Tendonitis Inflammation of a tendon around the shoulder, elbow, wrist, finger, thigh, knee or Achilles tendons.

What are tendons? Tendons are strong bands or cords of tissue that attach muscle to bone. They help move the bones and joints when the muscles contract. Some tendons are covered by a protective sheath. The sheath is lined with a membrane that contains synovial fluid, which helps the tendon to move easily and minimises friction. Tendon pain can be caused by small tears in the surrounding tissue, or the gradual deterioration of a tendon where it connects to the bone.

Symptoms of Tendonitis The main symptoms are pain and inflammation in the affected tendon. Pain that worsens when you move the affected area. A sensation that the tendon is grating or crackling as it moves. (can be felt under examination) Swelling Weakness in the affected area Development of a lump along the tendon.

Types of Tendonitis Tendonitis can occur in many different parts of the body. If the sheath surrounding it becomes inflamed, rather than the tendon itself, the condition is known as tenosynovitis. Supraspinatus tendonitis (shoulder) Inflammation of the tendon at the top of the shoulder joint. Often part of rotator cuff syndrome, where other tendons in the same area are also affected. Calcific tendonitis (shoulder) Calcium phosphate crystals form in the supraspinatus tendon in the shoulder. Cause long-term mild pain, plus short episodes of more severe pain. May cause shoulder to become weak or stiff. Similar to supraspinatus tendonitis, but the calcium crystals will be visible on an X-ray.

Biceps tendonitis (upper arm) Affects the tendon that attaches the bicep to the shoulder. Causes pain in shoulder and upper arm

Tennis elbow and golfer's elbow Tennis elbow - pain in the side of the elbow Golfer's elbow - pain in the middle of the elbow Pain usually around elbow joint, but may spread down forearm towards wrist. May have less grip strength as a result.

De Quervain's tenosynovitis (thumb) Inflammation of the sheath surrounding the thumb tendons, which run between the wrist and the thumb

Trigger finger or thumb Causes the finger or thumb to become fixed in a bent position, whch gives a clicking sensation when it is straightened out. Caused by thickening and inflammation of the tendon sheath in the palm of the hand

Achilles tendonitis (heel) Inflammation of the tendon between the heel and the calf muscle. What causes tendonitis Commonly caused by a tendon injury - playing sports that involve throwing or using a racquet, such as tennis. overusing a tendon Diagnosis If there is any doubt about the diagnosis, imaging tests can be carried out to provide more information about your injury. For example: an X-ray may show calcium deposits around a tendon, indicating calcific tendonitis, or it may reveal that you have a fractured or broken bone an ultrasound scan or magnetic resonance imaging (MRI) scan can provide a more detailed image for example, if it is not clear which tendon in your elbow is injured

Treatments of Tendonitis A painful tendon will often get better after a few days. Rest the affected area and stop exercise or activity that caused the symptoms. Using painkillers eg. paracetamol and ibuprofen and applying an ice pack my also relieve tendonitis. For more persistent cases, treatments such as physiotherapy, cortocosteroid injections or shock wave therapy may be recommended.

Sometimes, surgery may be recommended to treat long term tendon pain that has not improved following treatment, eg. Achilles tendinopathy or tennis elbow. Physiotherapy Special exercises to stretch and strengthen the tendon and surrounding muscles. Massaging the affected area. High-frequency sound waves (ultrasound) Narrow beams of light (lasers)

Corticosteroid injections Medicines that contain steroids and can be used to reduce inflammation. Injected around the affected tendon or into the tendon sheath. Relieve pain, but do not have a long-term effect and the pain often returns. Not possible to have more than 3 injections into the same area in a year, as it can increase the risk of the tendon rupturing.

Extracorporeal shock wave therapy (ESWT) Surgery It may be a possible option for some types of tendonitis, eg. tennis elbow, calcific tendonitis and bicep tendonitis. However Surgery is usually not necessary. Used when tendonitis has not responded to other treatments. Passing shock waves through the skin to affected areas. Relieves the pain caused by tennis elbow or Achilles tendonitis.

Preventions of Tendonitis Resting the affected area can stop tendonitis getting worse. Strengthening the muscles around the tendon can help prevent it reoccurring. Avoid repetitive movements of the affected area. If this is not possible, at least make sure that you rest regularly. Exercising the affected area will strengthen the muscles around the tendon and help prevent further problems. If you play a lot of sport or you exercise regularly, you can try to prevent tendonitis by warming up and cooling down properly before and afterwards.