{"id":1477,"date":"2024-03-12T17:01:42","date_gmt":"2024-03-12T21:01:42","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/?post_type=chapter&p=1477"},"modified":"2025-10-17T19:31:06","modified_gmt":"2025-10-17T23:31:06","slug":"tendinitis","status":"web-only","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/chapter\/tendinitis\/","title":{"raw":"Tendinitis","rendered":"Tendinitis"},"content":{"raw":"

Tendon<\/strong><\/h3>\r\nTendons are bands of dense regular connective tissue composed of collagen, proteoglycans, and tenocytes (elongated fibroblast type cells) that connect muscle to bone.\u00a0 Muscle is wrapped in 3 layers of connective tissue, the endomysium surrounding each myofiber (skeletal muscle cells), perimysium surrounding each bundle or fascicle of myofibers, and epimysium surrounding bundles of fascicles that make-up the muscle.\u00a0 The epimysium (or fascia) is composed of dense irregular connective tissue that extends to form the tendon that anchors the muscle to bones.\u00a0 The collagen within the tendon penetrates into the bone in the form of Sharpey\u2019s fibers giving strength and support.\u00a0 The elasticity of tendons allow for tendons to function not only in withstanding forces but also by acting as springs (see Plantar Fascia section) which makes walking and running more energy efficient.\u00a0 Tendon stretchiness also allows muscles to shorten and generate force in isometric contractions.\r\n\r\nInterestingly, sinew (fibrous tissues such as tendons or ligaments) was used historically by humans to create rope, thread, and bows taking advantage of the flexible, durable, and strong mechanical properties of tendons and ligaments.\r\n

Tendonitis<\/strong><\/h3>\r\nTendonitis by definition is characterized by inflammation of the tendon, often a result of an acute or chronic condition.\u00a0 Tendinitis may be associated with tendinosis, which is defined as tendon degeneration.\u00a0 The suffix -osis refers to a degenerative condition. The term tendinopathy may be used generally to indicate any problem with the tendon, with the suffix -pathy derived from a Greek word meaning disease or disorder.\r\n

Risk Factors and Prevention - Tendonitis<\/strong><\/h3>\r\nThe most common causes of tendonitis is due to over-use (e.g., tennis, golf, running) and the most common tendons affected include:\u00a0 tendons of the rotator cuff muscles of the shoulder (e..g, supraspinatus), biceps tendons, tendons in the elbow and wrist, the patellar tendon and iliotibial band at the knee, and the Achilles tendon of the heel.\r\n\r\n \r\n\r\nExamples:<\/strong>\r\n\r\nLateral epicondylitis<\/strong> is most commonly caused by racquet sports or manual labour.\r\n\r\nMedial epicondylitis<\/strong> is associated with golfing, baseball pitching, bowling and manual labour.\r\n\r\nRotator cuff tendinopathy<\/strong> often occurs with repetitive overhead arm movements (e.g., swimming, painting, throwing)\r\n\r\nPatellar tendinopathy<\/strong> is associated with running and jumping and can be experienced by runners, and volleyball and basketball players.\r\n\r\nIliotibial band syndrome<\/strong> and Achilles tendinopathy<\/strong> are associated with participating in football, dance, cycling, running\r\n\r\n \r\n\r\nPrevention of tendonitis involves gradually ramping up exercise and activity levels over time, as well as utilizing supportive shoes and equipment (e.g., properly strung tennis racquets)\r\n

Pathogenesis - Tendonitis<\/strong><\/h3>\r\nTendons that experience trauma, which can lead to tears that range in size from microtears to larger tears.\u00a0 The affected collagen, proteoglycans, associated vasculature, neurons, and cells such as tenocytes are able to regenerate, though full recovery depends on the extent of damage, overall health and age of individual, as well as treatment and rehabilitative strategies.\u00a0 Complications involving dystrophic calcification which impede healing and can lead to impaired function.\u00a0 Excessive scarring can lead to tendon shortening and loss of range of motion (adhesive capsulitis also known as frozen shoulder).\r\n\r\n*Note: \u00a0Unfortunately, calcium deposits can also occur spontaneously (without prior trauma to the tendon), in idiopathic calcifying tendinitis.\r\n

Signs and Symptoms - Tendonitis<\/strong><\/h3>\r\nSigns and symptoms include everything expected with an inflammatory condition.\u00a0 Locally, there will be swelling as well as pain, and possibly redness, warmth and impaired performance.\r\n\r\nComplications include tendon weakening, tendon rupture and adhesive capsulitis (i.e., frozen shoulder).\r\n

Diagnostic Tests - Tendonitis<\/strong><\/h3>\r\nPhysical examinations and imaging (e.g., x-ray, ultrasound and MRI) are useful in assessing injuries and the presence of calcium deposits.\r\n

Treatment - Tendonitis<\/strong><\/h3>\r\nTypical treatments involve PRICE (Protection with splinting or immobilization; Rest, Ice, Compression and Elevation), analgesic and anti-inflammatories (e.g., NSAIDs or topical non-steroidal anti-inflammatories), possibly corticosteroid injections and\/or surgery.\u00a0 New treatments are being developed all of the time, and there has been some success in treating calcific deposits with ESWT (extracorporeal shock wave therapy), TENS (transcutaneous electrical nerve stimulation), ultrasound-guided needling (breaking up calcium with needle), and barbotage (saline injection\/aspiration washes).\r\n\r\nAs always, each treatment has its pros, cons, and risks associated (e.g. ESWT is associated with risk of developing hematomas).\r\n\r\n \r\n\r\nRehabilitation typically involves a prescribed progression of stretching and strengthening activities to maintain and restore range motion, strength and activity levels.\r\n\r\n \r\n\r\n \r\n\r\nSummary\r\n
    \r\n \t
  • Carpal Tunnel Syndrome (CTS) is a repetitive strain injury.<\/li>\r\n \t
  • Inflammation and damage can occur if ergonomics aren't adjusted.<\/li>\r\n \t
  • Scar tissue buildup can increase pressure on nerves, causing pain, tingling, and weakness.<\/li>\r\n \t
  • Joint damage can increase the risk of developing osteoarthritis in the future.<\/li>\r\n \t
  • Preventing CTS involves adjusting keyboard ergonomics and ensuring proper movement mechanics.<\/li>\r\n \t
  • Tendinitis, indicated by \"-itis,\" involves tendon inflammation and can be caused by activities like tennis, hockey, painting, keyboard use, running, and massage.<\/li>\r\n \t
  • <\/li>\r\n \t
  • Tendinopathy: disease of tendons<\/li>\r\n \t
  • Examples: Tennis elbow (lateral side), Golfer's elbow (medial side)<\/li>\r\n \t
  • Pain due to micro-tears in tendon, bleeding, inflammation<\/li>\r\n \t
  • Signs and symptoms: pain on movement<\/li>\r\n \t
  • Treatment: RICE, anti-inflammatories, physical therapy, massage, rest<\/li>\r\n \t
  • Treatment: RICE, fluid aspiration, antibiotics for infection<\/li>\r\n \t
  • PRICE (Protection, Rest, Ice, Compression, Elevation) can help manage symptoms and prevent excessive scar tissue formation.<\/li>\r\n \t
  • <\/li>\r\n \t
  • Arthroscopy allows surgeons to view and repair joint injuries, such as ligament tears or meniscus tears.<\/li>\r\n \t
  • Viewing scope and surgical instruments for repairing damaged tissue<\/li>\r\n \t
  • Arthrography: X-ray or CT scan to view joint damage<\/li>\r\n \t
  • Radio-dense dye (iodine) for X-ray, MRI contrast medium for MRI<\/li>\r\n \t
  • <\/li>\r\n \t
  • Prevention: proper warm-up, technique, equipment, gradual activity increase<\/li>\r\n \t
  • Bursitis: often in knees from prolonged kneeling<\/li>\r\n<\/ul>\r\nRehab:\r\n
      \r\n \t
    • Tennis elbow:\r\n
        \r\n \t
      • Similar stretching regimen before adding weights.<\/li>\r\n \t
      • Gradual progression from weight-free to weighted stretches.<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t
      • Importance of prescribed exercises to prevent conditions like frozen shoulder.<\/li>\r\n \t
      • Exercises for other conditions: golf, pre-patellar bursitis.<\/li>\r\n \t
      • Challenge in replicating tendons synthetically due to high mechanical stresses.<\/li>\r\n \t
      • Rheumatic diseases: affect joints, tendons, ligaments, bones, or muscles.<\/li>\r\n<\/ul>","rendered":"

        Tendon<\/strong><\/h3>\n

        Tendons are bands of dense regular connective tissue composed of collagen, proteoglycans, and tenocytes (elongated fibroblast type cells) that connect muscle to bone.\u00a0 Muscle is wrapped in 3 layers of connective tissue, the endomysium surrounding each myofiber (skeletal muscle cells), perimysium surrounding each bundle or fascicle of myofibers, and epimysium surrounding bundles of fascicles that make-up the muscle.\u00a0 The epimysium (or fascia) is composed of dense irregular connective tissue that extends to form the tendon that anchors the muscle to bones.\u00a0 The collagen within the tendon penetrates into the bone in the form of Sharpey\u2019s fibers giving strength and support.\u00a0 The elasticity of tendons allow for tendons to function not only in withstanding forces but also by acting as springs (see Plantar Fascia section) which makes walking and running more energy efficient.\u00a0 Tendon stretchiness also allows muscles to shorten and generate force in isometric contractions.<\/p>\n

        Interestingly, sinew (fibrous tissues such as tendons or ligaments) was used historically by humans to create rope, thread, and bows taking advantage of the flexible, durable, and strong mechanical properties of tendons and ligaments.<\/p>\n

        Tendonitis<\/strong><\/h3>\n

        Tendonitis by definition is characterized by inflammation of the tendon, often a result of an acute or chronic condition.\u00a0 Tendinitis may be associated with tendinosis, which is defined as tendon degeneration.\u00a0 The suffix -osis refers to a degenerative condition. The term tendinopathy may be used generally to indicate any problem with the tendon, with the suffix -pathy derived from a Greek word meaning disease or disorder.<\/p>\n

        Risk Factors and Prevention – Tendonitis<\/strong><\/h3>\n

        The most common causes of tendonitis is due to over-use (e.g., tennis, golf, running) and the most common tendons affected include:\u00a0 tendons of the rotator cuff muscles of the shoulder (e..g, supraspinatus), biceps tendons, tendons in the elbow and wrist, the patellar tendon and iliotibial band at the knee, and the Achilles tendon of the heel.<\/p>\n

         <\/p>\n

        Examples:<\/strong><\/p>\n

        Lateral epicondylitis<\/strong> is most commonly caused by racquet sports or manual labour.<\/p>\n

        Medial epicondylitis<\/strong> is associated with golfing, baseball pitching, bowling and manual labour.<\/p>\n

        Rotator cuff tendinopathy<\/strong> often occurs with repetitive overhead arm movements (e.g., swimming, painting, throwing)<\/p>\n

        Patellar tendinopathy<\/strong> is associated with running and jumping and can be experienced by runners, and volleyball and basketball players.<\/p>\n

        Iliotibial band syndrome<\/strong> and Achilles tendinopathy<\/strong> are associated with participating in football, dance, cycling, running<\/p>\n

         <\/p>\n

        Prevention of tendonitis involves gradually ramping up exercise and activity levels over time, as well as utilizing supportive shoes and equipment (e.g., properly strung tennis racquets)<\/p>\n

        Pathogenesis – Tendonitis<\/strong><\/h3>\n

        Tendons that experience trauma, which can lead to tears that range in size from microtears to larger tears.\u00a0 The affected collagen, proteoglycans, associated vasculature, neurons, and cells such as tenocytes are able to regenerate, though full recovery depends on the extent of damage, overall health and age of individual, as well as treatment and rehabilitative strategies.\u00a0 Complications involving dystrophic calcification which impede healing and can lead to impaired function.\u00a0 Excessive scarring can lead to tendon shortening and loss of range of motion (adhesive capsulitis also known as frozen shoulder).<\/p>\n

        *Note: \u00a0Unfortunately, calcium deposits can also occur spontaneously (without prior trauma to the tendon), in idiopathic calcifying tendinitis.<\/p>\n

        Signs and Symptoms – Tendonitis<\/strong><\/h3>\n

        Signs and symptoms include everything expected with an inflammatory condition.\u00a0 Locally, there will be swelling as well as pain, and possibly redness, warmth and impaired performance.<\/p>\n

        Complications include tendon weakening, tendon rupture and adhesive capsulitis (i.e., frozen shoulder).<\/p>\n

        Diagnostic Tests – Tendonitis<\/strong><\/h3>\n

        Physical examinations and imaging (e.g., x-ray, ultrasound and MRI) are useful in assessing injuries and the presence of calcium deposits.<\/p>\n

        Treatment – Tendonitis<\/strong><\/h3>\n

        Typical treatments involve PRICE (Protection with splinting or immobilization; Rest, Ice, Compression and Elevation), analgesic and anti-inflammatories (e.g., NSAIDs or topical non-steroidal anti-inflammatories), possibly corticosteroid injections and\/or surgery.\u00a0 New treatments are being developed all of the time, and there has been some success in treating calcific deposits with ESWT (extracorporeal shock wave therapy), TENS (transcutaneous electrical nerve stimulation), ultrasound-guided needling (breaking up calcium with needle), and barbotage (saline injection\/aspiration washes).<\/p>\n

        As always, each treatment has its pros, cons, and risks associated (e.g. ESWT is associated with risk of developing hematomas).<\/p>\n

         <\/p>\n

        Rehabilitation typically involves a prescribed progression of stretching and strengthening activities to maintain and restore range motion, strength and activity levels.<\/p>\n

         <\/p>\n

         <\/p>\n

        Summary<\/p>\n

          \n
        • Carpal Tunnel Syndrome (CTS) is a repetitive strain injury.<\/li>\n
        • Inflammation and damage can occur if ergonomics aren’t adjusted.<\/li>\n
        • Scar tissue buildup can increase pressure on nerves, causing pain, tingling, and weakness.<\/li>\n
        • Joint damage can increase the risk of developing osteoarthritis in the future.<\/li>\n
        • Preventing CTS involves adjusting keyboard ergonomics and ensuring proper movement mechanics.<\/li>\n
        • Tendinitis, indicated by “-itis,” involves tendon inflammation and can be caused by activities like tennis, hockey, painting, keyboard use, running, and massage.<\/li>\n
        • <\/li>\n
        • Tendinopathy: disease of tendons<\/li>\n
        • Examples: Tennis elbow (lateral side), Golfer’s elbow (medial side)<\/li>\n
        • Pain due to micro-tears in tendon, bleeding, inflammation<\/li>\n
        • Signs and symptoms: pain on movement<\/li>\n
        • Treatment: RICE, anti-inflammatories, physical therapy, massage, rest<\/li>\n
        • Treatment: RICE, fluid aspiration, antibiotics for infection<\/li>\n
        • PRICE (Protection, Rest, Ice, Compression, Elevation) can help manage symptoms and prevent excessive scar tissue formation.<\/li>\n
        • <\/li>\n
        • Arthroscopy allows surgeons to view and repair joint injuries, such as ligament tears or meniscus tears.<\/li>\n
        • Viewing scope and surgical instruments for repairing damaged tissue<\/li>\n
        • Arthrography: X-ray or CT scan to view joint damage<\/li>\n
        • Radio-dense dye (iodine) for X-ray, MRI contrast medium for MRI<\/li>\n
        • <\/li>\n
        • Prevention: proper warm-up, technique, equipment, gradual activity increase<\/li>\n
        • Bursitis: often in knees from prolonged kneeling<\/li>\n<\/ul>\n

          Rehab:<\/p>\n

            \n
          • Tennis elbow:\n
              \n
            • Similar stretching regimen before adding weights.<\/li>\n
            • Gradual progression from weight-free to weighted stretches.<\/li>\n<\/ul>\n<\/li>\n
            • Importance of prescribed exercises to prevent conditions like frozen shoulder.<\/li>\n
            • Exercises for other conditions: golf, pre-patellar bursitis.<\/li>\n
            • Challenge in replicating tendons synthetically due to high mechanical stresses.<\/li>\n
            • Rheumatic diseases: affect joints, tendons, ligaments, bones, or muscles.<\/li>\n<\/ul>\n","protected":false},"author":1370,"menu_order":18,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"Pictures coming soon!","pb_authors":["zoe-soon"],"pb_section_license":"cc-by-nc-sa"},"chapter-type":[48],"contributor":[60],"license":[57],"class_list":["post-1477","chapter","type-chapter","status-web-only","hentry","chapter-type-standard","contributor-zoe-soon","license-cc-by-nc-sa"],"part":41,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/1477","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/users\/1370"}],"version-history":[{"count":8,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/1477\/revisions"}],"predecessor-version":[{"id":4254,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/1477\/revisions\/4254"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/parts\/41"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/1477\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/media?parent=1477"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapter-type?post=1477"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/contributor?post=1477"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/license?post=1477"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}