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Tendinitis

Tendinitis is a clinical term referring to the inflammation of the tendons which is caused by the repeated injury to affected tendon. Tendinitis can also be due to systemic diseases that decrease the elasticity of the tendons like diabetes and rheumatoid arthritis.


Presentation

The signs and symptoms of tendinitis typically occur at point of insertion of the tendon to the bone or muscles. Patients describe the pain to be dull and gnawing in character that aggravates with the moving and exertion of the affected limb or joint. Palpation of the lesion will reveal a certain degree of tenderness especially with manipulation and movement of the adjacent articular surface. Acute and chronic tendinitis will present with swelling with some erythema of the superficial skin over the affected site.

Reiter's Syndrome
  • The etiology is unknown, although repetitive or forceful trauma, exercise or strain, systemic diseases (rheumatoid arthritis, gout, Reiter's syndrome) and hypercholesterolemia are implicated.[ecopolitan.com]
  • Certain joint diseases, such as rheumatoid arthritis, systemic sclerosis, gout, diabetes, and reactive arthritis (previously called Reiter syndrome), can increase the risk of tenosynovitis.[msdmanuals.com]
  • There are certain diseases that can cause tendinitis, such as rheumatoid arthritis, gout, Reiter's syndrome, lupus, and diabetes. Sometimes, people with gout have uric acid crystals that appear in the tendon sheath that cause friction and tearing.[bodyandhealth.canada.com]
Soft Tissue Swelling
  • The diagnosis of retropharyngeal calcific tendinitis will be made radiologically by the detection of calcifications anterior to C1-C3 and prevertebral soft tissue swelling.[ncbi.nlm.nih.gov]
  • The diagnosis is made radiographically by a nearly pathognomonic amorphous calcification anterior to C1-C2 and prevertebral soft tissue swelling. We present a new case of this uncommon condition exhibiting some unusual features.[ncbi.nlm.nih.gov]
  • Ultrasound Features of calcific tendinitis on ultrasound may include 7 : a curvilinear/ovoid calcification with acoustic shadowing capsular soft tissue swelling MRI T1 hypointense homogeneous signal adjacent tendon may be thickened some enhancement surrounding[radiopaedia.org]
Sore Throat
  • CT should be performed in patients who present with nonspecific symptoms such as severe neck pain, sore throat, odynophagia, and mild fever.[ncbi.nlm.nih.gov]
  • The most common symptoms of RCT at presentation were neck pain (94%), limited range of motion (45%), odynophagia (45%), neck stiffness (42%), dysphagia (27%), sore throat (17%), and neck spasm (11%).[ncbi.nlm.nih.gov]
Pharyngitis
  • A nasofibrolaryngoscopy performed during the otorhinolaryngological examination revealed a slight bulging of the left posterolateral pharyngeal wall. The larynx was erythematous and the vocal cords were smooth and mobile; no masses were observed.[elsevier.es]
Odynophagia
  • A 46-year-old Caucasian man presented with a 1-day history of severe neck pain, headache and odynophagia.[ncbi.nlm.nih.gov]
  • The associated symptoms included neck pain, stiffness, odynophagia, and headache. The duration of symptoms varied from 2 days to 1 week.[ncbi.nlm.nih.gov]
  • Acute calcific tendinitis of the longus colli muscle (or retropharyngeal tendinitis) is an aseptic inflammatory process characterized by acute posterior neck pain, neck stiffness and dysphagia or odynophagia.[ncbi.nlm.nih.gov]
  • CT should be performed in patients who present with nonspecific symptoms such as severe neck pain, sore throat, odynophagia, and mild fever.[ncbi.nlm.nih.gov]
  • We describe a case of a 40-year-old patient who presented to the emergency department with severe odynophagia and exhibited the computed tomography findings necessary to confirm this disease.[ncbi.nlm.nih.gov]
Dysphagia
  • A 36-year-old woman presented with neck stiffness and torticollis accompanied by dysphagia and prevertebral space sensitivity on the second day.[ncbi.nlm.nih.gov]
  • Patients presenting with a triad of acute severe neck pan, stiff neck, and dysphagia may have retropharyngeal tendinitis.[ncbi.nlm.nih.gov]
  • Acute calcific longus colli tendinitis (LCT) has been reported as an unusual cause of acute-onset neck pain, dysphagia, and headache.(1-5) As described in most of the published reports, LCT traditionally manifests on computed tomography (CT) imaging as[ncbi.nlm.nih.gov]
  • Acute calcific longus colli tendinitis (ACLCT), a very rare cause of severe neck pain, dysphagia and odynophagia, is often mistaken for other common causes of neck pain.[ncbi.nlm.nih.gov]
  • Pain and dysphagia improved considerably within several hours; all symptoms resolved in 5 days.[elsevier.es]
Tendon Disorder
  • The aim of this mini-review is to explore the role of pro-inflammatory cytokines, particularly interleukin-1β (IL-1β) in tendon disorders.[ncbi.nlm.nih.gov]
  • Click here for Patient Education Bursa, Muscle, and Tendon Disorders Bursitis Fibromyalgia Tendinitis and Tenosynovitis Tendinitis is inflammation of a tendon, often developing after degeneration (tendinopathy).[msdmanuals.com]
  • The findings are similar to, but much more pronounced than, those found in studies looking at patients with frozen shoulder and other tendon disorders and diseases.[sciencedaily.com]
  • Figure 1 Figure 2 What are tendon disorders? Tendon disorders, or tendinopathies, are medical conditions that result in the tendons not functioning normally.[ccohs.ca]
  • disorders, like Achilles tendinopathy, are very common among athletes.[dx.doi.org]
Frozen Shoulder
  • Loss of motion in the shoulder, called "adhesive capsulitis" or frozen shoulder. How Can I Avoid Tendinitis? To avoid tendinitis, try these tips when performing activities: Take it slow at first. Gradually build up your activity level.[webmd.com]
  • The symptoms that you may feel are pain at the site of the tendon and surrounding area or loss of motion in the shoulder also called “frozen shoulder.” Tendinitis can occur in almost any area of the body where a tendon connects a bone to a muscle.[voa-online.com]
  • ‘Chronic shoulder problems usually fall into one of several categories, which include impingement syndrome, frozen shoulder and biceps tendonitis.’ ‘Older athletes are more likely to present with tendinitis in these areas.’[en.oxforddictionaries.com]
  • The findings are similar to, but much more pronounced than, those found in studies looking at patients with frozen shoulder and other tendon disorders and diseases.[sciencedaily.com]
Neck Pain
  • Acute calcific retropharyngeal tendinitis is a rare and underrecognized cause of atraumatic neck pain and stiffness.[ncbi.nlm.nih.gov]
  • Acute calcific longus colli tendinitis (ACLCT), a very rare cause of severe neck pain, dysphagia and odynophagia, is often mistaken for other common causes of neck pain.[ncbi.nlm.nih.gov]
  • Presented here is a rare cause of severe neck pain - acute longus colli calcific tendinitis - in a 54year old man who presented to the emergency department.[ncbi.nlm.nih.gov]
  • Acute calcific tendinitis of the longus colli muscle is a rare clinical entity that causes severe neck pain. This entity is not well recognized due to its nonspecific presentation such as acute neck pain, neck stiffness, and odynophagia.[ncbi.nlm.nih.gov]
  • We present a rare case of severe neck pain in a 45-year-old man with severe hidradenitis suppurativa who was participating in a study involving adalimumab.[ncbi.nlm.nih.gov]
Torticollis
  • We present a case exhibiting an uncommon symptom (torticollis) and a brief literature review to emphasize the risk of misdiagnosis.[ncbi.nlm.nih.gov]
  • He exhibited mild fever, torticollis, and a moderately elevated white blood count; no swelling of the retropharyngeal wall was observed.[ncbi.nlm.nih.gov]
Neck Stiffness
  • A 36-year-old woman presented with neck stiffness and torticollis accompanied by dysphagia and prevertebral space sensitivity on the second day.[ncbi.nlm.nih.gov]
  • The most common symptoms of RCT at presentation were neck pain (94%), limited range of motion (45%), odynophagia (45%), neck stiffness (42%), dysphagia (27%), sore throat (17%), and neck spasm (11%).[ncbi.nlm.nih.gov]
  • This entity is not well recognized due to its nonspecific presentation such as acute neck pain, neck stiffness, and odynophagia. The importance of this disease with a review of the literature is presented.[ncbi.nlm.nih.gov]
  • First described by Hartley 1 in 1964, longus colli tendinitis is characterised by a number of symptoms, including neck pain, neck stiffness, dysphagia, and odynophagia.[elsevier.es]
Intracranial Hemorrhage
  • However, this condition is often confused with life-threatening conditions such as infection (meningitis or retropharyngeal abscess), intracranial hemorrhage, trauma, herniation of cervical discs, or malignancy (Estimable et al. (2015) [1]).[ncbi.nlm.nih.gov]

Workup

A complete and thorough clinical history and physical examination will easily clinch the diagnosis of tendinitis [4]. In some cases, imaging techniques like X-ray may be requested by the physicians to rule out other disorders that can present similarly. The use of ultrasound on the diagnosis of patellar tendinitis may prove to be more specific compared to magnetic resonance (MRI) scans [5]. Although both ultrasound and MRI can be complementarily used in diagnosis of most tendinopathies [6].

Soft Tissue Calcification
  • We describe a case of an osteoid osteoma of the scaphoid bone associated with calcific tendinitis of the adjacent flexor carpi radialis tendon and periarticular soft tissue calcifications in a 21-year-old man presenting with radial-sided wrist pain.[ncbi.nlm.nih.gov]
  • Plain radiographs showed characteristic soft-tissue calcification overlying the insertion of the flexor carpi ulnaris tendon into the wrist. Treatment with ibuprofen and splinting resulted in complete symptom resolution.[ncbi.nlm.nih.gov]
Dyslipidemia
  • PubMed Google Scholar Gaida JE, Alfredson L, Kiss ZS, Wilson AM, Alfredson H, Cook JL: Dyslipidemia in Achilles tendinopathy is characteristic of insulin resistance. Med Sci Sports Exerc. 2009, 41 (6): 1194-1197. 10.1249/MSS.0b013e31819794c3.[dx.doi.org]

Treatment

In mild cases of tendinitis, adequate rest, ice packs, and over the counter pain relievers may be all that is needed to relieve the discomforts caused by the local inflammation of the affected tendon. Patients complaining of pain are usually prescribed with anti-inflammatory and analgesic agents like ibuprofen, aspirin, and naproxen to instantly relieve pain. Pain symptoms that are not relieved by rest and pain relievers are often times injected with local cortisone to control local inflammation and pain. The use of injectable corticosteroids however only gives symptomatic relief in a limited period of time and recurrence is very common in these cases [7].

Chronic tendinitis may benefit from platelet rich plasma (PRP) injections on the actual site of inflammation which have been proven to modulate the chronic signs of tendon inflammations [8]. In the same way, chronic tendinitis can also be treated with physical therapy and muscle strengthening exercises to control the symptoms [9]. Chronic tendinitis that is refractory to other conservative approaches may require the surgical removal of the necrotic tissue to afford permanent relief of the symptoms [10]. A minimally invasive procedure called focused aspiration of scar tissues (FAST) can be performed on chronic tendinitis through a small opening. FAST involves the careful surgical removal of the scar tissues embedded on the tendon while maintaining the integrity of the nearby normal tissues.

Prognosis

In general, acute tendinitis resolves spontaneously with rest even without treatment. Tendinitis that persists beyond 6 months becomes chronic and may require corrective surgery to relieve its pain symptoms.

Etiology

Although tendinitis can be caused by sudden injuries on the affected tendon, the majority of cases are caused by tendons that are physically overused and exposed to chronic friction. Most patients who develop tendinitis are those who have occupations and hobbies that require a repetitive movement of a single joint. This chronic stress can cause an acute and chronic inflammation of the affected tendon and joint.

Epidemiology

Tendinitis as an occupational disease reaches an incidence rating of 11 cases per one million individuals. Overuse tendinitis of the hand and wrist comprises up to 50% of all sports injury in the United States [2]. Achilles tendinitis occurs 4 to 7 times more frequent in males than in females. There is a male predilection for all forms of tendinitis. Occupational risks like exposure to prolonged vibrations, cold temperature, intense labor, and jobs that require awkward postures increase the risk for tendinitis. The occurrence of calcific tendinitis peaks at 30 to 40 years old and is most common among diabetics [3].

Sex distribution
Age distribution

Pathophysiology

The exact pathophysiology on the development of tendinitis is grossly unknown. The preponderance of tendinitis to the middle aged suggests that it attacks tendons with decreasing vascularity. The repetitive motions done in limbs during occupational chores predispose the ligaments to microtrauma and friction leading to eventual inflammation of the affected tissues. The close association of tendinitis with systemic immune disorders like rheumatoid arthritis, systemic sclerosis, and gouty arthritis may also suggest an immune mediated pathophysiology.

Prevention

The following tips are most helpful in preventing the occurrence of acute and chronic tendinitis:

  • Avoidance of activities that place excessive stress on a tendon.
  • Do periodic breaks and rests during prolonged occupational activities 
  • Mix low impact sport activities with the high impact activities that cause tendon discomforts.
  • Get professional help on the proper sporting techniques, tendinitis can occur with improper techniques.
  • Do preactivity stretching exercises to strengthen the muscles that supports the tendon.
  • Warm up before a sporting event to prevent accidental stretch of tendons and muscles.
  • Observe proper workplace ergonomics.

Summary

Tendinitis is the inflammation of the fibrous cords that attach the muscles to the bone. Tendinitis usually presents with pain and tenderness adjacent to the joints. It is commonly seen in the shoulder, wrist, elbow, and knees. Tendinitis is often times named after the sport that they are usually associated with, like tennis elbow, pitcher’s shoulder, golfer’s elbow, and jumper’s knee [1]. Majority of tendinitis can be relieved by conservative management like rest, physical therapy, and medications while severe forms require surgical intervention and repair.

Patient Information

Definition

Tendinitis is a clinical term referring to the inflammation of the tendons which is caused by the repeated microtrauma and friction to an affected tendon.

Cause

Tendinitis generally occurs as a result of overuse, trauma, and inflammation.

Symptoms

Patients will generally present with pain and swelling of the affected tendon. Pain is aggravated with the usage of the adjacent joint.

Diagnosis

A thorough physical examination and a complete medical history can ascertain the diagnosis of tendinitis. Imaging studies like X-ray and MRI of the affected limb may rule out other disorders that presents similarly to tendinitis.

Treatment and follow-up

Adequate rest, cold compress and over the counter pain relievers may relieve signs of acute tendinitis. A local injection of cortisone can instantly relieve the chronic pain in tendinitis. Surgical removal of the necrotic and scarring tissues may permanently address the pain symptoms of tendinitis.

References

Article

  1. Mann KJ, Edwards S, Drinkwater EJ, Bird SP. A lower limb assessment tool for athletes at risk of developing patellar tendinopathy. Med Sci Sports Exerc. Oct 10 2012.
  2. Ackermann PW, Renström P. Tendinopathy in sport. Sports Health. May 2012; 4(3):193-201. 
  3. Hegmann, Kurt E., ed. Chapter 24 – Nontraumatic Soft-Tissue Disorders. Occupational Medicine Practice Guidelines. 2nd ed. ACOEM, 573-625.
  4. Taylor SA, Hannafin JA. Evaluation and management of elbow tendinopathy. Sports Health. Sep 2012; 4(5):384-93.
  5. Warden SJ, Kiss ZS, Malara FA, Ooi AB, Cook JL, Crossley KM. Comparative accuracy of magnetic resonance imaging and ultrasonography in confirming clinically diagnosed patellar tendinopathy.Am J Sports Med. Mar 2007;35(3):427-36.
  6. Adler RS, Finzel KC. The complementary roles of MR imaging and ultrasound of tendons. Radiol Clin North Am. Jul 2005; 43(4):771-807, ix.
  7. Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. Nov 20 2010; 376(9754):1751-67.
  8. Moraes VY, Lenza M, Tamaoki MJ, Faloppa F, Belloti JC. Platelet-rich therapies for musculoskeletal soft tissue injuries. Cochrane Database Syst Rev. Dec 23 2013; 12:CD010071.
  9. Abate M, Schiavone C, Salini V. Usefulness of Rehabilitation in Patients with Rotator Cuff Calcific Tendinopathy after Ultrasound-Guided Percutaneous Treatment. Med Princ Pract. Sep 6 2014.
  10. Oki G, Iba K, Sasaki K, Yamashita T, Wada T. Time to functional recovery after arthroscopic surgery for tennis elbow. J Shoulder Elbow Surg. Oct 2014; 23(10):1527-31.

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Last updated: 2019-07-11 22:38