The treatment of tendonitis is not as simple as the therapy of other diseases because it takes patience to witness the reduction of symptoms. Also, an adequate diagnosis is essential to implement the right treatment options.
What is Tendonitis?
A tendon is a soft tissue that is responsible for attaching a muscle to the insertion point at a joint in the body. Tendons are thick cord-like structures and are tough enough to bear external stress. Tendonitis occurs when damage occurs to the tendons, resulting in inflammation, swelling, or tear. The patient experiences severe pain, stiffness, and immobilization of the arm and shoulder. Mild injuries of tendinitis recover on their own within a period of three to six weeks however, severe cases require medical attention, clinical therapy, and professional care. (1)
Degeneration of the tendon i.e., tendinosis is a very common cause. Other causes of tendonitis include injury, repetitive movements, and overuse of a muscle that ruptures the tendon. For example, excessive use of the biceps and shoulder joint by a tennis player can result in bicep tendonitis, a footballer can suffer from patellar tendonitis because of the overuse or injury of the knee joint, and an athlete is at risk of developing tendinitis of the Achilles tendon. Tennis elbow, jumper’s knee, and golfer’s elbow are the most common tendonitis injuries. Very similar causes can also lead to bursitis which involves the rupture and damage to the bursae which line the tendons and joints.
Signs and Symptoms
There are various symptoms presented by the patient when he or she suffers from tendonitis. (2) Such a case never comes silently, so the signs are usually evident, however, there are high chances of misdiagnosing the condition without proper steps of clinical examination. The symptoms of tendonitis are as follows:
- Pain on the affected limb is often long term, consistent and irradiating
- The swollen area around the ruptured tendon
- Tenderness
- Immobility of the affected limb
Diagnosis
Tendinopathies should be diagnosed by following the protocols of clinical examination. The physical exam must be conducted by the physician or the orthopaedic doctor first. This includes taking the patient history thoroughly and getting to know the occupation of the patient to assess the risk of tendinopathy. Next comes the assessment of the affected area using the senses of touch, hearing, and vision. The affected area might show swelling and redness. It will also be painful and stiff on the touch. The doctor might also ask you to try to move your affected limb in certain directions to analyze the possible range of motion. (3)
Following physical examination, the doctor is usually able to suspect a few disease conditions. However, a final diagnosis always requires confirmation which is done by radiological examination. X-ray is the first choice if any bone fractures, injuries, or arthritis are suspected. But conditions related to tendons are not detected in X-rays and need radiological techniques that can help visualize soft tissues. MRI scan is the best way to confirm the diagnosis of tendinopathies.
Tendonitis Treatment
The treatment options vary depending on the intensity of tendonitis and the methods adaptable or suitable for the patient and the physician. Healthcare provides a number of options, the major ones of which are as follows:
Home Management
Home management usually is based on the variation in temperature or minor management changes to help the inflammation heal. (4) The most common technique utilized is the application of heat packs. It is believed that heat comforts the swelling by dilating the blood vessels and promoting healing. The application of ice packs is also very helpful to ameliorate pain and manage symptoms of inflammation. Ice packs and hot packs both assist in pain relief and further improvement can also be noticed with the pain relief creams like methyl salicylate. Splints and elevation techniques are also used to help decrease pain and swelling.
Physical Therapy as a tendonitis treatment
Warm-up exercises are the first way of starting any physical therapy so that the blood flow increases and the patient does not feel fatigued. Physical therapists (5) ask the patient to move the affected limb or affected tendon in certain movements gradually. This eases the pain and allows widens the range of motion. Physiotherapists recommend following the exercises completely for the required period to see effective and complete results.
Medications
Over-the-counter medicines and prescription medicines both are employed in the medication therapy of tendonitis. (6)
Non-steroidal anti-inflammatory drugs:
NSAIDs are classed as prescription medicines and ibuprofen is the most preferable option when it comes to managing pain due to tendonitis. Ibuprofen and naproxen offer the least drug-drug interactions and drug-disease interactions. There are the safest medicines and so are also available as over-the-counter drugs in some countries.
Corticosteroid Injections:
Steroid injections are helpful in muscles and tendons that are not well-treated with physiotherapy or exercises, for example, De Quervain and epicondylitis. The injection is administered in the injured area and is commonly employed in rheumatology. The steroid injections should not be used frequently because of their possible side effects but it does successfully accelerate the speed of recovery, changing it from months to a few weeks.
Platelet-Rich-Plasma or PRP:
PRP is not only effective for tendonitis but also useful in conditions like rheumatoid arthritis. Injuries in the rotator cuff can be treated using prps. In this process, platelets and healing factors are injected into the injured area to speed up healing.
Shockwave Therapy as a tendonitis treatment
Shockwave therapy involves the delivery of extracorporeal shockwaves to the injured or inflamed tendons or other soft tissues. It is a widely accepted procedure to treat pain and accelerate healing.
Prolotherapy
In recent years, prolotherapy has built its reputation within the medical community due to its clinically proven ability to treat tendonitis.
Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.
Prolotherapy involves injecting a natural regenerative solution with small needles. This has been shown to reduce swelling, which helps with tendonitis.
As prolotherapy is helping to treat the root cause of tendonitis, it is deemed a permanent fix, preventing the symptoms from returning.
Surgical Procedures as tendonitis treatment
According to nih.gov, Achilles tendinopathy (7) is the most common tendonitis problem last reviewed in the lower body extremities. If the case of tendonitis is severe and not effectively managed by any other nonsurgical procedures, then surgery is the last option left.
Arthroscopy as a tendonitis treatment
Sports medicine often deals with orthopaedic procedures like arthroscopy because there is a high prevalence of tendinopathy and sports injuries. This involves applying a minor cut to invade the camera with the tube in the affected place. The injured tendon is viewed on the screen through the camera and the surgery is performed.
Open Surgery
Severe musculoskeletal problems cannot be treated without a complete incision. The surgery involves the cutting of the damaged portion of the muscle and reattaching it with the tendons to promote blood flow and increase the rate of tendon healing. Open surgeries have a greater risk of blood vessel and nerve damage so the least invasive procedures are preferred.
Frequently Asked Questions
- How long does tendonitis take to heal?
The healing of injured or damaged tendons is slow and takes from two to four weeks for moderate cases. If tendonitis is a chronic condition, the healing can take months.
- What happens if tendonitis goes untreated?
Untreated conditions of tendonitis can exacerbate badly. Not only the pain intensity will increase, but the duration of the condition will also prolong making it a chronic condition.
- Is heat or cold better for tendonitis?
Since tendonitis is very much like a tenon injury, applying heat is better. The blood vessels will dilate and increase the delivery of healing factors and blood platelets near the injured tendon. This will increase the rate of recovery.
- Does tendonitis show up on the x-ray?
No, tendonitis cannot be diagnosed through x-ray. Tendon is a soft tissue like ligaments and must be observed using MRI scans to make a final diagnosis.
- Can stretching make tendonitis worse?
If the tendinopathy is a severe case, stretching will not help but rather worsen the condition. It will cause irritation at the tendon’s insertion point and will give more pain to the patient, thus slowing the healing process.
- Does tendonitis get worse before it gets better?
If the patient with tendonitis does not rest, the healing speed will be slow. This makes the condition worse before it gets better. Initial rest is important to speed up recovery. After a few months, exercise and physiotherapy will help to heel.
References
- Almekinders, L. C. (1998). Tendinitis and Other Chronic Tendinopathies. JAAOS – Journal of the American Academy of Orthopaedic Surgeons, 6(3), 157–164. https://journals.lww.com/jaaos/Abstract/1998/05000/Tendinitis_and_Other_Chronic_Tendinopathies.3.aspx
- Lacitignola, L., Crovace, A., Rossi, G., & Francioso, E. (2008). Cell therapy for tendinitis, experimental and clinical report. Veterinary Research Communications, 32(S1), 33–38. https://doi.org/10.1007/s11259-008-9085-3
- Gross, M. T. (1992). Chronic Tendinitis: Pathomechanics of Injury, Factors Affecting the Healing Response, and Treatment. Journal of Orthopaedic & Sports Physical Therapy, 16(6), 248–261. https://doi.org/10.2519/jospt.1992.16.6.248
- Millar, N. L., Silbernagel, K. G., Thorborg, K., Kirwan, P. D., Galatz, L. M., Abrams, G. D., Murrell, G. A. C., McInnes, I. B., & Rodeo, S. A. (2021). Tendinopathy. Nature Reviews Disease Primers, 7(1). https://doi.org/10.1038/s41572-020-00234-1
- Doral, M., Bozkurt, Turhan, Donmez, Demirel, Kaya, Atay, Maffulli, N., & Ateşok, K. (2010). Achilles tendon rupture: physiotherapy and endoscopy-assisted surgical treatment of a common sports injury. Open Access Journal of Sports Medicine, 233. https://doi.org/10.2147/oajsm.s10670
- Maffulli, N. (2010). New options in the management of tendinopathy. Open Access Journal of Sports Medicine, 29. https://doi.org/10.2147/oajsm.s7751
- Longo, U. G., Ronga, M., & Maffulli, N. (2018, March 1). Achilles Tendinopathy. Www.ingentaconnect.com. https://www.ingentaconnect.com/content/wk/smart/2018/00000026/00000001/art00005