A tendon is the anatomical term used for the connective tissue which binds muscles to their attachments. Normally, muscles are attached directly to bone at either end. However, in some cases, tendon attachments are made with ligaments, joint capsules and strong layers of soft tissue known as fascia whose role it is to provide compartments within the body and strength.
Tendonitis is a familiar term used to describe pain and inflammation to any tendon. Tendinitis is also referred to as tendinopathy. As different muscles within the body have varied roles so do their respective tendons. Therefore, one singler cause of tendonitis does not exist and is often related to the particular body area affected.
The Achilles Tendon attaches the calf muscles to the heel bone and has a spring like structure which provides efficiency, particularly during walking and running. Unaccustomed increases in these activities particularly for individuals who walk/run with excessive rolling in of the feet (over-pronation) may cause this condition.
Patellar Tendonitis is also known as “jumper’s knee” as this tendon bears several times the bodyweight when landing. As this pseudonym suggests this condition is almost exclusively seen in sportsmen/sportswomen involved in athletics, basketball, netball and sometimes football.
Rotator cuff Tendonitis
The tendons of the rotator cuff muscles which function to move the shoulder joints may suffer with pain and inflammation as a secondary consequence of age related processes to the shoulder/s or due to being compressed repeatedly as the arm is lifted.
Tennis & Golfer’s Elbow
These conditions are named after their respective tasks due to the significant load each tendon undergoes performing these tasks. However, the most common cause of these conditions remains repetitive computer work with an incorrect ergonomic setup.
Tendonitis results in pain and swelling which can normally be felt to the affected tendon. Normally the middle portion of the tendon is affected but in some cases the symptoms can occur right at the insertion point of the tendon (insertional tendonitis).
Pain is felt when the affected muscle and tendon is being placed under load. In most cases, the symptoms ease off after a few minutes of an aggravating activity and then return if the activity is prolonged.
In rare cases of severe pain from tendonitis, the affected limb may begin to feel weak with certain tasks.
Physiotherapy is normally the first line of treatment for tendonitis. This normally involves appropriate stretches and placing a gradual amount of weight through the affected tendon with strengthening exercises.
However, a great number of patients do not get full resolution of their symptoms with these exercises. Fortunately, a growing number of orthopaedic treatments have emerged for tendinitis in recent years including:
- Injections of blood plasma (often termed platelet rich plasma injections or PRP injections)
- Shock wave therapy
- Surgery to resect the inflamed tendon tissue
For patients who have not found physiotherapy has enabled a return to normal function or sports, Circle Health is able to offer appointments with expert consultant orthopaedic surgeons or sports medicine consultants at short notice. Under these circumstances, our consultants are able to best guide management following an expertly conducted physical examination and imaging, normally in the form of an ultrasound or MRI scan.
Historically, patients with persistent tendonitis may have been offered corticosteroid injections. This is is now performed in very rare circumstances as evidence indicates there may be some negative side effects for tendons in the longer term. PRP injections may sometimes be offered as a treatment instead. Blood plasma (which is taken from patients through a small blood test, filtered and stored in a lab before the injection) contains natural substances which encourages healing without any obvious negative effects.
Shockwave therapy is a form of therapeutic ultrasound which delivers large amounts of mechanical “shockwaves” to the affected tendon. The intention is to induce a low level trauma to the tendon (which has failed to heal) in order to kickstart a healing response. As it is an invasive form of treatment, doses are spaced over a number of weeks. This gives the affected tendon time to strengthen itself between doses to limit the possibility of any damage (tear or rupture) to the tendon.
Although surgery is a relatively safe procedure with very small incisions being needed, there is still a small risk of infection. Due to this and with the development of the above treatments, surgery for tendinitis is offered only as a last resort.
Surgery involves identifying the exact location of pain and swelling to the tendon with a physical examination and diagnostic imaging. The swelling to this area is formed by an increase in micro blood vessels and calcific deposits. These pathological parts of the tendon are then resected leaving the healthy piece of tendon intact.