Tendinitis is the inflammation of a tendon or its sheath, the tendons being a kind of “ropes” made of collagenous fibers that attach the muscles to the bones. Tendinitis mainly results in pain, sometimes accompanied by swelling in the affected tendon. It is a musculoskeletal disorder (MSD).
Note: The term tendonitis is gradually being replaced in the medical community by the term tendinopathy, which more generally refers to tendon disease. Indeed, in many cases (especially cases of chronic tendinitis), what is known as tendonitis is not properly an inflammation, but rather a deterioration or degeneration of the tendon.
All tendons may be the site of tendonitis, but the most common tendinitis is:
- shoulder (tendon supraspinatus muscle);
- Achilles tendon;
- knee (sub-patellar tendinitis and crow’s feet);
- elbow (epicondylitis)
- wrist (tendonitis of Quervain);
- Hip (tendinitis of adductors).
Who is affected?
Tendinitis is more common among athletes, whether professional or amateur, and people whose profession requires repetitive actions.
Causes of the Tendinitis
Several elements may cause tendinopathy or tendinitis. Most often, the pain gradually sets in because of the repetition of a movement or excessive tendon strain.
Thus, most often, tendinitis is linked:
- to the practice of a sport (excessive solicitation, insufficient warm-up, incorrect technical gesture, sudden change of equipment …);
- to the exercise of a profession which requires to perform repetitive movements (line workers, musicians, for example);
- DIY, gardening;
- to strain repeated tendon (beatings, shocks);
- To a bad posture or prolonged maintaining a same position.
Some inflammatory rheumatism, such as spondyloarthropathy or rheumatoid arthritis, can also cause inflammation of a tendon.
Finally, the use of drugs, including fluoroquinolones and anabolic steroids (which can cause a rupture of tendon), can also be involved in some cases.
Evolution and possible complications
Most of the time, tendinitis is treated well with rest (stop triggering activity) and rehabilitation.
However, if the injured tendon is not resting, the fibers may take a long time to repair, lose flexibility and elasticity. In addition, the tendon can rupture (tendon rupture) if it is too damaged or under the impact of a shock or a force too violent, which requires a surgical operation.
Symptoms of Tendinitis
The main symptoms of tendonitis are:
- pains arising especially to the active mobilization of the limbs and which calm at rest;
- A swelling in the joint concerned can also be observed, but it is not systematic.
If tendinitis is not supported, the pain worsens, lasting even after exercise and limiting functional abilities.
Pain often persists for weeks to months, especially if tendonitis is not adequately managed. This is called chronic tendonitis.
By healing, damaged tendon fibers can also form an annoying nodule.
People at risk for Tendinitis
People most at risk of tendinitis are:
- Men 3;
- People who are getting older (the tendons lose their elasticity as they get older);
- People who have metabolic abnormalities (including gout) or inflammatory rheumatism;
- Women during menopause;
- People with a posture disorder or static (hollow or flat feet, knees in “X” …).
Factors that may increase the risk of tendinitis3 include:
- The intensive practice of a sport, especially tennis, running, golf, swimming, sports where we jump (basketball, volleyball) …;
- A profession that requires repetitive gestures (cleaning, construction …), vibration (jackhammer …), force or stay in the same position for a long time;
- Obesity or overweight.
Prevention of tendonitis (musculoskeletal disorder)
|Can we prevent?|
|It is possible to prevent the occurrence of tendinitis by adopting good practices before starting a sports session or by correcting a badly done gesture. In the workplace, it may be necessary to adapt the workstation to avoid aggravating tendon injuries.|
|Basic preventive measures|
|Several measures can reduce the risk of tendinitis, the watchword is to avoid any sudden change in the practice of sport or activity, whether it is a quantitative change (lifting weights too heavy, running for too long a distance, intensely following an injury or a break, etc.) or qualitative (different exercises, changing terrain or surface, changing equipment).
Generally, it is recommended:
In the workplace, it is recommended to take regular breaks and to vary the actions, if possible. An interview with the occupational physician is usually helpful in tailoring advice on a case-by-case basis.
Medical treatments for tendonitis (musculoskeletal disorder)
The treatment aims to remove the pain and identify the cause of tendonitis to prevent it from reappearing during the resumption of activities.
In most cases, tendinitis can be effectively managed by combining rest, pain medication and rehabilitation. But it often happens that the cure is long.
This is the first stage of treatment. It begins with a resting of the tendon and the application of ice, according to the protocol “GREC”: ice – rest – elevation – contention:
- Ice application: it reduces pain and swelling. It is necessary to apply the bag of ice (through a cloth) or the pack refrigerant on the reached articulation during 20 minutes, several times a day. For chronic tendinitis, the application of heat can also relieve;
- Rest: it is absolutely essential to stop the activity in question to allow the tendon to repair itself. Rest is needed as long as the pain persists, about one to three weeks for benign tendonitis, and one to three months for chronic tendonitis. Total immobilization is however contraindicated;
- Elevation : In case of tendonitis of the knee or Achilles tendon, it may be useful to elevate the leg at rest to reduce swelling;
- Contention: an elastic bandage may also be useful in case of swelling of the affected joint.
To relieve pain, taking paracetamol (acetaminophen) is recommended, without exceeding the maximum dose of 4 g / day.
Administration of no steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended for acute pain. However, it is increasingly questioned in the treatment of chronic tendonitis because they are often not associated with inflammation. In chronic tendinopathy, it could even be that NSAIDs have a deleterious effect on the healing of the tendon.
When application of ice and adequate tendon rest has not been successful in the treatment of acute tendonitis, corticosteroid infiltrations may relieve pain and reduce inflammation. However, they could increase the risk of partial or complete rupture of the tendon (notably by preventing the person from feeling the pain and thus letting it “force”).
In the acute phase, the application of an NSAID cream or gel may be preferable to oral NSAIDs because it can relieve pain without causing side effects.
Rehabilitation in physiotherapy (or physiotherapy) is essential to prevent recurrence, promote healing of the tendon and allow the resumption of sports practice.
Rehabilitation usually associates:
- Of massage in the acute phase, to relieve pain and increase blood flow to promote the repair of the tendon. Deep Transverse Massage (MTP) is often used two to three times a week. It is transverse to the tendon, but its effectiveness remains controversial from a scientific point of view;
- of stretching , which allow to progressively re-engage the tendon to win the amplitude and reduce the subsequent risk of injury;
- The exercises so-called “eccentric muscle work,” whose goal is to strengthen the muscle and tendon that these better support the requirements of the sport. This rehabilitation technique is the most effective for tendinopathies, but it is necessary to practice the exercises daily, for at least twelve weeks, which requires a good motivation.
Surgical treatment is proposed only in case of failure of medical treatment, as a last option. Surgical repair may be necessary in case of tendon rupture.
Results and indications vary depending on the affected tendon.
Extracorporeal shock waves
Shock waves are acoustic waves that act by “striking” the tendon fibers. They are increasingly used to treat chronic tendinopathy and several Meta-analyze have shown their effectiveness.
Although the mode of action of shock waves is not fully understood, it is thought that they relieve pain by stimulating local blood circulation and repairing damaged fibers.
Ultrasound is often used for their analgesic properties but no study has really demonstrated their effectiveness, except perhaps on certain tendinitis accompanied by calcifications.
Treatments under study
Several trials evaluate the efficacy of new treatments for tendinopathies, including local injections of Platelet Rich Plasma (PRP), botulinum toxin injections, Trinitrin (glyceryl trinitrate) patches, or acid injections. Intramuscular tendonous hyaluronic acid.