Recognizing the Symptoms of Tendonosis

Tendinosis is a common condition that affects many parts of the body. Tendons are long fibrous strands of connective tissue found throughout our bodies. They serve various functions including: supporting movement, regulating blood flow, and even acting as shock absorbers when moving or jumping from high places. [1]

The most commonly affected tendons are those in your back, knees, ankles and feet. However other areas such as the neck and shoulders may also be involved.

Symptoms of Tendinosis

Tendinosis can affect any part of the body, but it is most often seen in joints where there is excessive wear and tear due to repetitive motions. These include the wrists, elbows, knees, hips and shoulders.

Other conditions which can cause symptoms similar to tendinosis are osteoarthritis (wear and tear of cartilage) and rheumatoid arthritis (inflammation of the body’s own tissues).

In some cases the problem is not structural but rather psychological. For example, if you have had surgery for cancer or suffered a major injury then you might experience pain that does not respond to traditional treatments.

The following are some common symptoms of tendinosis:

Burning pain which worsens with activity and improves with rest

Pain which is felt during movement, especially at the start of an activity

Worsening pain after activity

Swelling and heat of the area

Tightness in the muscles near the affected area

Clicking or snapping sensations in the affected area

Stiffness in the affected area which wakes you up at night

Treatments for Tendinosis

The condition is normally treated with rest, anti-inflammatory medication, and physical therapy. In more severe cases surgery may be needed to release the tendon from any scar tissue or damaged areas.

If you have symptoms of tendinosis then your doctor may refer you to a physical therapist who can manipulate the affected area and teach you a gentle stretching routine which can enable you to return to your normal activities as soon as possible.

While rest is important it is also vital that you do not do too much before your treatment program has been completed. Continuing to overdo it will slow down the healing process and may even cause more damage.

Prevention of tendinosis

There are certain factors that can increase your risk of developing the condition. These include:

Age – The older you get, the more likely you are to develop symptoms of tendinosis. As you grow older your joints naturally begin to wear out.

This leads to a decrease in cartilage cushioning your bones and a loss of muscle strength which helps support your joints, especially when moving them through their full range of motion.

Repetition – Repetitive motions can lead to tendinosis. This is most commonly seen in factory workers who perform the same action thousands of times every day.

Repetitive motions of the wrist are a common cause of tendinosis in musicians and computer users. Excessive bending or twisting of your wrists, elbows, knees or ankles can also lead to the condition.

Overuse – Overuse can lead to tendinosis. This is common in athletes who train or compete more than once a day.

For example, runners are prone to overuse injuries of the knee, swimmers can develop the condition in their shoulder, and tennis players may find themselves suffering with pain in their elbow.

Obesity – Excess weight increases stress on your joints and can lead to tendinosis.

Genetics – If other members of your family have suffered from tendinosis then you are more likely to develop it.

Diabetes – This condition can lead to poor blood flow and nerve damage. Both these factors can affect the healing process of an injured tendon.

If you are at increased risk of developing tendinosis then the following steps will help to prevent the condition:

Maintain a healthy weight

Perform a warm up and stretch routine before you commence any physical activity

Gradually increase your training load or the intensity of your exercises

Make sure you allow enough rest between training sessions, rigid training schedules which do not allow for rest can lead to overtraining which puts you at risk of tendinosis as well as other overuse injuries.

If you have been diagnosed with tendinosis, especially if you are a novice or older athlete, your doctor may advise you to limit the amount of training that you do. Avoiding any actions or exercises that aggravate your symptoms is vital to enable the healing process to take place.

In more severe cases surgery may be required in order to release the affected tendon from any scar tissue or damaged areas. During your treatment program your physical therapist can advise you on the best course of action to follow.

Take your first step to recovery. Find a physical therapist near you.

Physical Therapy Treatment for Tendinosis

Tendinosis is a condition which affects the soft tissue around a joint; this includes muscles, tendons, and ligaments. It is also known as ‘tendinitis’, but this term is misleading as it implies an acute inflammatory process.

In fact, tendinosis is a gradual degenerative process with little inflammation involved.

The main symptom of this disorder is pain, which is generally felt during exercise or activity. Other symptoms may include joint stiffness, reduced range of motion and weakness in the surrounding muscles.

The pain associated with tendinosis is typically worse following activity and relieved by rest. There may be periodic flare-ups of pain which are associated with small tears in the affected soft tissue.

The causes of this condition are not well understood and factors such as overuse, age, gender, and others have all been suggested as potential contributing factors. Treatment for tendinosis will vary depending on the underlying cause.

Rest and treatment of any associated conditions (such as arthritis) may be recommended. Painkillers and anti-inflammatory medications may also be prescribed to relieve symptoms. Physical therapy can be an effective treatment option to restore range of motion, strength, and flexibility as well as to provide advice on a return to activity plan. Surgery may be required in some cases.

A doctor or physio will determine the best treatment option based on:

Your age

Your medical history

How long you have had the condition for

How severe your symptoms are

How well you respond to treatment

What would be the best way for you to recover?

Tendons are tough bands of fibrous tissue that connect muscles to bones. When muscles contract, they pull on tendons and this pulls bone joints closer together. There are several different types of tendon within the body. Each one has a different role such as allowing for internal organs to move or for teeth to bite.

Soft tissue injuries account for a large number of injuries seen by healthcare professionals. Tendon, ligament, and cartilage all fall under this category.

While some injuries are clearly obvious, others such as tendinosis may not be. It is a gradual degeneration of the tendon usually caused by overuse.

When tendons are placed under too much stress without adequate time to heal, tiny tears or splits can occur in the tissue making it weaker and more prone to further injury. This may lead to chronic pain and permanent disability if the problem is ignored.

Signs and symptoms of tendinosis usually begin gradually. There is often a period where the patient may notice an ache or soreness in the tendon.

This will then develop into pain especially when participating in specific activities that involves the tendon. Other signs and symptoms may include swelling, bruising, and a loss of flexibility in the joint attached to the tendon. Besides pain, other factors such as stiffness or swelling of the joint may be present.

Tendinosis is most common in middle-aged people, though it can occur at any age. It is more common in people who play sports, however it can also occur in people who do not exercise on a regular basis.

Certain jobs or hobbies that require repetitive motions may also cause tendinosis due to overuse. Some examples of these activities include painting, hammering, and playing musical instruments.

The cause of tendinosis is related to overuse. Commonly people who participate in power sports such as weight lifting or wrestling are more prone to this condition.

Repetitive motions such as typing on a keyboard for long hours each day may also lead to the condition. People who engage in these types of activities on a regular basis often develop small tears in their tendons which then causes the degenerative changes seen in tendinosis.

Stretching before and after physical activity may help to prevent small tears in the tendons. Wear and proper equipment while participating in physical activities can also help to prevent injury as well as ensure safety if an accident should occur.

If tendinosis is suspected, a medical professional should be consulted for diagnosis and treatment options.

Tendinosis Treatment

The best way to treat tendinosis is through activity modification, medications, and physical therapy. If you are not physically active and do not have a job or hobby that requires repetitive motions, then surgery may be unnecessary.

However, if tendinosis develops in a person who is physically active then non-surgical and surgical treatment options are possible.

Non-Surgical Treatment

A complete rest from all physical activity should be taken when tendinosis is diagnosed. Medications such as over the counter NSAIDs or prescription anti-inflammatories may help to decrease pain and swelling.

Ice packs can also help to decrease swelling and pain during the healing process.

A physical therapy program to restore strength and flexibility may also help to speed up recovery time and ensure a full recovery. Your physical therapist will teach you special exercises and stretches to perform at home.

A proper warm up before engaging in any physical activity and a cool down after activity is also advised when suffering from tendinosis.

If you participate in activities that involve the use of the tendon that is affected by tendinosis, your physical therapist can assist you with finding ways to continue these activities while still taking care of your injury. For example, if you play tennis and have tendinosis in your wrist, your therapist may suggest that you change your grip on the racket and take up a new hobby such as swimming or biking instead.

Surgery

If non-surgical treatment options fail to alleviate pain and restore function to the affected area then surgery may be required. Surgery for tendinosis involves cutting the affected tendon away from the sheath that surrounds it.

This is called a tenotomy. This allows the tendon to move more freely so that it can no longer rub against the sheath.

After surgery, the tendon will be covered with a protective layer of tissue known as a fascia. This helps to keep the tendon from moving too much which can cause it to reattach to the sheath.

Recovery time for this procedure depends on the severity of the condition and activity level of the patient.

Patients are encouraged to keep the affected area elevated above the heart as well as keep the area immobilized for up to a month after surgery. Before returning to work or engaging in physical activity, patients are required to have full range of motion in the involved joint and have normal strength and reflexes.

Take Home Message

While tendinosis is a fairly common condition, it can be cause for great frustration and concern. However, there are many ways in which to treat this condition depending on the patient’s activity level as well as the severity of the condition.

So if you find that you are in pain and your tendon is swollen or feels like a hard lump under the skin, do not hesitate to contact your physician who can assess your condition and recommend the proper treatment.

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Ultrasound guided aspiration of symptomatic supraspinatus calcific deposits by E Beutel – 2009

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Pain in the Cancer Rehabilitation Patient by T Mitchell – working-well.org

Gaming Disorder and Effects of Gaming on Health: An Overview by R Murphy, J Sokolof – … Pain Management in the Rehabilitation Patient, 2017 – Springer

Radial ridge excision for symptomatic volar tendon subluxation following de Quervain’s release by E Shaw – Decision Making in Pain Management, 2006 – Elsevier

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