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Tenosynovitis Content Supplied by NHS Choices
Introduction

Tendons are strong bands or cords of tissue that attach muscle to bone. They help move the bones and joints when muscles contract.

The main types of tendon injury are:

  • tendonitis - inflammation of a tendon
  • tendinopathy - the gradual deterioration of a tendon
  • tenosynovitis - inflammation of the protective sheath that surrounds a tendon
  • tendon rupture - a sudden tear in a tendon

Tendon injuries usually happen during sports or activities that involve sudden, sharp movements, such as throwing or jumping, or after repeated overuse of the tendons, such as running.

They can also be caused by repetitive daily activities, such as regularly using a computer keyboard and mouse. This is known as a repetitive strain injury (RSI).

Symptoms of a tendon injury

Tendon injuries can affect many different parts of the body. Commonly affected areas include the shoulders, elbows, wrists, knees, fingers and backs of the heels.

Symptoms of a tendon injury can include:

  • pain that gets worse when you move the affected area
  • stiffness in the affected area, which may be worse in the morning
  • weakness in the affected area or being unable to move a joint
  • a sensation that the tendon is grating or crackling as it moves
  • swelling, sometimes with heat or redness
  • a lump on the affected tendon

If your tendon ruptures, you will usually experience sudden and severe pain, which may eventually settle into a continuous, dull ache or no pain at all. Movement in the affected area may also become more difficult or even impossible.

Read more about the symptoms of tendon injuries.

When to see your GP

Minor tendon injuries can often be treated at home (see below). They will usually get better in a few weeks.

See your GP if your symptoms are severe or don't start to improve within a few weeks, or if you think you may have ruptured a tendon.

Your GP will usually be able to diagnose a tendon injury by asking about your symptoms and examining the affected area. Occasionally, they may request an X-ray, ultrasound scan or magnetic resonance imaging (MRI) scan to confirm the diagnosis.

Some medications may be related to tendon injuries, such as fluoroquinolone antibiotics and statins, so your GP may stop these if you're taking them.

Treating tendon injuries

If you think you have injured a tendon, stop doing the exercise or activity that caused your symptoms and rest the affected area initially. As your symptoms start to improve, you can gradually return to your normal activities.

In the meantime, taking paracetamol or ibuprofen and applying an ice pack or bag of frozen vegetables wrapped in a towel to the affected area may help relieve your pain.

For more persistent injuries, your GP may be able to refer you for treatments such as physiotherapy, corticosteroid injections or shock wave therapy.

In some cases, surgery may be recommended to treat long-term injuries that have not improved following other treatments, or to repair a ruptured tendon.

Read more about treating tendon injuries.

Preventing tendon injuries

You can help reduce your risk of tendon injuries by:

  • warming up before playing sport or exercising, and cooling down afterwards - read about how to warm up before exercising and how to stretch after exercising
  • making sure you use the correct equipment for the activity you're doing, such as wearing appropriate footwear
  • getting specialist coaching or training to help improve your technique in a particular sport
  • not exerting yourself beyond your physical capability
  • exercising the affected area to stretch and strengthen it - a physiotherapist may be able to advise you about the best exercises to do
  • avoiding repetitive movements when possible and make sure you take regular breaks
  • ensuring your desk, keyboard and mouse are in a comfortable position - read more about preventing RSI

If your job involves repetitive movements, ask your employer to provide rest periods, devices to support your wrists, and help with your posture.


Symptoms of a tendon injury

The main symptom of a tendon injury is pain in the affected tendon, which will usually get worse when you move it.

Other symptoms can include:

  • stiffness, which is often worse in the morning
  • weakness in the affected area or being unable to move a joint
  • swelling, sometimes with heat or redness
  • a sensation that the tendon is grating or crackling as it moves (this may be felt on examination)
  • a lump that develops along the tendon

Tendon injuries can often be treated with rest and painkillers at home (read more about treating tendon injuries), and will usually get better in a few weeks.

See your GP if your symptoms are severe or don't start to improve within a few weeks.

Specific tendon injuries

Tendon injuries can occur in many different parts of the body. Some common types are described below.

Supraspinatus tendonitis (shoulder)

Supraspinatus tendonitis is inflammation of the tendon at the top of the shoulder joint.

It causes shoulder pain when moving your arm, particularly if you lift it up high. The pain may also occur when you are lying on your shoulder at night.

Calcific tendonitis (shoulder)

In calcific tendonitis, small calcium crystals form in the supraspinatus tendon in your shoulder.

This can cause long-term mild pain, plus short episodes of more severe pain. The pain can spread down your arm or up into your neck. The condition may also cause your shoulder to become weak or stiff.

Biceps tendonitis (upper arm)

Biceps tendonitis affects the tendon that attaches the muscle on the front of your upper arm (bicep) to your shoulder.

This can cause pain in your shoulder and upper arm, which may be worse if you lift or reach overhead.

Tennis elbow and golfer's elbow

Tennis elbow is pain around the outside of the elbow. Golfer's elbow is pain around the inside of the elbow.

These conditions cause pain when you bend or straighten your elbow. The pain is usually around the elbow joint, but may spread down your forearm towards the wrist. You may have less grip strength as a result of the pain and your elbow may feel stiff.

De Quervain's disease (thumb and wrist)

In de Quervain's disease, the sheath surrounding the thumb tendons has become swollen and thick.

The main symptom is pain in the part of the wrist nearest the thumb, which gets worse as you use the hand and thumb. There may also be swelling in the wrist and "creaking" or "crunching" sensation when the thumb is moved.

Patellar tendonitis (knee)

Patellar tendonitis is inflammation of the tendon that connects the kneecap to the shin bone. It's sometimes called "jumper's knee" because it can be brought on by jumping activities such as basketball or volleyball.

Symptoms can include knee pain, swelling, redness and warmth.

In children, pain can occur just below the kneecap. This is known as Osgood Schlatter's disease.

Achilles tendinopathy (heel)

Achilles tendinopathy is a condition affecting the Achilles tendon, which runs between the heel and the calf muscle in the lower leg. It's thought to be caused by repeated damage to the Achilles tendon that fails to heal properly.

Symptoms can include pain and stiffness in the heel, which are usually worse in the morning. Sometimes there is also a swelling at the back of the heel.

Ruptured tendon

If a tendon ruptures (tears), you will normally experience sudden and severe pain in the affected area. This may have been accompanied by a "popping" or "snapping" sound.

The pain may eventually settle down to a continuous, dull ache, but the affected area will often be weak and difficult to move.

Commonly affected areas include the heels, upper arms, knees, thighs, lower legs and hands.

See your GP as soon as possible if you think you may have ruptured a tendon, as you may need to be referred to hospital for investigation or treatment.


Treating a tendon injury

Tendon injuries sometimes get better within a few weeks, but more persistent cases can last for several months.

There hasn't been much research into the best treatments for tendonitis and other tendon injuries, so it's not clear exactly which are the most effective.

Some of the treatments that may be recommended are described below, although your doctor may suggest different options depending on the specific injury you have.

The various treatments for tendon injuries are outlined below. You can also read a summary of the pros and cons of the treatments for tendon injuries, allowing you to compare your treatment options.

Self-care

Some tendon injuries can be cared for at home using the measures outlined below.

Rest

When you first injure your tendon, stop doing the activity that caused the injury and try to avoid any activities that cause your pain to get worse. This can help prevent any further damage and allow the tendon to heal.

Some form of support, such as a bandage, splint or brace, may help prevent the affected body part moving.

How long you need to rest for depends on which tendon is affected and how severely it's damaged. Prolonged rest is generally considered unhelpful as this can lead to long-term stiffness, so you should aim to gradually restart exercise when your pain allows.

Ice packs

Regularly applying an ice pack to the affected area during the first few days after the injury may help ease the pain and swelling.

Don't put ice directly on your skin though, as it may cause a cold burn. Instead, wrap it in a towel or put a towel over the injured area before applying the ice pack. A bag of ice cubes or frozen vegetables wrapped in a towel works just as well.

Hold the ice pack on the affected area for around 15-20 minutes several times a day.

Painkillers

Mild pain can sometimes be treated with over-the-counter painkillers such as paracetamol or ibuprofen. These are available as tablets or capsules, although ibuprofen also comes as a gel you apply directly to the affected area.

Before using these medications, check the leaflet that comes with them to see if they are suitable. Generally, ibuprofen shouldn't be used for long periods and isn't recommended for people with asthma, kidney disease or stomach ulcers.

Therapies and injections

See your GP if your symptoms are severe or are not getting better within a few weeks. They may be able to refer you for one of the more specialist treatments described below.

Physiotherapy

Physiotherapy for tendon injuries often involves a special exercise programme to help stretch and strengthen the injured tendon and surrounding muscles.

A physiotherapist may also be able to arrange an assessment of how you perform certain activities, such as running. You can then be advised of ways to improve any problems with your technique and posture that may have contributed to your injury.

Corticosteroid injections

Corticosteroids can be injected around injured tendons to reduce pain and inflammation. They can also be combined with local anaesthetic to further relieve pain.

However, while these injections can help reduce pain, they aren't effective for everyone and the effect sometimes only lasts a few weeks.

The injections can be repeated if they help, but a gap of at least six weeks between treatments, and a maximum of three injections into one area, is usually recommended because frequent injections can cause side effects.

Possible side effects include the weakening of the tendon (which can increase the risk of rupturing or tearing), and thinning and lightening of the skin.

Extracorporeal shock wave therapy

Extracorporeal shock wave therapy (ESWT) may be a treatment option for some tendon injuries that haven't responded to other treatments.

It involves passing shock waves through your skin to the affected area. This may be carried out over one or more sessions, and local anaesthetic may be used to numb the area first.

It's not clear exactly how ESWT works, but in some cases it helps break up deposits that have built up on an injured tendon and it may help promote healing.

Possible risks of ESWT include:

  • the tendon rupturing
  • temporary redness or swelling
  • pain during the treatment
  • feeling sick

The National Institute for Health and Care Excellence (NICE) has produced guidelines on ESWT for calcific tendonitis, ESWT for tennis elbow and ESWT for Achilles tendinopathy.

Surgery

Surgery may be an option for some tendon injuries, but this is often only considered as a last resort because it's not always effective and carries a risk of complications such as wound infections, scarring and rupturing of the affected tendon.

Surgery can be used to:

  • remove the damaged section of tendon
  • remove lumps or deposits that have formed on the tendon
  • encourage the tendon to heal
  • repair ruptured tendons

Increasingly, tendon operations in the shoulder and knee are carried out using a technique called arthroscopy. This is a type of keyhole surgery where special surgical instruments and a long, thin tube containing a camera are inserted through small cuts in your skin.

Arthroscopy can reduce scarring and allow you to recover more quickly, but it will often still be several weeks or months before you can return to your normal activities.


 
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