PhytoScience - Article

Tendinitis

 

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

Tendinitis in various locations in your body produces these specific types of pain:

  • Tennis elbow. This type causes pain on the outer side of your forearm near your elbow when you rotate your forearm or grip an object. Golfer's elbow causes pain on the inner part of your elbow.

  • Achilles tendinitis. This form causes pain just above your heel.

  • Adductor tendinitis. This type leads to pain in your groin.

  • Patellar tendinitis. In this type, you experience pain just below your kneecap.

  • Rotator cuff tendinitis. This tendinitis leads to shoulder pain.

If the sheath of tissue that surrounds the tendon becomes scarred and narrowed in small joints, such as the finger, it may cause the tendon to lock in one position, such as occurs in the condition called trigger finger. The pain of tendinitis is usually worse with activities that use the muscle that is attached to the involved tendon.

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.

Risk Factors

You have a greater risk of developing tendinitis if you perform excessive repetitive motions of your arms or legs.

For instance, professional baseball players, swimmers, tennis players and golfers are susceptible to tendinitis in their shoulders, arms and elbows. Basketball players, runners and dancers are more prone to tendon inflammation in their legs and feet.

But you don't have to be a professional athlete to develop tendinitis. The incidence of tendinitis increases with age as muscles and tendons lose some of their elasticity. Improper technique in any sport is one of the primary causes of overload on tissues, including tendons, which can contribute to tendinitis.

Some common names for various tendinitis problems are tennis elbow, golfer's elbow, pitcher's shoulder, swimmer's shoulder and jumper's knee.

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.

Screening and diagnosis

Your doctor may suspect you have tendinitis after observing the signs and symptoms of the condition or discussing them with you. But to make a diagnosis of tendinitis, your doctor will most likely want to review your medical history and conduct a thorough physical examination.

Imaging tests
An X-ray often isn't helpful in diagnosing tendinitis because tendons generally aren't visible in these images. Still, your doctor may order an X-ray if he or she wants to rule out a more serious condition involving the bone. Although rarely necessary, an imaging test known as magnetic resonance imaging (MRI) might be ordered to reveal any weakening or tearing of the tendon or changes in the tendon sheath or covering.

Your doctor may also recommend blood tests if he or she suspects that a condition such as rheumatoid arthritis may be an underlying cause of your tendinitis.

Complications

Tendinitis may become chronic or long term and can lead to the rupture of a tendon. Tendinitis can also cause permanent damage to the tissue that makes up your tendons.

Sometimes the discomfort of tendinitis disappears within a matter of weeks or months, especially if you rest the involved joint. If you continue to use the affected area while you still have signs and symptoms of tendinitis, the condition often heals more slowly and may progress to a chronic condition termed tendinosis or tendinopathy. This condition may change the structure of the tendon to a weaker, more fibrous tissue.

Treatment

The goals of tendinitis treatment are to relieve your pain and reduce inflammation. Often, home treatment; which includes rest, ice and over-the-counter pain relievers may be all that you need.

Other treatments for tendinitis include:

  • Corticosteroid injections or topical applications. Sometimes your doctor may inject a corticosteroid medication around a tendon to relieve tendinitis. Injections of cortisone reduce inflammation and can help ease pain.

    However, there are potential side effects. For example, repeated injections may weaken a tendon, increasing your risk of rupturing the tendon. Also, corticosteroid medications should never be directly injected into the tendon itself because this can contribute to tendon rupture. As an alternative to an injection, a corticosteroid solution can be topically applied to the painful region and drawn in through your skin using a gentle electric current via a process called iontophoresis.

  • Strengthening exercises and physical therapy. People with tendinitis and tendinosis may also benefit from a program of specific exercise designed to strengthen the force-absorbing capability of the muscle-tendon unit.

  • Surgery. 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.

Complementary and alternative medicine

Yoga and other relaxation techniques may help with chronic pain that occurs with some muscle and joint conditions. Yoga postures designed for strengthening, stretching and balancing each joint in the upper body, as well as the upper body itself, may help reduce the pain and improve the grip strength of people with tendinitis.

Other options for treatment involve special types of physical therapy. Many of the methods used for tendinitis include:

  • Heat
  • Massage
  • Chiropractic manipulation
  • Osteopathic manipulation
  • Water therapy (hydrotherapy)

Ultrasound treatments may be used, but have had variable results in studies. The National Institutes of Health has released a consensus statement acknowledging that acupuncture also may be useful for treating the symptoms of tendinitis. However, magnet therapy, laser acupuncture and chiropractic care haven't provided the same benefits in controlled trials.

Mangosteen: Mangosteen has been demonstrated to exhibit potent anti-inflammatory properties. Natural remedies that lower inflammation can be very beneficial in the prevention or treatment of chronic pain. Mangosteen can be used as an effective adjunct with standard therapies to reduce many of the side effects and helps to speed up recovery. mangosteen

When indicated; mangosteen juice, consumed daily, may be preferred over some medications that have adverse effects with prolonged usage. In case studies, mangosteen juice from the whole fruit puree has successfully been used to reduce inflamation and pain in conditions which include Carpal Tunnel Syndrome and Tendinitis.

Xanthones, which are unique to the mangosteen, as a class of phytonutrients are polyphenolic bioflavonoids. Over 60 research papers show anti-tumor, anti-proliferative, anti-microbial, anti-histamine, anti-inflammatory, anti-oxidant and gastrointestinal protective effects. Mangosteen has been used successfully for microbial (Viral, Bacterial and Fungal) conditions for centuries throughout Southeast Asia.

In some cases, people using mangosteen for the first time may experience a healing crisis or detoxifying effect {an increase or outbreak of symtoms that may last from 4 to 10 days} in the earliest stages of use. Once the body is cleared of the toxins that exasperate the condition, the healing process can get underway. This is normal and should be expected when using a quality natural product. Results will vary with individuals but the long term benefits are well worth the short term discomfort as mangosteen juice has been effective in some of the most severe cases of tendinitis.

Mangosteen juice from the whole fruit puree consumed daily, has successfully been used to treat inflammatory conditions and has demonstrated numerous additional benefits over other natural products. More mangosteen research is needed, but current scientific studies have demonstrated promising results. Mangosteen Science

You may have to experiment to find a treatment that works for you. Still, always check with your doctor before trying any complementary or alternative treatment.

Updated 03Feb2009