What Is It?

Tendonitis is the inflammation, irritation or microscopic tearing of a tendon — a band of tough, flexible, fibrous tissue that connects muscle to bone. Tendons range in size from the delicate, tiny bands of the hands to the heavy, ropelike cords that anchor the calf or thigh muscles. In most cases, tendonitis occurs because of overuse (too many repetitions of a particular body motion) or overload (a sudden increase in activity, with increased demand for muscle performance). Rarely, tendonitis occurs because of an infection, including gonorrhea. Although tendonitis can affect tendons anywhere in the body, the most common sites are the shoulder, elbow, knee, wrist and heel.

Tendonitis in the shoulder — Rotator-cuff tendonitis is the most common form of tendonitis to affect the shoulder joint. It involves the tendon of the supraspinatus muscle, which attaches to the upper portion of the humerus at the shoulder joint. Less commonly, the tendon of the infraspinatus muscle is affected. In most cases, the supraspinatus tendon is injured by overuse, typically in an occupation or sport that requires the arm to be elevated repeatedly. People at risk include carpenters, painters, welders, swimmers, tennis players and baseball players. The average patient is a male laborer older than 40, whose shoulder complaints are on the same side as his dominant hand, for example, right shoulder pain if he is right-handed.

Tendonitis in the elbow — Two forms of tendonitis commonly involve the elbow: lateral epicondylitis and medial epicondylitis. Both are very common overuse injuries among athletes involved in throwing and racquet sports.

Lateral epicondylitis (tennis elbow) causes pain on the outer side of the elbow joint. Lateral epicondylitis probably affects 40 percent to 50 percent of all adult athletes who play racquet sports. It also can be caused by any activity that repeatedly twists and flexes the wrist, such as pulling weeds, using a screwdriver or even carrying a briefcase.

Medial epicondylitis (golfer’s elbow) causes pain on the inner side of the elbow. It is a less common injury than tennis elbow and, despite its name, it is more likely to be related to occupation than to sports. When it does occur as a sports injury, medial epicondylitis can be triggered by swinging a golf club or throwing a baseball repeatedly.

Tendonitis in the knee — Jumper’s knee, the most common form of knee tendonitis, involves either the patellar tendon at the lower border of the kneecap or the quadriceps tendon at the upper border of the kneecap. It is a common overuse injury, especially in basketball players and long-distance runners.

Tendonitis in the wrist — In the wrist, tendonitis commonly appears in the form of de Quervain’s disease, a condition that causes pain in the back of the wrist at the base of the thumb. Although de Quervain’s disease usually occurs in people who perform repetitive grasping or pinching motions with the thumb, it sometimes develops spontaneously in pregnant women.

Achilles tendonitis — This form of tendonitis affects the Achilles tendon, the large ropelike tendon attached to the heel bone at the back of the foot. Achilles tendonitis is caused most often by overuse, especially in sports that require running or repetitive jumping, and it accounts for 15 percent of all running injuries. Achilles tendonitis also may be related to faulty running technique or to poorly fitting shoes, if the back of the shoe digs into the Achilles tendon above the heel. Less often, Achilles tendonitis is related to an inflammatory illness, such as ankylosing spondylitis, Reiter’s syndrome, gout or rheumatoid arthritis.

In general, tendonitis produces pain in the tissues surrounding a joint, especially after excessive use of the joint during play or work. In some cases, there also may be weakness at the involved joint, and the affected area may be red, swollen and warm to the touch.

When tendonitis occurs as a result of an infection such as gonorrhea, there may be other symptoms, including rash, fever, or a discharge from the vagina or penis.

More specific symptoms vary according to the location of the affected tendon:

• Rotator-cuff tendonitis — Usually dull, aching shoulder pain that is not easily localized. It often radiates into the upper arm toward the chest. The pain is often worse at night and may interfere with sleep.
• Tennis elbow — Pain in the outer side of the elbow. In some cases, the painful area extends down to the forearm and wrist
• Golfer’s elbow — Pain in the inner side of the elbow
• Jumper’s knee — Pain below the kneecap and, sometimes, above it
• De Quervain’s disease — Pain at the back of the wrist, near the base of the thumb
• Achilles tendonitis — Pain at the back of the heel or two to four inches above the heel

After reviewing your medical and orthopedic history, including any recent joint injuries, your doctor will ask you specific questions about your pain:

• What does your pain feel like (sharp, dull, burning)?
• Where is your pain located? Is it limited to one area or does it spread away from the joint to involve a wider area on your arm, leg or hand?
• Do you have tingling, numbness or weakness?
• When did your pain start? Did it begin after a sudden increase in your work activities or exercise? Might it be related to any new sport or exercise that you’ve recently tried?
• What makes it feel better, and what makes it worse?
• Does the pain disappear when you rest the affected area, or is it present even at rest?
• Have you had unprotected sex?

In most cases, a diagnosis can be made based on your medical history and symptoms, together with your occupational and sports history and the results of your physical examination. During the physical exam, your doctor will look for tenderness, swelling, redness, muscle weakness and limited motion in the area of the affected tendon. Your doctor also may ask you to perform specific limb maneuvers, such as raising your arm above your head or bending your wrist. These maneuvers may be painful, but they are a very important part of the diagnostic process, because they show the doctor which tendon is affected.

In certain people, blood tests may be necessary to rule out other causes of inflammation around the joints, such as gout or rheumatoid arthritis. X-rays also may be taken to confirm that there is no fracture, dislocation or bone disease. In people with Achilles tendonitis, ultrasound or magnetic resonance imaging (MRI) scans may be used to help evaluate the extent of tendon damage.

Depending on the location and severity of tendonitis, symptoms may last for a few days or for several weeks. If there is continued overuse or aggravation of the injured site, pain may worsen and persist for several months.

In many cases, the pain of tendonitis can be avoided by taking a few simple precautions. Some helpful strategies include:

• Always warm up before beginning strenuous exercise.
• If you want to intensify your exercise level, do it gradually.
• Be careful about the “no pain, no gain” approach. It is usually hard to distinguish an ache that indicates you’re building strength from an ache that signals tendon injury.
• Avoid activities that require prolonged periods of reaching over your head, such as painting the ceiling. If you must do this kind of work, take frequent breaks.
• Wear shoes that fit properly, especially if you participate in a sport that requires a lot of running, such as track, cross-country or basketball.
• If your injury seems to be related to faulty technique, ask your coach or trainer for guidance. If these people cannot help, then a doctor who specializes in sports medicine may be able to suggest a competent sports professional who can guide you.
• For people with medial or lateral epicondylitis related to racquet sports, changing to a racquet with a larger head may help to prevent re-injury, as long as the new racquet is not heavier than the original. Some specialists believe that this type of racquet cuts down on the transmission of vibrations to the arm.
• Tendonitis due to gonorrhea can be prevented by practicing safe sex.

The quicker your tendonitis is treated, the sooner you’ll recover full strength and flexibility. Your doctor initially may recommend that you apply ice packs to the painful area for 20-minute periods, three or four times a day. You also should ice the area immediately after any activity that aggravates your pain (such as tennis, running, etc.) To relieve pain and swelling, your doctor may suggest that you take ibuprofen (Advil, Motrin), aspirin or another nonprescription anti-inflammatory medication, usually for several weeks. You also will need to rest the affected area to allow your body to repair itself. The duration of this rest period varies from a few days to a few weeks. For example, patients with golfer’s elbow usually need to rest the affected elbow for at least one month. If an infection is causing the tendonitis, antibiotics may be required.

Depending on the location and severity of tendonitis, you may need temporary splinting, bracing or a sling (for tendonitis in the upper extremity). However, it is important to keep moving the joint to avoid getting a stiff, or “frozen,” joint.

For more serious cases of noninfectious tendonitis, your doctor may inject a corticosteroid drug or local anesthetic into the affected tendon. He or she also may refer you to a physical therapist for more specialized local treatments, such as deep heat treatments using ultrasound, friction massage or water therapy to improve joint mobility. The physical therapist also will guide you through a customized rehabilitation program that will help you to regain strength, motion and function. The length of time for rehabilitation varies depending on the type and severity of tendonitis. For example, it is usually at least two to six months for Achilles tendonitis and at least six months for epicondylitis.

Fortunately, surgery is rarely necessary to treat tendonitis. It is reserved for cases that do not respond to other types of treatment.

Call your doctor whenever you have a significant joint problem, such as severe pain, redness or swelling or loss of joint function. Also call your doctor if less severe joint pain persists beyond a few days.

With proper treatment, the affected tendon usually recovers completely. However, incomplete rehabilitation or a hasty return to activity can slow the healing process or lead to re-injury.

Diseases and Conditions Center

All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.