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  Tendonitis  
 
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Conditions that suggest it | Recommendations

 

Tendonitis is inflammation of a tendon - that strong, white, fibrous tissue connecting muscle to bone. Tendonitis can be associated with a calcium deposit, which can cause inflammation. It is one of the common causes of acute pain in the shoulder and can occur after an injury or as a result of repetitious movements. In rare cases, it may also result from a disease. Other causes of tendonitis include:

  • poorly-fitted shoes that rub against foot tendons
  • bone spurs in the feet or elsewhere that irritate tendons
  • obesity, which puts abnormal pressure on the legs and feet
  • repeated overuse of the wrist, which can inflame the tendons
  • overuse of the tendons in the shoulder, sometimes seen in swimmers or in the serving arm of a tennis player
  • overuse of arm muscles, which can cause inflammation of tendons in the elbow, such as tennis or golfer’s elbow.
Tendonitis usually causes one or more of the following symptoms:
  • a sharp or achy pain
  • tenderness and swelling
  • restricted movement in the area surrounding the injury
  • weakness in the arm or leg due to pain.
In cases of achilles tendonitis, if the tendon becomes more painful with greater activity such as running or playing sports, there is a chance the tendon could rupture: if not taken care of, tendonitis can weaken tendons, making them more susceptible to a tear. Antiinflammatory medication is appropriate for tendonitis or tenosynovitis.

Acute tendonitis often subsides within 10 to 14 days. If the pain worsens or continues after home care for over 14 days, a doctor should be consulted.

Tendisosis (not tendonitis).

The following is from the website of Hall Health Sports Medicine Clinic

Treatments targeting inflammation have limited effectiveness in the treatment of tendinosis since there is no inflammation present. Anti-inflammatory medications such as ibuprofen, naproxen, and similar prescription medications are good pain relievers which is why people with tendinosis may experience temporary relief when taking them. They will not, however, cure the problem of tendinosis. In fact, anti-inflammatory medication may actually impair tendon recovery as inflammation is the first stage of the healing process.

Newer treatments for tendinosis are all designed to stimulate healing. This can be done in a variety of ways.

Needling of the tendon or tenotomy

Some studies have shown that repetitively poking or needling the tendon and causing it to bleed may induce healing. Blood is made up of several elements. An important element for the healing of tendons are the platelets. Platelets are packed with growth factors that can jump start the stalled healing process in tendinosis. In a tenotomy procedure, the area is numbed with local anesthetic and then the tendon is needled or repeatedly poked to create small fenestrations and cause the tendon to bleed. Tendons are relatively avascular and do not have a lot of blood vessels in them. Sometimes the needling procedure alone is enough to stimulate healing. Sometimes the needling or tenotomy is combined with other procedures.

Autologous Blood Injections

In autologous blood injections, a small amount of blood (2-3 cc) is taken from the patients arm and injected back into the degenerative portion of the tendon using ultrasound guidance after the tenotomy. In studies that have looked at autologous blood injections there is a reported 80% - 95% satisfaction rate, and about a 5% - 15% failure rate. Studies report one to three injections with most patients receiving two injections. This treatment aims to stimulate the bodies own healing process to essentially grow new tendon. From the recruitment of the first new tenocyte (tendon cell) it takes 12 weeks to grow a new tendon fiber. If a patient has not experienced significant improvement in their symptoms at 6 – 12 weeks a second injection is typically recommended.

Platelet Rich Plasma

Platelet rich plasma is taking autologous blood injections one step further. Approximately 30cc of blood are drawn from the patient and then just the platelets are removed from the blood using a special technique. This platelet rich plasma, or PRP is then injected back into the degenerative area of the tendon under ultrasound guidance. PRP has 5 – 9 times the growth factors that autologous blood does.

Is there a role for cortisone injections?

Cortisone is a potent anti-inflammatory so for acute tendinitis it can be useful. It is also catabolic, meaning it dissolves scar tissue. In tendons where there is a lot of scar tissue, even if there is not inflammation, there may be a role. Your doctor can discuss which options are best for your situation.

What conditions can be treated?

Patellar tendinosis (jumper’s knee)
Achilles tendinosis
Lateral or medial epicondylsis (tennis or golfer’s elbow)
Hamstring tendinosis
Adductor tendinosis
Plantar fasciosis
Rotator cuff tendinosis
Risks of tenotomy, autologous blood or PRP injection:

Bleeding
Infection
Pain from the procedure
Tendon rupture
Lack of improvement
What to expect with tenotomy, autologous blood or PRP injection

Mild increased pain or discomfort for a few days to a week after the injection which is usually relieved by ice or acetaminophen (Tylenol). Applying an ice pack or cold compress periodically for 15-20 minutes to the injected area is recommended for the first 24 hours after the procedure.

You should avoid non-steroidal anti-inflammatory medications for the next 3 months. These include ibuprofen (Advil/Motrin), naproxen (Aleve), aspirin (unless recommended by a physician for other health problems), and prescription anti-inflammatory medications.

You should plan to rest from all exercise for 1 week after the injection.

In the second week, you may engage in light cross-training activities (such as riding a bike, swimming, and elliptical) if tolerated. Activities should be pain free or only mildly uncomfortable.

In the third week, you can gradually increase your activity level, duration, and intensity as tolerated assuming minimal or no discomfort.

You should schedule a follow-up appointment at 4 weeks.

Return to sports that involve running or jumping will depend on your clinical improvement, the type of problem you had, the procedure you got and whether or not you get a second injection but is usually around 12 weeks.


Authored by: Kim Harmon, M.D.


 

 
 

Conditions that suggest Tendonitis:
 
 
Hormones  Hypothyroidism
 Chronic tendonitis is occasionally associated with hypothyroidism.
 
 

Recommendations for Tendonitis:
 
 
Botanical  Turmeric Extract, Curcumin
 A derivative of a common culinary spice found in Indian curries could offer a new treatment hope for sufferers of the painful condition tendinitis, an international team of researchers has shown.

Researchers at The University of Nottingham and Ludwig Maximilians University in Munich have shown that curcumin, which also gives the spice turmeric its trademark bright yellow colouring, can be used to suppress biological mechanisms that spark inflammation in tendon diseases.

Dr Ali Mobasheri of the University’s School of Veterinary Medicine and Science, who co-led the research, said: “Our research is not suggesting that curry, turmeric or curcumin are cures for inflammatory conditions such as tendinitis and arthritis. “However, we believe that it could offer scientists an important new lead in the treatment of these painful conditions through nutrition. Further research into curcumin, and chemically-modified versions of it, should be the subject of future investigations and complementary therapies aimed at reducing the use of non-steroidal anti-inflammatory drugs, the only drugs currently available for the treatment of tendinitis and various forms of arthritis.” [Curcumin Modulates Nuclear Factor ?B (NF-?B)-mediated Inflammation in Human Tenocytes in Vitro: ROLE OF THE PHOSPHATIDYLINOSITOL 3-KINASE/Akt PATHWAY. J. Biol. Chem. 2011, 286: 28556-28566, June 13, 2011.]

Drug

Not recommended:
  Conventional Drugs / Information
 Cortisone shots may reduce the pain and assist in recovery, but will not regrow damaged tissue. Some doctors have made the claim, now supported by evidence, that cortisone shots can in fact weaken the structures being treated, and do not recommend them in spite of the temporary relief they may offer. (Care must be taken when injecting cortisone near any ligament or tendon: they must not be injected into.)

While the use of anti-inflammatories may reduce the swelling and pain, they also may hinder permanent recovery. Inflammation is part of the process for normal tendon regrowth. The chronic use of anti-inflammatories should be approached with caution.

Hormone

  Progesterone
 Progesterone (especially when mixed with vitamin E) has been used topically for the relief of tendonitis pain.

Lab Tests/Rule-Outs

  Test Thyroid Function
 Chronic tendonitis is occasionally associated with hypothyroidism.

Mineral

  MSM (Methyl Sulfonyl Methane)
 Natural agents that have been used in tendonitis include MSM orally for pain relief.

Skin

  DMSO Topically
 DMSO has been used successfully to reduce inflammation and pain.

Surgery/Invasive

  Prolotherapy
 Prolotherapy is the treatment of choice for any weakened ligament or tendon and its associated pain. Prolotherapy successfully regrows tendons and ligaments and reduces or eliminates pain from tendonitis.
 
 


KEY
Weak or unproven link
May do some good
Likely to help
Highly recommended
May have adverse consequences







GLOSSARY

Acute:  An illness or symptom of sudden onset, which generally has a short duration.

Anesthetic:  Agent causing loss of sensation by neurological dysfunction or a pharmacological depression of nerve function.

Anti-inflammatory:  Reducing inflammation by acting on body mechanisms, without directly acting on the cause of inflammation, e.g., glucocorticoids, aspirin.

Calcium:  The body's most abundant mineral. Its primary function is to help build and maintain bones and teeth. Calcium is also important to heart health, nerves, muscles and skin. Calcium helps control blood acid-alkaline balance, plays a role in cell division, muscle growth and iron utilization, activates certain enzymes, and helps transport nutrients through cell membranes. Calcium also forms a cellular cement called ground substance that helps hold cells and tissues together.

cc:  Cubic Centimeter. 29.6cc is 1 fl. oz; 1000cc is 1 liter; 3788cc is 1 gallon.

Chronic:  Usually Chronic illness: Illness extending over a long period of time.

Hypothyroidism:  Diminished production of thyroid hormone, leading to low metabolic rate, tendency to gain weight, and sleepiness.

Scar Tissue:  Fibrous tissue replacing normal tissues destroyed by injury or disease.

Tenosynovitis:  Tenosynovitis is inflammation of the lining of the sheath that surrounds a tendon. The synovium is a lining of the protective sheath that covers tendons. Tenosynovitis is inflammation of this sheath. The cause of the inflammation may be unknown, or it may result from infection, injury overuse, and strain. The wrists, hands, and feet are commonly affected, but the condition may occur with any tendon sheath.