Tendinitis (Epicondylitis, Tenosynovitis)

Tendons are the tough, fibrous bands of tissue that connect muscles to bones; tendinitis occurs when these tissues become inflamed. Athletes often suffer tendinitis, and the disorder may be identified with a particular sport or activity to indicate its location -- for example, tennis elbow, golfers shoulder, runners ankle, or housemaid's knee.

Because tendons have only a limited ability to stretch and contract, they are also easily torn when subjected to excessive strain. A torn Achilles tendon, which connects to the heel, is common among athletes and dancers.

An even more frequent occupational complaint is tenosynovitis, inflammation of the synovium, the fibrous sheath that surrounds or lines the tendons. When the synovium becomes inflamed, the tendon is unable to move smoothly within its covering. This is a special problem for people whose jobs entail repetitive motions.

Tendinitis begins with weakness, stiffness, swelling, and tenderness in the area. Continued use of the inflamed tendons brings worsening pain until even the slightest demand becomes excruciating. The condition is often confused with, or accompanied by, bursitis, an inflammation of the bursa, the fluid-filled sac that reduces friction between tendons and bones.

With proper treatment, mild tendinitis usually heals completely after two or three weeks. However, continued use of the inflamed tendons can result in chronic tendinitis and, in turn, increasing disability.

Diagnostic Studies and Procedures

A doctor can usually diagnose tendinitis on the basis of symptoms and a physical examination. However, X-rays may be taken to rule out a fracture, arthritis, and other disorders that cause pain, swelling, and inflammation.

Doctors who specialize in sports medicine and performing-arts medicine may use electromyographic studies and videotapes to analyze movements of joints and their supporting structures. They can then identify specific movements that may induce tendinitis.

Medical Treatments

Most tendinitis can be managed with self-care (see below), but in chronic cases, injections of a steroid, such as hydrocortisone, directly into the inflamed area may be recommended. These injections do not cause as many side effects as steroids taken systemically; even so, excessive shots can weaken the tendon and lead to its rupture.

In some cases, such as so-called baseball, or mallet, finger, splinting may be necessary to immobilize the finger and allow the tendon to repair itself.

A ruptured tendon that fails to reattach itself may require surgical repair.

Alternative Therapies

Alexander Technique. By analyzing the faulty postural habits that strain the joints and supporting tissues, a practitioner of this technique can help an individual relearn postures and body movements to prevent tendinitis.

Herbal Medicine. Compresses soaked in comfrey, arnica, or witch hazel are said to alleviate inflammation and speed up healing of tendinitis. To prepare a comfrey or arnica compress, brew a strong tea of the herb, allow it to cool, soak a clean cloth in it, and apply it to the painful area. These herbs can also be used to make a poultice for the same purpose.

Hydrotherapy. Whirlpool baths, hot and cold soaks, and exercising in water may alleviate pain and help restore the function of the injured area.

Massage. Gentle kneading and massaging of the area surrounding the inflammation can ease discomfort and may hasten healing by increasing circulation in the area. However, avoid direct massage of the inflamed portion, as this may exacerbate the injury.

Physical Therapy. A physical therapist who specializes in sports injuries can provide exercises that gradually restore function without causing a recurrence of the tendinitis. Such a therapist may use whirlpool baths and devise a rehabilitation program to restore normal joint movement by strengthening the affected muscles. Follow-up visits are scheduled to monitor progress and add to the exercise regimen. A physical therapist can also give advice on support bandages to prevent future flare-ups.

Self-Treatment

Rest is the key to prompt recovery from tendinitis. If necessary, immobilize the injured area with a splint or sling. In the early stages of inflammation, apply ice packs. As healing progresses, switch to heat, or alternate hot and cold packs.

To avoid a recurrence and the risk of chronic tendinitis, it may be wise to consult an exercise physiologist or a professional trainer. An improper grip on a tennis racket or a faulty golf swing may be responsible for tennis elbow or golfer's shoulder.

Consider asking a pro to check your equipment. Using a racket that is too heavy or too tightly strung can cause tennis elbow; wearing improper or poorly fitted running shoes can result in Achilles tendinitis.

Overuse is responsible for many cases of chronic tendinitis, especially among youngsters. Budding baseball pitchers have had their careers cut short by little leaguer's elbow, a traction injury affecting the cartilage caused by throwing too much at an early age.

Weight training to strengthen certain muscles can help prevent tendinitis. If you are plagued with tennis elbow, for example, work on strengthening your forearm muscles by exercising with small three- to five-pound weights; flex and extend your wrists with your forearms resting on a flat surface.

Other Causes of Tendon Pain

Symptoms similar to those of tendinitis; can result from muscle strain, frozen shoulder, shin splints, stress fractures, runner's knee, and other sports injuries.