Tendinitis is an inflammatory process in the tendon area. It can occur acutely or chronically. With chronic form, degenerative processes develop over time in the area of the affected tendon. As a rule, the part adjacent to the bone suffers, less often the inflammation spreads throughout the tendon. Pathology is accompanied by pain during movements, slight edema, hyperemia and local fever. Treatment can be either conservative or operative. Prevention of exacerbations is of great importance in chronic tendinitis.
ICD 10
M75.2 M76.7 M76.5 M76.6
Causes
Tendinitis is a disease of the tendon. It is accompanied by inflammation, and subsequently by degeneration of part of the tendon fibers and adjacent tissues. Disease can be acute or subacute, but more often it is chronic. As a rule, tendons located next to the elbow, shoulder, knee and hip joints suffer. Tendons in the ankle and wrist joint may also be affected.
Tendinitis can develop in a person of any gender and age, but it is usually observed in athletes and in people of monotonous physical labor. The cause of the pathology is too high loads on the tendon, leading to its microtraumatization. With age, due to the weakening of the ligaments, the likelihood of developing the disease increases. In this case, calcium salts are often deposited at the site of inflammation, that is, calcifying tendinitis occurs.
Causes
A high level of motor activity and microtrauma occupy the first place among the causes of pathology. Some athletes fall into the risk group: tennis players, golfers, throwers and skiers, as well as people engaged in monotonous physical labor: gardeners, carpenters, painters.
However, in some cases, tendinitis occurs for other reasons, for example, against the background of some rheumatic diseases and thyroid diseases. Pathology can also result from a number of infections (gonorrhea), develop as a result of the action of medications or due to abnormalities in the structure of the skeleton, for example, with different lengths of the lower extremities.
Pathogenesis
A tendon is a dense and durable inelastic weight formed by bundles of collagen fibers that can connect muscle to bone or one bone to another. The purpose of tendons is to transmit movement, ensure its accurate trajectory, as well as maintain joint stability. With repeated intensive or too frequent movements, the processes of fatigue in the tendon prevail over the processes of recovery. There is a so-called fatigue injury.
At first, the tendon tissue swells, the collagen fibers begin to split. If the load persists, then islands of fatty degeneration, tissue necrosis and deposits of calcium salts form in these places. The resulting solid calcifications further injure the surrounding tissues. The inflammatory process is spreading. Degeneration joins the inflammation, the strength of the tendon decreases, which further increases the likelihood of repeated microtrauma.
Symptoms
Tendinitis usually develops gradually. At first, the patient is concerned about short-term pain that occurs only at the peak of physical activity on the corresponding area. The rest of the time there are no unpleasant sensations, the patient retains his usual level of physical activity. Then the pain syndrome becomes more pronounced and appears even with relatively small loads.
Subsequently, tendinitis pains acquire an intense paroxysmal character and begin to interfere with normal daily activities. During the examination, redness and local temperature rise are determined. Sometimes there is swelling, usually indistinct. Pain is detected during active movements, passive movements are painless. Palpation along the tendon is painful.
A characteristic sign of tendinitis is crunching or crackling during movements. The sound can be loud, freely audible at a distance, or detected only with a phonendoscope.
Lateral tendinitis
Lateral epicondylitis (lateral tendinitis or tennis player’s elbow) is an inflammation of the tendons that attach to the extensor muscles of the wrist: the short and long wrist extensor, the shoulder-beam muscle. Tendons of other muscles are less often affected: the elbow extensor of the hand, the long radial extensor and the general extensor of the fingers.
Lateral tendinitis is one of the most common diseases of the elbow joint in traumatology and orthopedics that occur in athletes. This form of tendinitis affects about 45% of professionals and about 20% of amateurs, on average playing once a week. The probability of development increases after 40 years. The patient complains of pain on the outer surface of the elbow joint, often giving off on the outer part of the forearm and shoulder. There is a gradually increasing weakness of the brush.
Over time, the patient begins to experience difficulties even with simple everyday movements: shaking hands, twisting the laundry, lifting the cup. Palpation reveals a clearly localized painful area on the outer surface of the elbow and above the lateral part of the condyle. The pain increases when trying to straighten the bent middle finger with overcoming resistance.
Medial tendinitis
Medial epicondylitis, also known as tendinitis of the pronators and flexor muscles of the forearm or the golfer’s elbow develops with inflammation of the tendons of the long palmar muscle, elbow and radial flexors of the wrist, as well as the round pronator. Medial tendinitis is detected 7-10 times less often than lateral.
This disease develops in people engaged in light, but monotonous physical labor, during which they have to perform repetitive rotational movements with their hand. In addition to golf enthusiasts, installers, typists and seamstresses often suffer from medial epicondylitis. Among athletes, tedninitis is also common in those who play baseball, gymnastics, regular and table tennis.
The symptoms resemble lateral tendinitis, but the painful area is located on the inner side of the elbow joint. When bending the hand and pressing on the area of injury, pain occurs over the inner part of the condyle.
Tendinitis of the patellar ligament
Tendinitis of the patellar ligament or jumper’s knee is inflammation in the area of the patellar ligament. It usually develops gradually and is primarily chronic. It is caused by short-term, but extremely intense loads on the quadriceps muscle. In the initial stages of knee tendinitis, soreness occurs after physical exertion.
Over time, the pain begins to appear not only after, but also during physical exertion, and then even at rest. When examining a patient suffering from tendinitis, soreness is detected with active extension of the lower leg and when pressing on the injury zone. In severe cases, local edema may occur.
Tendinitis of the shoulder joint
It can affect one or more tendons of the muscles of the rotator cuff of the shoulder. Tendons of the supraspinatus muscle and biceps are most often affected. Isolated lesions eventually spread to neighboring structures with the development of widespread tendinitis of the shoulder joint. At first, the patient is concerned about pain during movement, then the pain syndrome occurs at night.
In the advanced stages, the pain appears at rest, persists for many hours, intensifies even with movements without the participation of the shoulder joint: bending the elbow, turning the hand, shaking hands. Movement restriction progresses as the disease develops. At first, there is a slight stiffness, at later stages, in some cases, contractures are formed. During periods of exacerbations, edema is possible. Redness and an increase in local temperature are rarely observed.
Diagnostics
The examination is carried out by orthopedic doctors. Complaints, anamnesis data and results of external examination are used for diagnosis. The following additional techniques may be prescribed to patients:
- Radiography. It is usually uninformative, since the changes do not affect bones, but soft tissue structures. It is performed during differential diagnostics. With normal tendinitis, there are no changes in the images, with calcifying, calcification areas are found.
- Ultrasound. Ultrasonography reveals thickening and inhomogeneity of the tendon structure, a decrease in echogenicity. In 30% of cases, increased vascularization is detected.
- MRI. Magnetic resonance imaging confirms the thickening and swelling of the tendon, allows you to accurately determine the localization and prevalence of pathology.
Laboratory tests are uninformative. Pathology is differentiated with bursitis and tendovaginitis, sometimes with tendon tears.
Treatment
Treatment of lateral tendinitis
The treatment plan is determined by the severity of the disease. With non-sharp pains, the load on the elbow should be excluded. After the complete disappearance of pain, it is recommended to resume the load, at first – in the most gentle mode. In the absence of unpleasant symptoms in the future, the load is very smoothly and gradually increased. With tendinitis with severe pain syndrome, the following are indicated:
- short-term immobilization using a light plastic or plaster splint;
- local nonsteroidal anti-inflammatory drugs (ointments and gels);
- reflexology;
- physiotherapy: phonophoresis with hydrocortisone, electrophoresis with novocaine solution.
After the elimination of intense pain, therapeutic gymnastics is recommended. With tendinitis, accompanied by persistent pain syndrome, and the absence of effect from conservative therapy, blockades with glucocorticosteroid drugs are performed. The indication for surgical treatment of tendinitis is the ineffectiveness of conservative therapy for one year with the reliable exclusion of other possible causes of pain syndrome. There are 4 methods of surgical treatment:
- Goimann’s laxative surgery (partial severing of extensor tendons in the attachment area);
- excision of altered tendon tissues with its subsequent fixation to the external condyle;
- intraarticular removal of the annular ligament and synovial sac;
- tendon elongation.
In the postoperative period, short-term immobilization is carried out. Then the doctor prescribes therapeutic gymnastics to the patient to restore the volume of movements in the elbow joint and strengthen the muscles.
Treatment of medial tendinitis
Conservative treatment is carried out according to the same scheme as with lateral form. If conservative therapy is ineffective, a surgical operation is performed – excision of the altered sections of the tendons of the circular pronator and radial flexor of the wrist with their subsequent stitching. After the operation, short–term immobilization, physiotherapy procedures are prescribed, followed by physical therapy classes.
Treatment of patellar ligament tendinitis
Conservative therapy includes exclusion of loads, short-term immobilization, local anti-inflammatory drugs, cold and physiotherapy (ultrasound). Blockades in this type of tendinitis are contraindicated, since the introduction of glucocorticosteroids sometimes causes a weakening of the patellar ligament with its subsequent rupture.
The indication for surgical treatment is considered to be the ineffectiveness of conservative measures for 1.5-3 months or mucosal degeneration of the tendon detected on MRI. During the operation, the damaged area is excised and the remaining part of the tendon is reconstructed. The choice of the method of surgical intervention (open – through a conventional incision or arthroscopic – through a small puncture) depends on the prevalence and nature of pathological changes.
If the ligament is pinched due to a bone growth on the patella, arthroscopic surgery is possible. With extensive pathological changes in the tendon tissue, a large incision is necessary. After surgery, a plastic or plaster splint is applied to a patient with tendinitis. Subsequently, restorative therapeutic gymnastics is prescribed.
Treatment of shoulder tendinitis
Therapy is carried out on an outpatient basis. It is possible to use soft bandages and orthopedic devices, but prolonged immobilization is not recommended, since it can cause restriction of movements in the joint. The following methods are indicated:
- Medicines. Muscle relaxants, NSAIDs of general action are used. Topically applied gels and ointments with anti-inflammatory and warming effect.
- Physical therapy. Medicinal electrophoresis, laser therapy, magnetotherapy are prescribed. Massage, cryotherapy and shock wave therapy are successfully used.
If the above methods are ineffective, joint blockades are performed. Surgical interventions are required by approximately 10% of patients. Indications for surgery are late stages of the disease, joint stiffness due to the presence of scarring. Apply:
- Redressation. The orthopedist takes the patient by the hand and tears the capsule of the joint, making excessive movements. The procedure is performed under anesthesia.
- Open methodology. Scar tissue is excised through a large incision.
- Arthroscopic technique. For excision of scars, special tools are used, which are inserted into the affected area through small punctures.
After the interventions, painkillers and antibacterial drugs, physiotherapy, physical therapy are prescribed. The duration of rehabilitation ranges from 1.5 to 3 months.
Forecast
At the initial stage, the prognosis is favorable. Timely initiation of treatment allows to eliminate inflammatory phenomena and prevent degeneration of the tendon. In advanced cases, patients are concerned about recurrent pain, weakening and restriction of limb mobility, and the likelihood of injuries increases. The long-term results of surgical interventions are usually good, there is a complete restoration of the volume of movements.
Prevention
The main measure for the prevention of tendinitis is the exclusion of constant overloads of the tendon. Professional and sports loads should be increased gradually. Training should begin with a mandatory warm-up. In case of a history of limb injuries, it is recommended to use orthopedic products.