Tendonitis

Tendonitis (also spelled tendinitis) is the inflammation or irritation of a tendon, which is the thick, fibrous cord that attaches muscle to bone.

Tendons help muscles move bones, and tendonitis occurs when these tendons become irritated, often due to repetitive motions or overuse. It commonly causes pain and tenderness around the affected joint, and it can affect any tendon in the body.

Common Causes of Tendonitis:

1. Repetitive motion or overuse: Repeated movements in work or sports can irritate tendons.
2. Sudden increase in activity level: Jumping into intense physical activity without proper preparation.
3. Age: Tendons become less flexible with age, increasing the likelihood of injury.
4. Injury: Trauma or sudden injury to a tendon can lead to inflammation.
5. Poor posture or technique: Improper posture or technique during activities can put extra strain on tendons.
6. Certain medical conditions: Conditions like diabetes or rheumatoid arthritis can increase the risk of tendonitis.

Symptoms of Tendonitis:

• Pain: Often described as a dull ache, particularly when moving the affected limb or joint.
• Tenderness: The area around the tendon may be sensitive to touch.
• Swelling: Mild swelling around the affected area.
• Stiffness: Reduced range of motion in the joint near the affected tendon.
• Warmth and redness: In more severe cases, the skin around the tendon may feel warm or look red.

Common Types of Tendonitis:

1. Achilles Tendonitis:
   • Inflammation of the tendon at the back of the ankle (Achilles tendon).
   • Common in runners and people who participate in sports that involve jumping.
   • Symptoms include pain at the back of the ankle and stiffness that may improve after warming up.
2. Tennis Elbow (Lateral Epicondylitis):
   • Affects the tendons on the outside of the elbow.
   • Often caused by repetitive wrist and arm movements.
   • Symptoms include pain and tenderness on the outer part of the elbow.
3. Golfer’s Elbow (Medial Epicondylitis):
   • Affects the tendons on the inside of the elbow.
   • Caused by repetitive stress from gripping or lifting objects.
   • Symptoms include pain on the inner side of the elbow and sometimes radiating down the forearm.
4. Rotator Cuff Tendonitis:
   • Inflammation of the tendons around the shoulder joint.
   • Common in people who perform overhead activities, such as painters or athletes.
   • Symptoms include shoulder pain, particularly when raising the arm, and a feeling of weakness.
5. Patellar Tendonitis (Jumper’s Knee):
   • Involves inflammation of the tendon connecting the kneecap to the shinbone.
   • Common in sports that involve jumping or frequent bending of the knee.
   • Symptoms include pain in the front of the knee, particularly when jumping or squatting.
6. De Quervain’s Tenosynovitis:
   • Affects the tendons on the thumb side of the wrist.
   • Often seen in people who engage in repetitive hand and wrist motions, such as lifting or texting.
   • Symptoms include pain and swelling near the base of the thumb.
7. Trigger Finger (Stenosing Tenosynovitis):
   • A condition where a finger or thumb gets stuck in a bent position and then straightens with a snap.
   • Caused by inflammation in the tendon sheath in the palm of the hand.
   • Symptoms include pain and a catching or popping sensation when moving the affected finger.

Diagnosis:

Tendonitis is usually diagnosed through a physical examination, where the doctor checks for pain, swelling, and tenderness around the affected area. In some cases, imaging tests such as X-rays or ultrasound may be used to rule out other conditions or assess the severity of the tendon injury.

Treatment for Tendonitis:

1. Rest:
   • Avoid activities that aggravate the pain. Resting the affected area helps reduce inflammation and allows the tendon to heal.
2. Ice:
   • Apply ice to the affected area for 15-20 minutes several times a day to reduce pain and swelling.
3. Compression and Elevation:
   • Wrapping the area with an elastic bandage and elevating it can help reduce swelling.
4. NSAIDs:
   • Nonsteroidal anti-inflammatory drugs like ibuprofen or naproxen can reduce inflammation and pain.
5. Physical Therapy:
   • Exercises to stretch and strengthen the muscles and tendons around the affected joint can aid recovery and prevent further injury.
   • Therapists may use ultrasound or electrical stimulation to promote healing.
6. Steroid Injections:
   • Corticosteroid injections may be used for severe or chronic tendonitis to reduce inflammation.
   • These should be used with caution, as repeated injections can weaken the tendon over time.
7. Braces or Splints:
   • Wearing a brace or splint can help immobilize the affected area and relieve pressure on the tendon during healing.
8. Surgery:
   • In rare cases, when conservative treatments fail and the tendonitis becomes chronic, surgery may be necessary to repair the damaged tendon.

Prevention:

• Proper warm-up: Stretch and warm up before physical activities to reduce strain on tendons.
• Gradual progression: Increase the intensity of exercises or activities gradually to avoid overloading the tendons.
• Correct technique: Use proper posture and technique during activities to avoid unnecessary strain on tendons.
• Strengthen muscles: Strengthening the muscles around tendons can help support and protect them from injury.
• Rest and recovery: Take breaks during repetitive activities and ensure enough recovery time between intense workouts.

Prognosis:

With proper treatment and rest, most cases of tendonitis improve within a few weeks. However, if left untreated or if the activity causing the irritation is not modified, it can lead to chronic tendonitis or even a tendon rupture, which requires surgical intervention.

Listing of Medications for Tendonitis Treatment

When treating tendonitis, the goal is to reduce inflammation, relieve pain, and promote healing. Treatment options often involve a combination of rest, physical therapy, and medications. Below is a detailed list of medications that are commonly used for tendonitis treatment:

1. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

These are the most commonly prescribed medications for reducing pain and inflammation in tendonitis.

Over-the-counter (OTC) NSAIDs:

• Ibuprofen (e.g., Advil, Motrin)
• Naproxen (e.g., Aleve)
• Aspirin

Prescription NSAIDs:

• Diclofenac (e.g., Voltaren, Cataflam, Zorvolex)
  • Available as oral tablets and topical gels.
• Indomethacin (e.g., Indocin)
  • Typically used for more severe cases of inflammation.
• Meloxicam (e.g., Mobic)
  • Often prescribed for longer-term use due to its once-daily dosing.
• Celecoxib (e.g., Celebrex)
  • A COX-2 inhibitor that may have fewer gastrointestinal side effects compared to traditional NSAIDs.

2. Corticosteroids

Corticosteroid medications help to reduce severe inflammation, especially in chronic tendonitis cases. These are typically administered through injections directly into the inflamed tendon.

• Methylprednisolone (e.g., Depo-Medrol)
• Triamcinolone (e.g., Kenalog)
• Hydrocortisone

Note: Corticosteroid injections are typically used sparingly, as repeated injections can weaken the tendon over time and increase the risk of tendon rupture.

3. Topical Analgesics

Topical medications are applied directly to the skin over the affected tendon and are helpful in managing localized pain and inflammation.

• Diclofenac gel (e.g., Voltaren Gel)
  • An NSAID-based topical gel commonly used for tendonitis.
• Capsaicin cream (e.g., Zostrix)
  • Reduces pain by depleting substance P, a chemical involved in pain signaling.
• Lidocaine patches (e.g., Lidoderm)
  • Provides localized pain relief by numbing the area.

4. Pain Relievers (Analgesics)

If NSAIDs are not suitable due to contraindications or side effects, other pain relievers may be used to manage tendonitis pain.

• Acetaminophen (e.g., Tylenol)
  • Provides pain relief but does not reduce inflammation.
  • Often used when NSAIDs are not recommended due to gastrointestinal or kidney concerns.

5. Muscle Relaxants

In some cases, muscle relaxants may be prescribed to reduce muscle tension and spasms associated with tendonitis.

• Cyclobenzaprine (e.g., Flexeril)
• Methocarbamol (e.g., Robaxin)

These are typically used for short-term relief in acute tendonitis cases.

6. Opioids (Short-term Use)

For severe pain that is not relieved by NSAIDs or other medications, doctors may prescribe opioids for short-term use. Opioids are not typically used for long-term management due to the risk of dependence.

• Codeine (e.g., Tylenol with Codeine)
• Hydrocodone (e.g., Norco, Vicodin)
• Oxycodone (e.g., Percocet)

7. Platelet-Rich Plasma (PRP) Therapy

This is a more recent treatment option for tendonitis and involves injecting concentrated platelets from the patient’s blood into the affected tendon. PRP therapy aims to promote healing and reduce inflammation.

• While PRP therapy is not a medication, it is a treatment that has shown promise, especially for chronic tendonitis.

8. Supplements for Tendon Health

While not medications, certain supplements may help support tendon health and recovery from tendonitis. These are often used alongside other treatments.

• Glucosamine and Chondroitin:
  • These supplements are believed to support joint and tendon health.
• Omega-3 Fatty Acids:
  • Found in fish oil, these have anti-inflammatory properties.
• Collagen Supplements:
  • Collagen is important for tendon health and repair.
• Vitamin C:
  • Supports collagen production and tendon repair.

9. Antibiotics (in Rare Cases)

While antibiotics are not typically used for tendonitis, some antibiotics like fluoroquinolones (e.g., ciprofloxacin, levofloxacin) are known to increase the risk of tendonitis and tendon rupture, particularly in older adults. If tendonitis occurs in patients taking fluoroquinolones, the medication should be discontinued, and alternative antibiotics should be considered.

Combination Therapy

In some cases, a combination of therapies might be used. For instance:

• NSAIDs for initial inflammation relief.
• Corticosteroid injections for severe pain and inflammation.
• Physical therapy and topical treatments for long-term management.

Important Notes:

• Long-term use of NSAIDs should be monitored by a doctor, as these drugs can cause gastrointestinal problems, kidney issues, and cardiovascular risks.
• Steroid injections should be used with caution, especially in tendons, as repeated injections can lead to tendon weakening and even rupture.
• Consult a doctor for the best treatment plan, as medications should be chosen based on individual health conditions, medical history, and the severity of tendonitis.

By following a balanced treatment plan, combining medications with physical therapy and rest, most tendonitis cases can be effectively managed.