought to be tendinitis is usually tendinosis 1 , 2 , 3 , 4 , 5. Even tiny movements, such as clicking a mouse, can cause tendinosis, when done repeatedly. The confusion about the difference between tendinitis and tendinosis is widespread. Many injuries commonly presumed to be tendinitis are actually tendinosis. The histology of tennis elbow shows that it is actually tendinosis 5. These changes result in a loss of strength in the tendon and increase the bulk of the tendon, both of which contribute to the cycle of injury and can set the stage for secondary conditions, such as tendinitis and nerve impingement.
My study leads me to believe that, in the forearm and wrist, tendinosis can result in secondary carpal tunnel syndrome; this is because the thickening of the tendons with excess ground substance and the swelling of the surrounding tissue crowds and compresses the median nerve. There is a prevalent supposition that tendinosis begins with tendinitis, which then instigates a healing process that changes the collagen and weakens the tendon, becoming tendinosis. Perhaps this supposition exists because the stages of soft-tissue healing are generally listed as, in short: inflammation response, regeneration collagen production , and remodeling strengthening the collagen in the direction of the forces placed upon it.
In one article, tendinitis is cited as the first stage of a tendinopathy; tendinosis is cited as the second stage and rupture as the third stage.
The fourth stage is described as a combination of stages 2 and 3, along with fibrosis and calcification 2. The suggestion that tendinitis precedes tendinosis is at odds with the fact that a healthy tendon is up to twice as strong as the muscle, making the body of the tendon unlikely to tear before the muscle unless the tendon has already been weakened by degenerative changes 6. The idea that tendinitis is the first stage of tendinosis seems to presume that micro-tears and inflammation are a precursor to collagen degeneration.
Histopathologic analyses show that torn fibers, scar tissue, and calcification are only found in conjunction with tendinosis some of the time, and inflammatory cells are rarely found in conjunction with tendinosis, supporting the hypothesis that tendinitis occurs secondarily to tendinosis 1 , 2 , 3 , 5 , 7.
Arnoczky et al. The most important reason to distinguish between tendinitis and tendinosis is the differing treatment goals and timelines. In fact, some treatments to reduce inflammation are contraindicated with tendinosis.
Ibuprofen, a nonsteroidal anti-inflammatory, is associated with inhibited collagen repair 9. Corticosteroid injections inhibited collagen repair in one study, and were found to be a predictor of later tendon tears 3 , 4 , The healing time for tendinitis is several days to 6 weeks, depending on whether treatment starts with early presentation or chronic presentation 3. Khan et al. It is suggested by Rattray and Ludwig 10 that effective treatment might take up to 9 months once the tendinosis is chronic.
Knowing these timelines is part of creating an effective treatment plan. It is a matter of coincidence that some of the separate treatment goals for tendinitis and tendinosis result in overlapping beneficial treatment methods. For example, deep-friction treatments are beneficial for both conditions, but for very different reasons. In the case of tendinitis, deep friction serves to reduce adhesions and create functional scar tissue once inflammation has subsided.
In the case of tendinosis, deep-friction treatments serve to stimulate fibroblast activity and collagen production Lucky concurrence of treatment recommendations is not to be substituted for a thorough understanding of which condition is being treated. Accurate assessment techniques and knowledge of the relevant condition will result in the most appropriate application of treatment. The primary treatment goals for tendinosis are to: break the cycle of injury; reduce ground substance, pathologic vascularization, and subsequent tendon thickening; and optimize collagen production and maturation so that the tendon regains normal tensile strength 3.
Massage therapists must be aware of their own skill set in applying treatment recommendations and educating patients about self-care. People with low-grade tendon injuries often find it difficult to rest as much as is necessary, especially as symptoms subside 3. With repetitive work tasks, the patient is recommended to take a break for one minute every 15 minutes and a five-minute break every 20—30 minutes Some people will need to rest even more than this at the start of treatment.
The patient should be advised to stay aware of their body as it heals. Using proper technique is especially important when performing repetitive sports movements or job-related activities. Improper technique can overload the tendon — which can occur, for instance, with tennis elbow — and lead to tendinitis. Risk factors for developing tendinitis include age, working in particular jobs or participating in certain sports.
As people get older, their tendons become less flexible — which makes them easier to injure. You may be more likely to develop tendinitis if you participate in certain sports that involve repetitive motions, especially if your technique isn't optimal. This can occur with:. Without proper treatment, tendinitis can increase your risk of experiencing tendon rupture — a much more serious condition that may require surgery.
If tendon irritation persists for several weeks or months, a condition known as tendinosis may develop. This condition involves degenerative changes in the tendon, along with abnormal new blood vessel growth.
Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. Overview Shoulder joint Open pop-up dialog box Close. Shoulder joint Tendons are thick fibrous cords that attach muscles to bone.
Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Adams JG. Tendinitis and bursitis.
0コメント