tendonitis

tendinitis summary

Tendinitis is the inflammation of a tendon that is mainly characterized by chronic or acute pain and thickening of the tendons.
It is usually caused due to excessive use of the tendons and occurs mainly in workers (using computers, activities with repeated movements, etc.) and in non-professional athletes. Some medications can cause tendonitis.
The biggest complaints are chronic pain, but there are acute pains.

The diagnosis can be made through the patient’s history, clinical examination, x-ray, magnetic resonance and ultrasound.

Decreased activity in the affected area or even immobilization are essential steps in the treatment.

Drug treatment is usually performed using non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, naproxen and diclofenac; in the acute phase of pain, as well as cold compresses. In more severe cases, glucocorticoids and physiotherapy sessions may be used.

Acupuncture , strengthening, stretching, localized massages , among others, can be used as very efficient non-drug treatments.

There are some tips to prevent tendinitis: always warm up before exercising, drink plenty of water, avoid repetitive movements, if this is not possible, take breaks every hour to stretch; maintain a good posture in front of the computer (hands straight and screen at eye level) and in cases of pain, see a doctor.

Definition

Tendinitis is the inflammation of a tendon that is mainly characterized by chronic or acute pain and thickening of the tendons. In medical or clinical language, the term tendinopathy is often preferred, mainly because these tendon problems are not caused exclusively by inflammation.

The tendon helps in the contraction of the muscle, it is a set of collagen-based fibers that connect the bone and the muscle, normally they are well united. In tendinitis, the collagen is disordered, with proliferation and chronic irritation of the tissue.

It is important to note that there are numerous tendons in the body, but only a few can be painful, such as:

– the Achilles tendon

– the carpal tunnel (we speak of carpal tunnel syndrome)

– the elbow (we speak of epicondylitis or “tennis elbow”)

– the rotator cuff (we are talking about rotator cuff tendinopathy), is a set of tendons and muscles located at shoulder level. At shoulder level, another form of tendinitis is biceps tendonitis. In this case, the pain is felt in front or on the side of the shoulder

– the knee

The patient’s history can elucidate the type of training or activity that caused the tendinitis.

Epidemiology 

It is estimated that up to 3.8% of adults suffer from shoulder tendonitis.

Tendinitis is more common with advancing age.

Causes

The main causes or risk factors for tendonitis are:

– Overuse of tendons. Some medical sources believe that this is the main cause of tendonitis.

– An intense effort, after the lack of physical exercise (ex: a person who is not training abruptly resumes the exercises and gets injured)

– Dehydration and incorrect nutrition.

– Repetitive movements of sudden tension, as in the case of athletes

– One false move

– The stress

– A bad posture in the joint

– The use of very flat shoes (without any heels)

– Taking certain medications (fluoroquinolone, a class of antibiotics that can cause problems in the tendon region, especially the Achilles tendon). Note: if you discover that you have tendonitis after taking an antibiotic, you must consult a doctor so that he authorizes the interruption of the treatment.

– Medications other than antibiotics that may be related to tendonitis are listed below, for each there was at least one confirmed case.
Amlodipine (Achilles tendon)
> Statins . Of the tendinitis caused by statins, atorvatatin (37%) is the main cause, followed by simvastatin (31%), pravastatin (22%), fluvastatin (5%) and rosuvastatin (5%).
> Clopidogrel
> Gemifloxacin
> Isotretinoin (Achilles tendon)
> Levofloxacin
> Moxifloxacin
> Norfloxacin
>  Orfloxacin

Genetic influence:
Tendonitis appears to have a genetic influence, which would explain why some people suffer more than others, especially among professional athletes. In fact, in 2014 a Brazilian study that carried out the DNA analysis of 138 volleyball players from the main Brazilian league (Superliga) revealed two genetic changes that would lead to a predisposition to suffer from tendinitis. These 2 genes in question are BMP4 (a protein that stimulates bone formation) and FGF3 (which stimulates the formation of fibroblasts). Of the 138 participants, 38% had tendonitis. In this group of athletes with tendinitis, 66% had the genetic predisposition of the BMP4 gene, compared to only 9% in the group of athletes without tendonitis. This study, carried out by the Into institute,in Rio de Janeiro, was published in 2014 in the scientific journal Journal of Science and Medicine of Sport .

Symptoms

The main symptoms of tendinitis are mainly throbbing pain (eg when moving).

Because it is an inflammation, other signs may be related, such as redness, an increase in temperature and swelling at the site of tendon inflammation.

Caution: as pain is the main symptom, tendinitis can often be confused with other diseases, such as rheumatoid arthritis .

Symptoms usually appear in the joint.

Location of tendinitis
The areas of the body most affected by tendinitis are mainly the shoulders, elbows, hips, knees and ankles.

Diagnosis

To diagnose tendinitis, the doctor can, for example, feel to observe the exact location of the pain or else tense the muscle.

Some exams can help the doctor in the diagnosis, such as: x-ray, magnetic resonance and ultrasound. Another factor that helps a lot in the diagnosis is the anamnesis, where the patient tells the doctor his story, his complaints, his routines and answers pertinent questions, usually it is very important to confirm the tendinitis, determine its cause and degree.

The use of questionnaires can help the physician’s assessment, as they perform a functional assessment using points. One of the most famous and well-established questionnaires is the Instituto de Vivtorio de Assessoria Esportiva (VISA) questionnaire for patellar tendinitis and the VISA-A for Achilles tendonitis.

Studies (read in Causes ) have shown the influence of heredity or genetics on the onset of tendinitis. Diagnostic tests based on the identification of certain genes (eg BMP4) can be especially useful for professional sportsmen in order to avoid injuries and strengthen tendons during physical preparation.

The diagnosis must always be made by a doctor, so we recommend that in case of doubt you always consult one.

Treatments

The first measure to be taken to treat tendinitis is to stop any movement in the place where it is located (for example: shoulder, arm, etc.), that is, it is important to immobilize the joint. Subsequently, a rehabilitation and progressive return of activities of the tendon should be carried out.

Then, it is strongly recommended to apply a cold compress (it can be ice covered with a tissue or an ice pack) for about half an hour on the area of ​​inflammation.

– The drug treatment recommended to be taken at the beginning is paracetamol . For example, 1 gram 3 times a day (adult dosage).

– You can also use an NSAID (non-steroidal anti-inflammatory drug) such as ibuprofen , aspirin , naproxen (500mg every 12 hours; max 1250 mg/day) or even diclofenac (Voltaren® Emulgel). This last substance can also be used in the form of a cream, poultice or gel.

– Plaster or creams based on Glyceryl Trinitrate (GNT) can also be used.

– Glucocorticoids, more severe cases. These corticosteroid injections take place directly around the affected tendon. However, repeated injections should be avoided, as they can weaken the tendon and increase the risk of tendon rupture, as reported by the Mayo Clinic ( Mayo Clinic ).

If the pain does not stop after 3 days, consult a doctor.

In case of persistent pain, the doctor may prescribe stronger treatments, such as corticoids (corticoid infiltration), or physiotherapy sessions.

Physiotherapy is a great treatment option already well established.

Eccentric exercises (application of a load to stretch a muscle) and other high-load exercises are widely used in the treatment of various tendinitis. As well as stretching.

There are other unconventional treatments, such as:

– Electroacupuncture Ryodoraku, a study with athletes shows complete pain relief in 74.1% of cases, it is a quick, easy-to-perform and low-cost treatment.

– Surgery, recommended only in cases resistant to conservative treatments.

Some medications recommended for cases of tendonitis contain vitamins B1 and B6.

Surgery
In some specific or severe cases, for example when the tendon has ruptured or separated from the bone, the doctor may perform surgery. Sometimes the doctor will seek to remove the scar tissue found in the tendon, especially during chronic inflammation, the operation is called focused aspiration of scar tissue (FAST).

Herbal medicine

Certain medicinal plants can be used as a complementary measure in the treatment of tendinitis, such as:

– Devil’s claw , in tablet or capsule form;

– Cayenne pepper , in plaster form;

– arnica , in the form of a gel, for example;

– the baleeira herb , in the form of a gel, cream or infusion (compress).

therapy tips

– It is very important that, in case of tendonitis, you seek treatment as soon as possible (eg joint immobilization, cold compresses, medication… see all treatments)

Prevention

These are some effective measures to prevent tendonitis:

– Warm up before starting a physical exercise, sport or effort

– Drink plenty of fluids

– Reduce repetitive movements

– If it is not possible to avoid repetitive movements, take short breaks every hour in the activity and stretch.

– If you spend a lot of time at the computer, try to use ergonomic keyboards and mice, they greatly reduce cases of tendonitis.

– Maintain a balanced diet, especially before exercising.

– Strengthen your muscles before starting to practice a sport, especially tennis.

– After playing sports, stretch.

– If a sport causes tendonitis, try to play different sports or physical exercises to strengthen other muscles and joints.

– In cases of treatment with an antibiotic of the fluoroquinolone family (eg ciprofloxacin) in which the person has pain or inflammation in one or more tendons, if possible, it is recommended to immediately stop the treatment and consult a doctor quickly, according to Anvisa ( drug regulatory agency in Brazil) in 2020. Fluoroquinolones are known to cause serious side effects on tendons (and muscles), sometimes leading to tendon rupture.

Sources and references: 
Clínica Mayo (Mayo Clinic), Journal of Science and Medicine of Sport, Folha de S.Paulo.

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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