The cause is not always known.
Tendons are painful, particularly when moved, and sometimes swollen.
The diagnosis is usually based on symptoms and results of a physical examination.
Using a splint, applying heat or cold, and taking nonsteroidal anti-inflammatory drugs can help.
Tendons are fibrous cords of tough tissue that connect muscles to bones. Some tendons are surrounded by tendon sheaths. (See also Introduction to Muscle, Bursa, and Tendon Disorders Introduction to Muscle, Bursa, and Tendon Disorders The muscles, bursae, tendons, and bones must be healthy and functioning correctly for the body to move normally. Muscles, which contract to produce movement, are connected to the bones by tendons... read more .)
The cause of tendinitis is often unknown. Tendinitis usually occurs during middle or older age, as the tendons weaken and become more susceptible to injury and inflammation. (Weakening of the tendon, called tendinopathy, usually results from many small tears that occur over time. Affected tendons may gradually or suddenly tear completely.) Tendinitis also occurs in younger people who exercise vigorously (who may develop rotator cuff tendinitis Rotator Cuff Tendinitis Tendinitis is inflammation of a tendon. Tenosynovitis is tendinitis accompanied by inflammation of the protective covering around the tendon (tendon sheath). The cause is not always known. Tendons... read more —see also Rotator Cuff Injury/Subacromial Bursitis Rotator Cuff Injury/Subacromial Bursitis The muscles that help hold the upper arm in the shoulder joint (the rotator cuff muscles) can get pinched (shoulder impingement syndrome), become inflamed (tendinitis), or can tear partially... read more ) and in people who do repetitive tasks.
Certain tendons are particularly susceptible to inflammation:
Tendons of the shoulder (rotator cuff): Inflammation of these tendons is the most common cause of shoulder pain (see Rotator Cuff Injury/Subacromial Bursitis Rotator Cuff Injury/Subacromial Bursitis The muscles that help hold the upper arm in the shoulder joint (the rotator cuff muscles) can get pinched (shoulder impingement syndrome), become inflamed (tendinitis), or can tear partially... read more ).
The two tendons that extend the thumb away from the hand: Inflammation of these tendons is called De Quervain syndrome De Quervain Syndrome De Quervain syndrome is swelling and inflammation of the tendons or tendon sheaths that move the thumb outward. (See also Overview of Hand Disorders.) De Quervain syndrome usually occurs after... read more .
The flexor tendons that clench the fingers: Inflammation causes these tendons to get caught in their sheaths, resulting in a popping feeling (trigger finger Trigger Finger Trigger finger is locking of a finger in a bent position caused by inflammation of a tendon in the finger. (See also Overview of Hand Disorders.) The cause of trigger finger is unknown. Trigger... read more
).
The tendon above the biceps muscle in the upper arm (bicipital tendon): Pain can occur when the elbow is bent or the arm is elevated or rotated.
Achilles tendon in the heel: Pain occurs at the back of the heel (Achilles tendinitis Achilles Tendinitis Achilles tendinitis is inflammation of the Achilles tendon, the tough band of tissue connecting the calf muscles to the heel. (See also Overview of Sports Injuries.) Achilles tendinitis is very... read more ).
A tendon that runs over the side of the knee (popliteus tendon): Pain occurs on the outer part of the knee.
Tendons near the hip bone (trochanter): Because bursae may also be affected, the term trochanteric bursitis is often used to include inflammation of these tendons.
Some antibiotics, such as fluoroquinolones Fluoroquinolones Fluoroquinolones are a class of broad-spectrum antibiotics that are used to treat a variety of infections. Fluoroquinolones include the following: Ciprofloxacin Delafloxacin Gemifloxacin read more , may increase the risk of tendinopathy (weakening of the tendon) and rupture of the tendon.
Certain joint diseases, such as rheumatoid arthritis Rheumatoid Arthritis (RA) Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints.... read more , systemic sclerosis Systemic Sclerosis Systemic sclerosis is a rare, chronic autoimmune connective tissue disorder characterized by degenerative changes and scarring in the skin, joints, and internal organs and by blood vessel abnormalities... read more
, gout Gout Gout is a disorder in which deposits of uric acid crystals accumulate in the joints because of high blood levels of uric acid (hyperuricemia). The accumulations of crystals cause flares (attacks)... read more
, diabetes Diabetes Mellitus (DM) Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high. Symptoms of diabetes may... read more , and reactive arthritis Reactive Arthritis Reactive arthritis (previously called Reiter syndrome) is a spondyloarthritis causing inflammation of the joints and tendon attachments at the joints, often related to an infection. Joint pain... read more
(previously called Reiter syndrome), can increase the risk of tenosynovitis. In people with gonorrhea Symptoms Gonorrhea is a sexually transmitted infection caused by the bacteria Neisseria gonorrhoeae, which infect the lining of the urethra, cervix, rectum, or throat, or the membranes that cover... read more
, especially women, gonococcal bacteria can cause tenosynovitis, usually affecting the tissues of the shoulders, wrists, fingers, hips, ankles, or feet.
Symptoms of Tendinitis and Tenosynovitis
The inflamed tendons are usually painful when moved or when pressed. Moving the joints near the tendon, even a little, may cause pain, depending on how severe the tendinitis is. Occasionally, the tendons or their sheaths swell and feel warm.
If tendinitis lasts a long time, calcium may become deposited. The area around the shoulder joint is often affected. In addition to being painful, the shoulder may feel stiff and weak. It may snap or catch when moved.
Diagnosis of Tendinitis and Tenosynovitis
A doctor's evaluation
Sometimes imaging tests
Doctors can usually diagnose tendinitis based on the symptoms and results of a physical examination.
Sometimes magnetic resonance imaging Magnetic Resonance Imaging (MRI) Magnetic resonance imaging (MRI) is a type of medical imaging that uses a strong magnetic field and very high frequency radio waves to produce highly detailed images. During an MRI, a computer... read more (MRI) or ultrasonography Ultrasonography Ultrasonography is a type of medical imaging that uses high-frequency sound (ultrasound) waves to produce images of internal organs and other tissues. During an ultrasound, a device called a... read more
is helpful.
Treatment of Tendinitis and Tenosynovitis
Rest or immobilization, heat or cold, followed by exercises
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Sometimes injections of corticosteroids
Rest or immobilization with a splint or cast and application of heat Heat therapy Professional rehabilitation therapists treat pain and inflammation. Such treatment makes movement easier and enables people to participate more fully in rehabilitation. Techniques used include... read more or cold Cold therapy (cryotherapy) Professional rehabilitation therapists treat pain and inflammation. Such treatment makes movement easier and enables people to participate more fully in rehabilitation. Techniques used include... read more —whichever works—are often helpful. Taking NSAIDs Nonopioid Pain Relievers Pain relievers (analgesics) are the main drugs used to treat pain. Doctors choose a pain reliever based on the type and duration of pain and on the drug's likely benefits and risks. Most pain... read more for 7 to 10 days can reduce the pain and inflammation.
Sometimes corticosteroids (such as betamethasone, methylprednisolone, or triamcinolone) and anesthetics (such as lidocaine) are injected into the tendon sheath. Rarely, the injection causes pain hours later because the corticosteroid temporarily forms crystals inside the joint or sheath. This pain lasts less than 24 hours and can be treated with cold compresses and pain relievers.
Other drugs may be used, depending on the cause. For example, if gout Gout Gout is a disorder in which deposits of uric acid crystals accumulate in the joints because of high blood levels of uric acid (hyperuricemia). The accumulations of crystals cause flares (attacks)... read more is the cause, indomethacin or colchicine may be used.
After inflammation is controlled, exercises to increase the range of motion Range-of-motion exercises Physical therapy, a component of rehabilitation, involves exercising and manipulating the body with an emphasis on the back, upper arms, and legs. It can improve joint and muscle function, helping... read more should be done several times a day.
Chronic, persistent tendinitis can occur in rheumatoid arthritis Rheumatoid Arthritis (RA) Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints.... read more and may have to be treated surgically to remove inflamed tissues. Physical therapy Physical Therapy (PT) Physical therapy, a component of rehabilitation, involves exercising and manipulating the body with an emphasis on the back, upper arms, and legs. It can improve joint and muscle function, helping... read more to increase range of motion and rehabilitate muscles and tendons may be needed after surgery. Surgery is occasionally needed to remove calcium deposits or repair the tendon from areas of long-standing tendinitis, such as the area around the shoulder joint. Occasionally, surgery is done to release scars that limit function or to remove part of a bone that is rubbing against a tendon.
Rotator Cuff Tendinitis
Rotator cuff tendinitis (see Rotator Cuff Injury/Subacromial Bursitis Rotator Cuff Injury/Subacromial Bursitis The muscles that help hold the upper arm in the shoulder joint (the rotator cuff muscles) can get pinched (shoulder impingement syndrome), become inflamed (tendinitis), or can tear partially... read more ) is the most common cause of shoulder pain. It causes pain when the arm is raised (particularly between 40° and 120°) or when people dress. People often have pain during the night, especially when they lie on the affected arm.
Symptoms of rotator cuff tendinitis may occur suddenly and be severe, especially after physical activity, or they may develop more slowly and be milder.
Doctors may do x-rays X-Rays X-rays are a type of medical imaging that use very low-dose radiation waves to take pictures of bones and soft tissues. X-rays may be used alone (conventional x-ray imaging) or combined with... read more to look for calcium deposits in the tendon. Sometimes magnetic resonance imaging Magnetic Resonance Imaging (MRI) Magnetic resonance imaging (MRI) is a type of medical imaging that uses a strong magnetic field and very high frequency radio waves to produce highly detailed images. During an MRI, a computer... read more (MRI) or ultrasonography Ultrasonography Ultrasonography is a type of medical imaging that uses high-frequency sound (ultrasound) waves to produce images of internal organs and other tissues. During an ultrasound, a device called a... read more
is helpful to confirm there is not a complete tendon tear.
Range-of-motion exercises Range-of-motion exercises Physical therapy, a component of rehabilitation, involves exercising and manipulating the body with an emphasis on the back, upper arms, and legs. It can improve joint and muscle function, helping... read more , nonsteroidal anti-inflammatory drugs Nonopioid Pain Relievers Pain relievers (analgesics) are the main drugs used to treat pain. Doctors choose a pain reliever based on the type and duration of pain and on the drug's likely benefits and risks. Most pain... read more (NSAIDs), and sometimes a corticosteroid injection can be used for treatment. Rarely, surgery is done to remove calcium deposits or repair the tendon if is completely torn.
Drugs Mentioned In This Article
Generic Name | Select Brand Names |
---|---|
betamethasone |
Adbeon, Alphatrex, Beta 1 Kit, Beta Derm , Betanate , Betatrex, Beta-Val, BSP 0820, Celestone, Del-Beta , Diprolene, Diprolene AF, Diprosone, Luxiq Foam, Maxivate, ReadySharp Betamethasone, Sernivo, Valisone |
methylprednisolone |
A-Methapred, Depmedalone-40, Depmedalone-80 , Depo-Medrol, Medrol, Medrol Dosepak, Solu-Medrol |
triamcinolone |
Aristocort, Aristocort A, Aristocort Forte, Aristocort HP, Aristo-Pak, Aristospan, Azmacort, Children's Nasacort Allergy 24HR Nasal Spray, Cinalog, Cinolar, Flutex, Hexatrione, Kenalog, Kenalog in Orabase, Kenalog-10, Kenalog-40, Kenalog-80, Nasacort, Nasacort AQ, Oralone, SP Rx 228 , Tac-3 , Triacet , Triamonide , Trianex , Triderm , Triesence, XIPERE, Zilretta |
lidocaine |
7T Lido, Akten , ALOCANE, ANASTIA, AneCream, Anestacon, Aspercreme with Lidocaine, Astero , BenGay, Blue Tube, Blue-Emu, CidalEaze, DermacinRx Lidogel, DermacinRx Lidorex, DERMALID, Ela-Max, GEN7T, Glydo, Gold Bond, LidaMantle, Lidocan, Lidocare, Lidoderm, LidoDose, LidoDose Pediatric, Lidofore, LidoHeal-90, LIDO-K , Lidomar , Lidomark, LidoReal-30, LidoRx, Lidosense 4 , Lidosense 5, Lidosol, Lidosol-50, LIDO-SORB, Lidotral, Lidovix L, LIDOZION, Lidozo, LMX 4, LMX 4 with Tegaderm, LMX 5, LTA, Lydexa, Moxicaine, Numbonex, ReadySharp Lidocaine, RectaSmoothe, RectiCare, Salonpas Lidocaine, Senatec, Solarcaine, SUN BURNT PLUS, Tranzarel, Xyliderm, Xylocaine, Xylocaine Dental, Xylocaine in Dextrose, Xylocaine MPF, Xylocaine Topical, Xylocaine Topical Jelly, Xylocaine Topical Solution, Xylocaine Viscous, Zilactin-L, Zingo, Zionodi, ZTlido |
indomethacin |
Indocin, Indocin SR, TIVORBEX |
colchicine |
ColciGel, Colcrys , GLOPERBA, LODOCO, MITIGARE |