Tendinopathy and Tendon Injury

22nd May 2007 at 19:54 BST by Dr C.A.Jenner MB BS, FRCA. Permalink.

This article discusses the condition of tendinopathy in detail.

Tendinopathy and Tendon Injury

Introduction

Tendinopathy is defined as a medical condition characterised by a painful or a torn tendon. The term tendinopathy is commonly used as a collective term for tendonitis and tendinosis.

While tendonitis implies inflammation of the tendon, tendinosis is characterised by a tendon pain that occurs as a symptom of a series of microtears in the connective tissue in or around the tendon.

Causes and Trends

Tendinopathy is most likely to inflict those who perform repetitive tasks in their jobs, sports or other routine activities. Daily jobs like tool use, gardening, cooking and cleaning often require repetitive movement and expose you to the risk of developing tendinopathy.

In general, occurrence of a tendon injury follows one of the two trends:

1. Gradually, resulting from prolonged overuse, such as repeated twisting.
2. Abruptly, as with a weakened tendon which is more likely to rupture or tear than a healthy tendon.

The most commonly affected areas in the condition of tendinopathy include the shoulder, elbow, wrist, hip, knee and ankle. Tennis Elbow and Achilles tendinopathy are some of the most well-known forms of tendon injuries.

Key Symptoms

Symptoms of tendinopathy may differ in every patient. However, there are some common symptoms associated to the condition. The most prominent amongst these are:

• Pain, redness, warmth and tenderness around the affected tendon. These symptoms might also be accompanied by a swelling near the injured tendon.
• Increase in pain and other related symptoms occurring with activity.
• A crunchy sound (crepitus) when the tendon is used, which is normally an uncomfortable or painful feeling.
• Worsening of the symptoms, mainly pain and stiffness during the night and while getting up from the bed in the morning.
• Stiffness near the affected joint area
• Presence of calcium crystals in the tendon (calcific tendonitis)

The symptoms of tendinopathy are often likened to those of bursitis, characterised by the inflammation of the bursa.

Diagnosis and Treatment

Generally, an initial examination confirms the presence of a tendon injury or tendinopathy. However, in some cases, the following tests have to be conducted to confirm the diagnosis:

• X-rays
• MRI (Magnetic Resonance Imaging)
• Ultrasound

Treatment Options

Apart from the general home remedies and self-care measures, the physician might consider one of or more of the following treatment options for patients suffering from a tendon injury:

• Physical therapy for pain relief without excessive medications
• Corticosteroid injections, for relief from pain and swelling
• Braces, splints, slings or crutches, which may be advised for providing proper rest to tendons
• A severely damaged tendon might be put in a cast
• Surgery is also an option but is advised only in case of a ruptured tendon

Some of the latest innovations in the treatment modalities of tendinopathy include:

• Applying nitric oxide to the skin
• Shock wave therapy, that involves directing ultrasonic or shock waves at the injured tendon
• Open or Arthroscopic surgery, conducted to treat calcific tendonitis that is not responding to non-surgical forms of treatment

Self Care

There are a plenty of self care measures that can help you to prevent and treat tendinopathy. Here we list the most important amongst them:

1. Rest: It is important that you give enough rest to the affected area and get an adequate amount of sleep. Check if you need to make long-term changes in the kind of activities you do to reduce the strain on affected tendons.
2. Ice and Cold Packs: Applying ice and cold packs immediately when the pain is felt is extremely helpful. Ice should be applied for 10 to 15 minutes, twice an hour, for 72 hours.
3. Pain-relieving medications: Acetaminophen and nonsteroidal ant-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen and aspirin are useful in controlling the pain.
4. Exercises: Range of motion exercises done in the resting period have known to alleviate symptoms associated with tendinopathy. The joint should be moved through its full range of motion for best results.
5. Avoid tobacco: Research shows that tendon injuries heal more slowly in smokers as against the non-smokers.

Other important steps you can take to prevent recurrence of tendinopathy include:

• Adequate warm-up and stretches
• Strengthening of muscles
• Altering the pattern of daily activity

Important Note

Though movement and mild exercise are known to reduce stiffness associated with tendinopathy, the injury can actually worsen if the tendon is not allowed to rest or heal. It is important to do only mild exercises and also maintain a proper cooling down schedule so that the affected tendon gets s adequate rest.

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