What is it?

Tendinitis is inflammation or irritation of a tendon — any one of the thick fibrous cords that attach muscles to bones. The condition, which causes pain and tenderness just outside a joint, can occur in any of your body's tendons. Tendinitis is common around your shoulders, elbows, wrists and heels.

If tendinitis is severe and leads to the rupture of a tendon, you may need surgical repair. But many times, rest and medications to reduce the pain and inflammation of tendinitis may be the only treatments you need. You can also take preventive measures to reduce your chance of developing tendinitis.



Signs and symptoms

Symptoms of tendinitis that are produced near a joint aggravated by movement include the following:

>Pain
>Tenderness
>Mild swelling, in some cases
>Grating feeling of tendon on movement
>Joint warmth

Causes

Tendons are usually surrounded by a sheath of tissue similar to the lining of the joints (synovium). They're subject to the wear and tear of aging, direct injury and inflammatory diseases. The most common cause of tendinitis is injury or overuse during work or play.

The pain is usually the result of a small tear in or inflammation of the tendon that links your muscle to your bone. Tendinitis can also be associated with inflammatory diseases that occur throughout your body, such as rheumatoid arthritis.

When to seek medical advice

Most cases of tendinitis don't require a doctor's care. But if you experience pain that interferes with your normal day-to-day activities or have soreness that doesn't improve despite self-care measures, see your doctor. He or she may be able to help you find ways to reduce your discomfort. Your doctor may also want to conduct tests to rule out other conditions that may be causing the problem.

See your doctor if you have a fever and the area affected by tendinitis appears red or swollen and warm (inflamed). These signs and symptoms may indicate you have an infection.

Treatment

>Rest
>Immobilization
>Plaster cast
>Splinting joint
>Corticosteroid
>Heat packs
>Ice packs
>NSAIDs
>Surger (Depending on the degree and type of tendon tear, you may benefit from a surgical procedure that can improve tendon health. In certain people, surgeons can repair full-thickness tendon tears to reduce pain and restore function.)

Prevention

To reduce your chance of developing tendinitis, follow these suggestions:

>Ease up. Avoid activities that place excessive stress on your tendons, especially for prolonged periods. If you notice pain during a particular exercise, stop and rest.
>Mix it up. If one exercise or activity causes you a particular, persistent pain, try something else. Cross-training can help you mix up an impact-loading exercise, such as running, with lower impact exercise, such as biking or swimming.
>Improve your technique. If your technique in an activity or exercise is flawed, you could be setting yourself up for problems with your tendons. Consider taking lessons or getting professional instructions when starting a new sport or using exercise equipment.
>Stretch. After warming up and again after you exercise, take time to stretch in order to maximize the range of motion of your joints. This can help to minimize repetitive microtrauma on tight tissues.
>Use proper workplace ergonomics. At your workplace, get a proper ergonomic assessment. Fitting your work space to your body is essential to ensure that no tendons are continually stressed or overloaded.
>Prepare your muscles to play. Strengthening muscles used in your activity or sport can help them better withstand stress and load.

To avoid a recurrence of tendinitis, warm up before exercising and cool down afterward. Strengthening exercises also may help prevent further episodes of tendinitis.

Self-care

To treat tendinitis at home, P.R.I.C.E. is the acronym to remember — protection, rest, ice, compression and elevation. This treatment can help speed your recovery and help prevent further problems. P.R.I.C.E. involves doing the following:

>Protection. Immobilize the affected area to encourage healing and to protect it from further injury. You may need to use elastic wraps, slings, splints, crutches or canes.
>Rest. Avoid activities that increase the pain or swelling. Don't try to work or play through the pain. Rest is essential to tissue healing. But it doesn't mean complete bed rest. You can do other activities and exercises that don't stress the injured tendon. Swimming and water exercise may be well tolerated.
>Ice. To decrease pain, muscle spasm and swelling, apply ice to the injured area for up to 20 minutes, several times a day. Ice packs, ice massage or slush baths with ice and water all can help. For an ice massage, freeze a plastic foam cup full of water so that you can hold the cup while applying the ice directly to the skin.
>Compression. Because swelling can result in loss of motion in an injured joint, compress the area until the swelling has ceased. Wraps or compressive elastic bandages (Ace) are best.
>Elevation. If tendinitis affects your knee, raise the affected leg above the level of your heart to reduce swelling.

Although rest is a key part of treating tendinitis, prolonged inactivity can cause stiffness in your joints. After a few days of completely resting the injured area, gently move it through its full range of motion to maintain joint flexibility.

Anti-inflammatory medications
You can also try nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (Advil, Motrin, others), or products containing acetaminophen (Tylenol, others) in an attempt to reduce the discomfort associated with tendinitis.

Be sure to talk to your doctor if you need NSAIDs for an extended time because some of these drugs should be used for only short periods — around seven to 10 days — to avoid complications. If you take NSAIDS frequently or take more than the recommended dose, these medications can cause stomach pain, stomach bleeding and ulcers. If you have liver problems, talk to your doctor before using products containing acetaminophen.

In the future, more options may be available to treat acute pain. An NSAID patch and injections of tissue plasminogen activator (TPA) factor are being studied to treat pain.