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Tendonitis

 


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Class
Musculo-skeletal system
Description
Tendonitis is the inflammation of a tendon, the strong, cord-like, white fibrous tissue that connects muscles to bones. The tendons generally run through a sheath or canal called the synovial sheath. Inflammation of the synovial sheath is called synovitis, while inflammation of the sheath and tendon together is called tenosynovitis.

Tendons of the shoulder, elbow, wrist, finger, thigh, knee or back of the heel (Achilles tendon) are the most common areas to be affected by tendonitis as these are the tendons most frequently used.

Tendonitis can occur in any one at any age, but is more common in adults who take part in a lot of sporting activities.
Causes
Tendonitis is most commonly due to overuse. Chronic tendonitis can lead to weakening of the tendon and, in extreme cases, the tendon may tear (rupture of the tendon). Many types of tendonitis are linked to a specific sport or activity. For example, overuse of the tendons in the shoulder, seen in swimmers; tennis elbow, from repetitive overstretching of the arm muscles by those who play racket sports; tendonitis in the feet and ankles of runners; repetitive strain injury in tendons of the wrist in keyboard operators. Other causes of tendonitis are often physical, such as obesity, where the excess weight puts an abnormal strain on the legs and feet.
Symptoms
Symptoms of tendonitis tend to come and go as the tendon is used or rested. Tendonitis typically causes a sharp or aching pain with tenderness and swelling over the affected tendon. There may also be restricted movement or weakness in the affected area, usually due to pain. Excess fluid may form, which can be felt as the tendon moves. With Achilles tendonitis, if activities such as running are continued, there is a risk that the tendon may rupture. Even the smaller tendons of the wrist and upper arm can tear with overuse. If this happens, there is often bleeding into the space around the tear and the blood tracks up the muscle and appears under the skin as a vivid bruise, often some distance from the original tear.
Treatment
Strict rest of the affected area, with the application of ice to reduce swelling for the first 24-48 hours helps to relieve the pain of acute tendonitis. After the initial swelling is reduced, the application of gentle heat will help with muscle relaxation.

For adults, oral analgesics such as aspirin or ibuprofen taken by mouth in the form of tablets or capsules will help reduce pain and inflammation during the healing process. Topical analgesics such as ibuprofen, ketoprofen and piroxicam, available in the form of creams, gels or sprays may be applied directly to the affected area to reduce pain and inflammation. Other preparations, known as rubefacients, contain a mixture of ingredients that bring a feeling of warmth when applied to the affected area. Bruising may be reduced by the use of ointments containing arnica tincture. The act of rubbing any of these topical preparations into the affected area also helps ease discomfort.

Ruptures to the tendon will usually repair themselves with rest and treatment, but severe cases may require splinting to ensure total rest to the tendon. If there is severe or recurrent pain, a doctor may prescribe an injection with an anti-inflammatory or steroid drug. Treatment for tenosynovitis is the same as that for tendonitis.
When to consult your pharmacist
Your pharmacist is able to supply a wide range of oral analgesics, topical analgesics and rubefacients without the need for a prescription. Always tell your pharmacist if you are taking any other medicines or have any other medical conditions. Some of the preparations, for example those that contain aspirin or derivatives of aspirin, or drugs known as non-steroidal anti-inflammatory drugs, should not be taken by people who have developed asthma or other allergic reactions to these drugs in the past. These preparations should also be avoided by women who may be pregnant or breast feeding. These drugs may also interfere with the action of other medicines such as warfarin, increasing the risk of bleeding. Aspirin should not be used by children under 16 years of age.

Your pharmacist is also able to supply a range of dressings and bandages that can be used to support joints during exercise to reduce the risk of tendonitis developing.
When to consult your doctor
See your doctor if the pain does not ease after a few days of rest and basic treatment. If there is severe or recurrent pain, the tendon sheath may require an injection with an anti-inflammatory or steroid drug to reduce the inflammation.
Living with tendonitis
While experiencing tendonitis you will need to modify the activities that first caused the problem. Avoid aggravating repetitive activities that put a strain on the tendons. Avoid over-training in sports, always do gentle warm up and warm down exercises. Take frequent rest breaks and always stop if pain occurs or gets worse. Use joint braces, compression bandages or splints to provide support to the area.

If tendonitis is particularly severe, regular physiotherapy and massage may help. If you take analgesics to ease the pain, never exceed the stated dose and do not take them for long periods.

If starting a new sport or a new activity that involves a lot of physical movement, take things slowly at first and gradually build up your level of activity.
Useful Tips
  • Pay close attention to your body's warning signs - fatigue and pain in a muscle or tendon are signs that you're overstraining them
  • Stretch thoroughly before undertaking exercise and stop before you're exhausted. Stretch and warm down afterwards
  • If taking up gymnastics or a sport for the first time, get advice on caring for your tendons and joints from your instructor
  • Use elastic support for areas such as the wrist and knee
  • Remember to change posture and position to prevent tendonitis caused by repetitive movements such as typing


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