What Is Tendinitis?

Tendinitis is a soft tissue injury caused by the inflammation and swelling of a tendon. Tendons are fibrous and dense tissues that attach muscles to bones. Tendinitis is caused by a sudden injury or repetitive motions performed in everyday life, either at home, at work, or while exercising. 

In some people, cases of tendinitis are caused by inflammatory rheumatic diseases, metabolic imbalances and the use of some medication like fluoroquinolone antibiotics and statins.

Tendinitis often affects body parts like shoulders, elbows, writs, knees, and ankles, and it can cause tenderness and pain in areas nearby joints. Tendinitis is a manageable injury that can be resolved quickly if treated properly. However, in some cases, tendinitis can become a long term issue that can result in re-injury, chronic pain, and potential tendon rupture. 

Tendinitis can affect anyone but individuals who regularly exercise and athletes are at a higher risk for developing it. Adults over 40 are also at a higher risk of it.

Tendinitis Symptoms

The main symptoms of tendinitis are pain and swelling at and around your tendons. Symptom severity will depend from case to case.

Common symptoms of tendonitis are:

• Pain and tenderness on a tendon and areas near a joint
• Swelling
• Thickening of a tendon
• Muscle weakness
• Pain around the tendon at night
• Pain that gets worse when moving or doing an activity or pain that lingers for a few hours after finishing an activity or exercise 
• Stiffness in the joints and/or muscles in the morning
• Consistent muted pain when even when resting
• Pain that does not allow you to move a joint

If your pain symptoms are gradually increasing for three to six weeks, or you start noticing increased swelling or redness around your joints, you should see your doctor to get an evaluation.

What Causes Tendinitis?

Tendinitis occurs when tendons get inflamed. This can be the result of repetitive motions, injuries, and other medical conditions.

Repetitive Movements

Repetitive motions can cause a type of mechanical overload that leads to tendon wear and inflammation. Once the tendon becomes inflamed, it can rub up against bones, causing pain and affecting joint mobility.

Tendinitis can affect tendons all across the body, but it most often occurs in the legs, knees, elbows and shoulders. The forms of tendinitis are usually named after the sport or activity that results in the injury. Common examples are:

• Tennis elbow
• Golfer’s elbow
• Pitcher’s shoulder
• Jumper’s knee

Tendinitis is also oftentimes caused by routine day-to-day activities that require repetitive motions. Some common repetitive motion causes of tendinitis include:

• Typing on your computer
• Clenching tools too hard
• Improper posture or abnormal walking gait
• Cleaning windows and floors around the house
• Painting a ceiling or wall
• Clenching the wheel while driving for a long period of time

People’s whose jobs require repetitive motions—like musicians, gardeners, or carpenters—have a higher risk of developing tendonitis.

Medical Conditions

There are certain medical conditions that can be the primary cause of cases of tendinitis or can contribute to tendinitis symptoms. These medical conditions usually involve metabolic imbalances or chronic pain. Some examples are:

• Rheumatoid arthritis
• Osteoarthritis
• Gout
• Diabetes
• Hyperthyroidism 
  

Medications

Fluoroquinolone antibiotics are antibiotics that are used to treat urinary tract infections, pneumonia, gastroenteritis and other bacterial infections.

In 2008 the FDA required a warning label to be applied to fluoroquinolone antibiotics after receiving numerous reports of increased cases of tendinitis and tendon ruptures reported by people using these antibiotics. These antibiotics' side effects decreased tendon strength which increased the risk of tendon ruptures.

Additionally, some studies have reported cases of tendonitis related to the use of statins, glucocorticoids and aromatase inhibitors.

Risk Factors

The risk for developing tendinitis increases over time. Adults over 40 are at a higher risk for developing tendinitis than younger people. However, some risk factors are under your control. The following are some movement and exercise-related factors that might increase your risk of developing tendinitis:

• Sudden increases in training and/or exercise
• Poor movement patterns (e.g. abnormal running gait, poor weightlifting techniques)
• Poor equipment (e.g. running with worn out running shoes) 

How Is Tendinitis Diagnosed?

Your healthcare provider will use a combination of approaches to reach a diagnosis and identify the severity of your tendinitis case. Approaches include evaluating your medical history and recent physical history, performing a physical examination and if necessary, diagnostic imaging.

Medical History

Because tendinitis can be the result of repeated movements or a sudden injury, your doctor will start by asking you to describe the event or activity that first caused your pain.

Your doctor might ask you more detailed questions to help identify how the injury happened. Questions your doctor might ask include:

• Has there been any recent sudden increase in your exercising routine?
• Has there been any specific change in equipment or type of exercise you’re doing (e.g. a new racquet or running on a different surface than you used to hill)?
• Have you recently returned to exercising after a long time of inactivity?
• Does your family have a history of inflammatory conditions (inflammatory joint or spinal disease, psoriasis, or inflammatory bowel disease)?
• Have you taken any of the following medications recently, quinolone antibiotics, aromatase inhibitors, statins?
  

Physical Examination

During a physical examination for tendinitis, your doctor will perform a palpation assessment, where they will apply light to firm pressure with their hands or fingers to the affected area to assess any structural issues like thickening of the tendon.

For some deeper tendons, doctors might need to apply firmer pressure to further assess the degree of the injury.

Additionally, during your physical examination your doctor might check structures, joints and any other parts that function with your tendon to move. This assessment can help evaluate if you have tendinitis or have suffered a more serious injury like a tendon rupture.

Imaging

In some cases, a doctor might call for imaging, like X-rays, magnetic resonance imaging (MRI), or ultrasounds to get a clearer picture of the state of your injured tendon. 

These imaging strategies can give doctors a detailed view of the state of your tendon, revealing potential issues like microscopic tears or tendon thickening which can contribute to the pain and inflammation that occurs during tendinitis. 

Treatments for Tendonitis

• Rest: Resting the area where you’re feeling pain prevents aggravating your tendinitis and is usually one of the first steps to recovery. If your tendinitis is a result of an exercise regimen or repeated movements at work, your healthcare provider will recommend stopping these activities for a determined period of time.
• Ice: Ice is a common pain management strategy. Ice is used to control swelling and pain and it can be applied using ice packs, cold baths or coolant sprays. Your doctor might recommend applying ice to the affected tendon for 10-15 minutes a couple times a day.
• Medicines: Your doctor may prescribe anti-inflammatory drugs like aspirin and ibuprofen to help manage the pain. These anti-inflammatory drugs can be bought over-the-counter (OTC) and come in the form of oral tables and topical creams. Corticosteroids are also sometimes used and administered as injections into the inflamed tendon.  
• Structural supports or ergonomics: Your doctor can prescribe support devices to help prevent aggravating your tendinitis injury by taking stress off your tendon. Devices like splits, braces, canes and orthotics are designed to help support your injured limb as it goes through the recovery process.
• Physical therapy: If your tendinitis symptoms continue for a few weeks, you might get referred to a physical therapist. They might help you perform range-of-motion exercises that are designed to progressively strengthen the injured tendon and muscles around it, help improve mobility, and avoid re-injury.
• Surgery: In some cases, surgery is performed to remove inflamed tissue in and around the tendon. If there is no significant improvement in your tendinitis symptoms after 6-12 months of a physical therapy regimen, your healthcare provider might recommend it. Also, if tendinitis symptoms progress and the weakened tendon tears completely, surgery is required to repair the damage caused by the torn tendon.

How to Prevent Tendonitis

There are a lot of preventative measures people can take to prevent tendinitis. These measures can help reduce the likelihood of developing tendinitis as a result of exercise, repetitive motions at work, or routine day-to-day activities:

• Warm up and stretch before exercising
• If starting a new exercise or activity, slowly ramp up the intensity of your workout over time
• Exercise regularly, rather than sporadically
• Learn and maintain proper posture
• Make sure exercise equipment is fits you properly and/or is the correct size for you
• Stop any activity or motion that causes you joint pain
• Don't grip objects too hard or for too long
• Wear comfortable shoes and check them for wear and tear
• Avoid carrying heavy items

Related Complications

If your tendinitis continues to worsen, you might suffer from re-injuring your inflamed tendon or a complete tear of the tendon which will require surgery and a longer recovery period.

The Achilles tendon is the most common type of tendon rupture. It takes around 6 months to recover from an Achilles tear injury, on average.

Living with Tendinitis

While tendinitis can be an uncomfortable condition that can affect your day-to-day life, there are many ways to cope with your tendinitis symptoms and manage the pain:

• Rest the limb associated with the tendon pain
• Ice the area for 10-15 minutes daily
• Take OTC medications to manage pain symptoms
• Begin a rehabilitation program
• Use a split or a brace on the affected limb