What is Tendonitis?
Tendonitis is often an overuse injury of the tendon (tissue connecting muscles to bones). Tendons frequently affected are located around the heels, knees, shoulders, wrists, and elbows. This happens when extra stress is placed on the tendons through repetitive activities. Examples include participating in sports such as running or baseball, or hobbies such as painting and gardening. Repetitive tasks at work are another frequent cause of tendonitis.

Individuals who increase the intensity of their exercise without proper flexibility or conditioning are more likely to develop tendonitis. Not allowing enough time for the tendons to recover between exercise sessions is another common cause. Tendonitis also increases with age because the tendons lose their springiness over time.

The best ways to prevent tendonitis are to warm up prior to exercise, balance strength and flexibility around joints, and incorporate proper training and recovery. Changing your workspace set-up can help reduce the stress placed on the tendons as well.

Symptoms of Tendonitis
Typical symptoms of tendonitis include stiffness, mild swelling, and pain near the joint, often described as a dull ache. The pain associated with tendonitis often increases over time, but may be sudden and severe. If left untreated, the symptoms can worsen and become chronic.

Treatment of Tendonitis
Tendonitis is initially treated with the RICE protocol. This includes rest, ice, compression, and elevation of the affected area to relieve the pain and swelling, as well as over-the-counter pain medication such as Tylenol or Ibuprofen. You will also need to adjust your activity while recovering to what does not make your symptoms worse such as swimming instead of running.
A physician can assist in the treatment in several ways. They may recommend short term use of a sling, brace, wrap, or crutches to minimize use of the tendon. Physical therapy either at home or with a therapist may be prescribed. Osteopathic Manipulative Techniques (OMT) can be performed during your visit to improve pain, motion, and function. A corticosteroid injection may be recommended to reduce pain and swelling, however this must be used infrequently to avoid weakening the tendon and increasing the risk of rupture. Other procedures and injections may be trialed as well to recover.

X-ray and occasionally MRI may be used to look for other injuries and to obtain further details about the tendonitis. Also, with the assistance of in-office ultrasound, a physician can determine the extent of injury and use the results to direct further treatment. 

In-office ultrasound is often used to guide a corticosteroid injection or newer treatments such as platelet rich plasma, prolotherapy, dry needling, trigger point injection, and percutaneous needle tenotomy. These treatment options are
used when symptoms are not improving with more conservative care discussed previously. They help promote the body’s
ability to repair the tendon by creating controlled inflammation in order to stimulate the healing process. This is important since tendons do not have an adequate blood supply to promote proper healing on their own. These non-surgical options can be performed in the office and are well tolerated. 

Surgery may be necessary in severe cases of tendonitis that do not respond to other treatments.

Everyone recovers from an injury at a different rate. Return to activity is determined by how soon the tendon recovers and not by how many days or weeks it has been since the injury. The goal is to return to normal activity as soon as is safely possible. 

If you are suffering from tendonitis, we are here to help you regain pain-free function as quickly as possible. We can assist in determining the appropriate course of treatment and guide your return to activity in a safe manner to prevent reoccurrences or further injury.

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