Orthopedics-Online

Tendinitis

Definition - what is tendinitis?

Tendonitis is a clinical picture in which a tendon is inflamed due to overstimulation or unusual stress.
Tendons are tight connective tissue that connect the muscles to the bones at the ends of a muscle. They ensure the power transmission from the muscle to the skeleton.

Tendonitis is often used synonymously with the term tendonitis in colloquial language and sometimes also in the clinic.
Tendons that run over bones or protruding bones, for example, are surrounded by a gelatinous tendon sheath. As a slide rail and cushion, it protects the eyes from mechanical stress.

In theory, tendinitis can occur anywhere. Common locations are arms and forearms, but also shoulders, knees, hips or groin and the tendons on the heel and soles of the feet. Acute tendinitis usually only lasts a few days and can be treated conservatively.
Prolonged symptoms should be presented to a doctor.

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Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
As a passionate athlete, I have specialized in the treatment of sports diseases for professionals and hobby athletes.
The focus is therefore on diseases of the muscles, tendons and joints.

In order to be able to treat successfully in orthopedics, a thorough examination, diagnosis and a medical history are required.
In our very economic world in particular, there is too little time to thoroughly grasp the complex diseases of orthopedics and thus initiate targeted treatment.
I don't want to join the ranks of "quick knife pullers".

The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Further information about myself can be found at Dr. Nicolas Gumpert

Causes - what causes tendinitis?

Generally speaking, tendinitis is caused by excessive exercise.
This can be caused by too much training, unfamiliar movements and excessive stress in physically demanding jobs.
Misaligned joints or the wrong sportswear, especially shoes, can lead to permanent irritation of tendons.
The excessive irritation leads to inflammation, the tendon shows many tiny microcracks. Tendonitis is rarely caused by rheumatological diseases.

Read more on the subject at: Tendonitis in rheumatism

Symptoms - what signs accompany tendinitis?

Tendonitis is usually only noticeable with slight pain, which then becomes worse as the disease progresses and under pressure and is described as stinging or burning. It is not uncommon for there to be up to 24 hours between a triggering activity such as excessive stress and the first perceived symptoms.
In addition, a reddening of the corresponding part of the body can occur, sometimes a swelling can be seen. With tendinitis, the pain is particularly stressful when moving. The pain intensity increases relatively quickly and ultimately leads to limited mobility. If the course is protracted or complicated, the tendinitis continues to develop, so that in some cases a slight crunch can be heard when moving, which is caused by calcium deposits.
In the worst case, if left untreated, a tendon can be so damaged by the tendinitis that it ruptures.

Diagnosis - how is tendinitis diagnosed?

The diagnosis of tendinitis is based on a detailed medical history, movement tests and precise palpation of the affected area.
Tension pain over the affected tendon is typical.
In addition, the ultrasound is used to detect major damage and swellings. In cases of doubt, magnetic resonance imaging (MRI) can provide precise information about the extent of the injury.

Therapy - what helps with tendinitis?

The therapy of tendinitis primarily involves rest and rest.
Acute, i.e. Cooling compresses help within 24 hours, and warmth is recommended as the process continues. Compressive bandages stabilize the tendon.
To fight the inflammation, anti-inflammatory drugs (NSAIDs) such as diclofenac or ibuprofen can be used as a tablet or ointment.

If the first symptoms subside, light stretching exercises help to combat the tendinitis and to regain full resilience more quickly.
In chronic cases, surgical interventions may have to be carried out. E.g. torn tendons are healed.

Read also: Home remedies for tendinitis

Duration of tendinitis

The duration of tendinitis depends heavily on its cause and the severity of the inflammation. Slight inflammation caused by a one-off, slight overload can heal after a few days through immobilization and cooling. More severe tendinitis usually takes a few weeks and only gets better with pain reliever and anti-inflammatory medication.

In very rare cases, tendinitis can become permanent and lead to remodeling and wear processes in the affected area. It is important to note that the duration and time of healing depend heavily on individual behavior. If the affected area is carefully relieved, immobilized and cooled, this shortens the healing time, while continuing the loading or overloading leads to an aggravation and permanent persistence of the inflammation.

What is the prognosis?

In most cases, tendinitis is a painful but mundane sports injury that heals spontaneously with the above conservative measures.

There are differences in the length of time until symptoms are free. This takes a few days on the arm, and the Achilles tendon often takes weeks. Is the tendinitis e.g. Due to anatomical misalignments on the shoulder, the disease can be more persistent and should be treated by experts.

It is important to take a break from existing tendinitis in order to prevent a chronic course. Here it is possible that the tendon is permanently damaged so that it has to be surgically repaired.

Prophylaxis for tendinitis

Prophylaxis of tendinitis always consists in choosing the right level of stress.

Athletes should always slowly dare to take on a higher level of strain in order to get their tendons used to it. This is especially true for newcomers.
A sufficient warm-up program with stretching exercises is mandatory before training. The right equipment can also effectively prevent tendonitis.

In the case of stress during work, you should be careful not to move too one-sided and e.g. to take several small breaks in the office. Ergonomically designed keyboards and mice and proper posture also play an important role in preventing tendonitis.

In the following, the special features of the possible localizations of tendinitis are discussed

Localization of tendinitis

Tendinitis of the shoulder

Tendonitis is comparatively common on the shoulder because it is a highly stressed, complicated joint with many degrees of freedom.

A number of tendons are possible, the supraspinatus tendon or a tendon of the biceps being particularly affected.

Symptoms
The tendinitis on the shoulder is noticeable through pain, swelling and, in some cases, severely restricted mobility. The pain is stronger when moving.
Spreading the arm is particularly problematic.

root cause
The cause of tendinitis on the shoulder is usually excessive stress during sport or physical work. Frequent overhead work can promote tendinitis, but tennis players or handball players, who increase the load excessively, also suffer from it.

In addition, an anatomical peculiarity in the shoulder comes into question as a cause, which is known as the so-called impingement syndrome. The tendon of the supraspinatus muscle runs through a narrow point between the bones in the shoulder. The tendon may become pinched here, causing severe irritation to the tendon. Tendonitis develops.
The biceps tendon also runs in the shoulder in a kind of canal that is sometimes too narrow. Inflammation of the biceps tendon develops here too.

diagnosis
When diagnosing tendinitis of the shoulder, questions about the nature of the pain, sporting activities or changes at work are of greatest importance. The typical creeping onset with movement-dependent pain, possibly with a suitable trigger, can provide a lot of information. The anamnesis is supplemented by a test of mobility in the shoulder joint.

Experienced examiners can make more precise statements with the ultrasound. If you are uncertain, an MRI of the shoulder shows the tendons best.

therapy
The most effective measure for tendinitis in the shoulder is to keep the joint still for a few days.
Acute cold helps, in the course warming compresses. If the tendinitis persists, anti-inflammatory drugs such as diclofenac can be given.
If the impingement syndrome is the cause, it helps to strengthen the muscles around the joint through physiotherapy / physiotherapy in order to relieve the affected tendon.
In exceptional cases, tendinitis on the shoulder must be treated with a minimally invasive procedure.

Read more on the subject at: Tendinitis in the shoulder

Tendonitis on the arm / forearm

Tendonitis is also not uncommon on the arm or forearm. The tendon sheaths are usually affected here.

Symptoms

The tendinitis is manifested by pain and possibly slight swelling.Just one finger movement can cause severe pain in the forearm, an inflamed biceps tendon hurts when bent in the arm.
Tendonitis on the forearm is of particular importance, as the tendons that control the hand are affected here and lead to severe restrictions.

causes

Overstimulation of the tendons on the arm or forearm is the main cause of tendinitis. Many complaints on the forearm are caused by work as well as sport.
The tendons on the forearm move the hand and fingers, so tendinitis on the forearm is often a factor in people working in the office. As a result of the frequent typing on the keyboard in connection with an incorrect posture at the desk, the tendons and surrounding covers on the forearm can become so irritated that they become infected. A similar phenomenon can be seen in guitar players. Here, too, tendinitis, especially involving the tendon sheaths, is not uncommon.
In addition to these locations, the biceps tendon on the arm is often the site of complaints. Certain exercises in the fitness area such as biceps curls or pull-ups put a lot of stress on these muscles, so it is not uncommon to develop tendinitis on the arm after extensive training.

diagnosis

At the beginning there is a survey about the type and duration of the complaints as well as the most recent activities. The arm or forearm is then tested for pressure and stretching pain at the specified locations, followed by a test of mobility. In the case of tendinitis, this diagnosis is usually sufficient to initiate therapy. In cases of doubt, the exact extent of the inflammation on the arm or forearm can be determined using MRI.

therapy

In addition to protecting the affected areas, cool compresses that are later used to warm up can relieve pain and inflammation. Anti-inflammatory tablets or ointments help this process. Persistent complaints may require the use of cortisone as an ointment or direct injection; surgical interventions are rarely required.

Please also read our article on this Tendinitis in the arm

Tendonitis on the elbow

The elbow is also exposed to great mechanical force through its movements. The tendons of the upper and lower arm muscles run at and around the elbow. Incorrect strain or excessive strain can lead to irritation in the area of the tendons of the elbow. If, despite an irritation, no consistent restraint is observed, this can result in tendinitis in the elbow.

Symptoms

Symptoms include pulling and burning pains, as well as sometimes restricted mobility in the area of the elbow joint.

therapy

The first and most important treatment measure is cooling and immobilization of the elbow. Taping or anti-inflammatory and pain relieving medication can also accelerate the recovery process.

Read more about this on our website Tendonitis on the elbow.

Tendonitis of the thumb

The thumb is stabilized by strong muscles, which, in addition to supporting and holding, also ensure movement. Each muscle is attached to specific metacarpal bones or to a bone of the wrist with a tendon. The tendon is subject to increased friction with every movement and can become inflamed as a result. Risk factors for tendinitis of the thumb are excessive stress on the joint or very unfamiliar movements.
If certain movements in the thumb are performed particularly frequently, excessive irritation of the thumb tendon can result. In the worst case, the tendon becomes inflamed.

Symptoms

The first signs of tendonitis of the thumb are pulling and burning pain. The pain is localized in the area of the tendon attachment and can be triggered primarily by moving the thumb. With severe inflammation of the thumb, pain in the thumb joint can occur even at rest.

diagnosis

The diagnosis is made clinically, i.e. the examiner will ask the patient how long the pain has existed and where it is located and whether any unusual movements have been made beforehand. An ultrasound examination is carried out less often.

therapy

The treatment is done by immobilizing the thumb and cooling it with ice. Anti-inflammatory drugs can also be used. Sometimes it may be necessary to fix the thumb additionally. Either fixing bandages or small splints are suitable for this. The duration of tendonitis of the thumb varies depending on the severity of the inflammation and the consistency of the treatment.

For more information, see: Tendinitis in the thumb

Tendonitis in the wrist

Tendons run in the wrist that connect the muscles of the forearm to the hand and are therefore particularly responsible for bending the hand and fingers. Inflammation of these eyes is not as common, but it can occur in some cases. The causes are usually an overload or poor posture of the wrist. One-sided activity, such as long typing on a keyboard or unusual movements and stimuli, can also lead to tendinitis in the wrist.

The symptoms start a few hours to a day after exposure. They are usually expressed in swelling, reddening and warming of the wrist. Tendonitis is also associated with pain and restricted wrist movement due to the swelling. If these symptoms occur, the hand should first be immobilized and cooled. Immobilization can also take place using a bandage or a splint.

If there is no improvement, anti-inflammatory and pain reliever medication such as ibuprofen can be taken. Physiotherapy can be useful if movement in the wrist is restricted for a long time. If the disease takes a very severe and complicated course in which calcium deposits form, an operation may also be necessary in rare cases.

For detailed information on this topic, see:

Inflammation of the wrist
Tendonitis on the wrist

Tendinitis of the hip

Tendons, which can become inflamed in some cases, also run in the hip area, often affecting other structures such as bursa, a type of cushioning cushion.

Symptoms

The tendinitis of the hip is particularly noticeable when walking. There is pain that can also occur at rest. Sometimes you can feel a kind of snap of a tendon over a protruding bone.

causes

The most common form of tendinitis on the hip is what is known as Trochanteric endinosis. On the lateral thigh there is a kind of tendon bundle that runs over a bony protrusion of the thigh (greater trochanter) on the hip. At this point there is often strong mechanical stress when this bundle rubs over the bone. Overloading in sports usually leads to tendinitis, but malpositions in the hip joint also promote inflammation at this point.

diagnosis

Inquiring about the complaints is in the foreground in tendinitis of the hip, usually there is also pressure pain over the tendon.
On the ultrasound, the doctor can see thickening and possibly calcification, which are signs of inflammation. Further technical measures such as an MRI are appropriate in case of doubt.

therapy

The most important thing is to minimize the stress on the hips as much as possible and to protect the tendons. If the pain occurs acutely after exercise, cooling measures help. If the symptoms persist, the use of anti-inflammatory agents such as diclofenac is recommended. Misalignments should be treated with physiotherapy.

Read more on this topic at: Tendinitis on the hip

Tendonitis on the knee

With the exception of a few cases, knee tendinitis is a symptom that can affect athletes in particular, but also people who work hard physically.

Symptoms

The tendinitis is also noticeable in the knee through pain, which is initially noticeable when moving and later also when resting. The location of the pain depends on the cause, frontally or laterally.

causes

The cause of tendinitis in the knee is a burden that is beyond normal. Excessive stress irritates the tendons so that the body reacts with an inflammatory reaction. There are different symptoms of the knee depending on the type of sport practiced:

The jumper's knee: In this case, the kneecap tendon is affected because it is irritated by strong tensile and stretching forces, especially during jumping movements. Tendonitis develops, which leads to pain in the front of the knee.
The runner's knee: In very active runners, tendinitis is observed in a tendon plate that runs from the hip to the knee on the side of the thigh. Footballers and tennis players are also increasingly affected. Because this tendon plate runs over a protruding bone on the knee, the inflammation causes pain when moving sideways on the knee.
Tendonitis on the back of the thigh: As part of an overload, usually in running, the tendon of the back of the thigh muscle can also be affected and develop tendinitis. This causes pain when the knee or hip is extended, which is located laterally in the hollow of the knee.

diagnosis

Regardless of the tendon affected, knee tendinitis is primarily determined by history. Pressure pain in the affected area and impaired function confirm the diagnosis. In doubtful cases, an X-ray or an MRI of the knee can also be useful to rule out the involvement of other structures.

therapy

First of all, you should spare a knee that is affected by tendinitis. Cooling measures support healing. For longer complaints, e.g. Diclofenac is used, which has an analgesic effect and inhibits inflammation. In most cases, these measures are sufficient to adequately treat the knee tendinitis. If the tendon is badly affected, a small operation is available.

Our next articles may also be of interest to you:

Tendinitis in the hollow of the knee
Patellar tendinitis

Tendonitis on the thigh

There are many muscle groups and vision on the thigh, so tendinitis is not uncommon here. Often the adductors, which are located on the inside of the thigh, are involved.

Symptoms

Many athletes complain of pain in their thighs and groin, especially footballers. In addition, depending on the area affected, there is limited movement.
If the adductors are affected, pulling the leg up causes discomfort.

causes

Tendonitis on the thigh is almost always caused by excessive or newly occurring, unusual strain that leads to irritation and inflammation of one or more tendons. Soccer players or tennis players are often affected by adductor problems, as sudden and quick lunges are often made to the side, which irritate the tendons there.

diagnosis

The nature of the discomfort that might be related to a triggering event and some clinical tests are quick to suggest tendinitis in the thigh. It is more difficult to pull the leg up, and there is also pain on pressure over the tendon insertion.
The ultrasound confirms the diagnosis. Examinations such as an MRI are indicated in cases of doubt.

therapy

First and foremost is the protection of the corresponding muscle groups. Healing is supported by cold and, in the course, heat or anti-inflammatory drugs such as diclofenac or ibuprofen. Surgical interventions are carried out in exceptional cases, but are rarely crowned with success.

Read more about this under:

Tendonitis on the thigh
Tendinitis in the leg

Tendonitis of the heel and sole of the foot

There are two places on the foot where tendinitis is common.
The sole of the foot or the Achilles tendon on the back above the heel.

Symptoms

Tendonitis on the heel or on the sole of the foot is particularly stressful because walking is sometimes severely restricted. In addition, the patients complain of pain that occurs at rest and is movement-dependent. Stepping on is painful, as is lifting the foot.

causes

For foot complaints, there are two main clinical pictures to consider:

Plantar fasciitis: Tendonitis on the sole of the foot is usually caused by a disease called plantar fasciitis. It is an inflammation of the plantar tendon that pulls the sole of the foot down to the toes. Overloading from running, sprinting, playing football, but also using the wrong footwear lead to permanent irritation and inflammation of the tendon.
Achilles tendonitis: A common cause of heel pain is tendinitis of the Achilles tendon. This strongest tendon in the body is stressed during a variety of activities. Overloading leads to tendinitis relatively quickly. Excessive running of any kind is responsible. Excessive speed or long runs, which the body is not used to, lead to pain in the heel. Unsuitable shoes or malpositions in the ankle can also cause tendinitis on the heel.

Read our article about tendinitis of the ankle

diagnosis

The decisive factor is the typical anamnesis with classic symptoms and the associated previous stress. Movement tests and precise palpation suggest the corresponding tendon that is tender on pressure. Damage to the tendons is detected in the ultrasound and possibly MRI. Malpositions may need to be examined further.

therapy

Immediate protection and cooling compresses help in acute cases, while warmth promotes healing in the further course. The sports break can take several weeks. Anti-inflammatory agents aid healing. Cushioning insoles in the shoe and physical therapy exercises can also be useful. Chronic tendinitis sometimes requires surgical therapy.

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