Tendonitis

Tendons are the strong tissues that attach muscles to your bones, such as those you can see on the back of your hand when you extend your fingers. Tendonitis is an injury, often due to overuse or repetition of a certain movement over a period of time, that causes the affected tendon to become inflamed.

Tendinosis is chronic (long-term) tendonitis. Some tendons are covered by a tendon sheath (synovium) which contains fluid (synovial fluid) to allow them to glide easily. Tenosynovitis is when there's damage to this sheath. Tendinopathy is a general term that means injury to the tendon without specifying what the damage specifically is.

The most common types of tendonitis are:

Shoulder

• Calcific tendonitis – caused by a build-up of calcium crystals, most commonly affecting your shoulders
• Rotator cuff tendonitis – affecting your shoulders, but can also cause neck pain
• Supraspinatus tendonitis – affecting a tendon in your shoulder

Elbow

• Tennis elbow – causing elbow pain on the outside of your joint

Hand

• DeQuervain’s tenosynovitis – affecting your wrists and thumbs
• Trigger finger

Knee

• Jumper’s knee – causing knee pain

Foot

• Achilles tendonitis – causing heel pain

Tendonitis is common in middle-aged people who do a lot of sport. It also occurs if you do a lot of repetitive tasks at work.

You’re also more likely to have tendonitis if you have some types of arthritis, such as rheumatoid arthritis, or an infection.

In some cases, there’s no obvious cause (idiopathic).

You can treat a mild tendon injury at home and it should improve in two to three weeks. More serious injuries can take a few months.

Symptoms of tendonitis include:

• Feeling a lump in the tendon area
• Grating or cracking when you move the tendon (crepitus)
• Pain (in the affected tendon) that gets worse when you move
• Problems moving the tendon and the body part connected to it
• Swelling, heat and redness

You should see your doctor if:

• Your symptoms haven’t improved in a few weeks
• You’re in a lot of pain
• You think you’ve torn (ruptured) the tendon

Your doctor will discuss your symptoms and examine you to diagnose tendonitis or tenosynovitis. They'll check for any swelling or tenderness and pain when you move the tendon.

Your doctor may also press on the tendon and ask you to move or contract the muscle attached at the same time.

In most cases, you won’t need any more tests. However, your doctor may arrange for blood tests if they think there may be an infection.

They may also arrange for an X-ray, ultrasound scan or an MRI scan to rule out other conditions.

You may be able to treat yourself at home to bring down swelling and support the injured area.

• Rest as much as possible
• Apply an ice pack regularly
• Wrap a bandage around the affected area
• Elevate the injured area on a pillow or cushion when you’re sitting or lying down
• Take painkillers such as tablets, topical creams or gels, if advised by your doctor

To prevent any further swelling for the first two to three days, try to avoid:

• Heat – such as heat packs or hot baths
• Alcohol
• Massages

Your doctor may also arrange for you to have physiotherapy. Eccentric strengthening exercises – where you lengthen your muscles while contracting them – have been shown to be particularly successful in treating chronic tendon conditions.

You may also be referred for a scan at a hospital if your doctor believes you have another injury, such as a broken bone.

If you’re suffering from long-term or severe tendonitis, your doctor may advise:

• Extracorporeal shockwave therapy (ESWT) to help improve healing in your tendon
• Platelet-rich plasma (PRP) injections to speed up your recovery – this is a relatively new treatment and involves separating platelets and other healing factors from a sample of your blood. These are then injected into your area of pain to promote healing
• Steroid injections to reduce inflammation and pain – this is not recommended for you if you’ve had tendonitis pain lasting longer than three months
• Surgery to repair your tendon and remove damaged tissue

Once you can move the injured area without pain, you should try to move it often so the tendon does not become stiff.

Recovery can take anywhere between a couple of weeks to several months, and this depends on which tendon is injured.

How long it takes for you to recover will also depend on how well you’re able to rest the affected area. For example, if you have injured a tendon in your right wrist and you’re right handed, you may find it hard to rest the affected tendon fully as you’ll need to use it in daily activities.

Tendonitis is commonly caused by sudden or repetitive movements such as running or throwing. To reduce your risk of tendon injuries, you should:

• Warm-up before exercising and stretch well after you’ve finished
• Wear suitable shoes for your activity
• Take regular breaks from any repetitive exercises
• Consider getting lessons or an instructor if you're starting new activities
• Utilise exercises that strengthen your muscles around tendons, you may want to speak to a physiotherapist
• Stop and rest from your activity if you notice any pain
• Have a mix of high and low-impact exercises in your routine
• Avoid over-exercising any tired muscles
• Avoid repeating the same exercise routines

What is the best treatment for tendonitis?

Usually, the RICE method (rest, ice, compression and elevation) is enough to treat your tendonitis pain at home. Your GP may also suggest you take some painkillers too.

In some cases, you may be advised to seek advice from a physiotherapist. If your symptoms are more severe, you could be recommended treatments such as extracorporeal shockwave therapy, platelet rich plasma injections, steroid injections or surgery.

Does tendonitis ever go away?

Tendonitis may go away on its own over time. If not, your doctor will recommend treatments to reduce pain and inflammation. When treated properly, most tendonitis conditions don’t leave any damage.

How long does tendonitis take to heal?

Your recovery can take anywhere between a couple of weeks to several months.

Is heat or cold better for tendonitis?

Ice is very good for reducing any swelling and pain you may have in your tendon. If you don’t have an ice pack, a bag of frozen peas wrapped in a tea towel will work just as well.

You should not use heat on your tendon for the first three days of your injury. After this, heat may be used to increase blood flow to an injury and may help encourage healing. Heat also relaxes muscles, which promotes pain relief.

Is tendonitis a form of arthritis?

Tendonitis and arthritis are not the same condition, but you are more likely to develop tendonitis if you suffer from rheumatoid arthritis.

The two are similar as the pain you experience is worse during movement. However, unlike arthritis, the pain in tendonitis is often in parts of the body far from a joint.

Can stretching make tendonitis worse?

Stretching after exercise is very important in the prevention of developing tendonitis. You may find that some stretches cause you pain in your tendon and in this instance you should stop. For advice on stretches and exercises you can do with tendonitis, you should speak to your GP or physiotherapist.