Tendinitis Pain

Learning about tendinopathies:	What is a tendon injury? What causes a tendon injury? What are the symptoms? How can I prevent a tendon injury?
Being diagnosed:	How is a tendon injury diagnosed?
Getting treatment:	What is the treatment for a tendon injury? What can I do to treat a tendon injury at home?
Ongoing concerns:	How can I keep a tendon injury from coming back?

Tendon Injury:

Tendons are the tough fibers that connect muscle to bone. For an example, see a picture of the Achilles tendon, which connects the calf muscle to the heel bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to happen suddenly, but usually it is the result of many tiny tears to the tendon that have happened over time. Doctors may use different terms to describe a tendon injury. You may hear:

• Tendonitis- This actually means "inflammation of the tendon," but inflammation is rarely the cause of tendon pain.
• Tendinosis- This refers to tiny tears in the tissue in and around the tendon caused by overuse.

Although many doctors may still use the term tendonitis to describe a tendon injury, most experts now use the term tendinopathy to include both inflammation and micro tears.

Causes of a Tendon Injury:Most tendon injuries are the result of gradual wear and tear to the tendon from overuse or aging. Anyone can have a tendon injury, but people who repeat the same motions over and over in their jobs, sports, or daily activities are more likely to damage a tendon. A tendon injury can happen suddenly or little by little. You are more likely to have a sudden injury if the tendon has been weakened over time.

Symptoms of a Tendon Injury:

Tendinopathy usually causes pain, stiffness, and loss of strength in the affected area.

• The pain may get worse when you use the tendon.

• The pain and stiffness may increase during the night or when you get up in the morning.

• The area may be tender, red, warm, or swollen if there is inflammation.

• Use of the tendon may result in a crunchy sound or feeling .

• The symptoms of a tendon injury can be a lot like those caused by bursitis.

  Diagnosis of a Tendon Injury:

  To diagnose a tendon injury, a doctor will ask questios about your health history, about your symptoms, and the doctor will complete a physical exam. If the injury is related to your use of a tool or sports equipment, the doctor may ask you to show how you use it. If your symptoms are severe or do not improve with treatment, your doctor may want you to have a test, such as an X-ray, ultrasound, or MRI.

  Tendonitis:

Tendonitis is an inflammation in or around a tendon, a band of fibrous tissue that connects muscle to bone and transmits the force the muscle exerts. Tendons are designed to withstand bending, stretching, and twisting, but they can become inflamed because of overuse, disease, or injuries that leave them with torn fibers or other damage. Tendonitis around the heel is known as Achilles tendonitis, and on the outside of an elbow it is called tennis elbow. The pain can be significant and worsens if damage progresses because of continued use of the joint. Most tendonitis heals in about two (2) weeks, but chronic tendonitis often can take more than six (6) weeks to heal because the sufferer doesn't give the tendon time to heal. In chronic cases, you may have locking of the joint in one position due to scarring or narrowing of the sheath of tissue that surrounds the tendon. Diseases such as diabetes, arthritis, and gout can slow healing.

Causes of Tendonitis:

Tendons can become inflamed when overstressed from any activity. Weekend athletes, who exercise sporadically rather than regularly, are often laid low by sore tendons. But by far the most common cause is repetitive stress -- repeatedly using the same joints for the same stressful movements.n. This happens not only in sports but also in many types of office work and other situations. Tendons are also more likely to become inflamed with increasing age since muscles and tendons tend to lose their elasticity over time.

Treatment of Tendonitis:

In most cases, you can treat a tendon injury at home. To get the best results, start these steps right away:

• Rest the painful area.
• Avoid any activity that makes the pain worse.
• Apply ice or cold packs for ten to fifteen (10-15) minutes at a time as often as two (2) times an hour for the first seventy-two (72) hours. Continue to use ice as long as it helps.
• Take over-the-counter pain relievers such as ibuprofen, naproxen (NSAIDs), or acetaminophen if needed.
• Perform gentle Range of Motion exercises.
• Stretch to prevent stiffness.

As soon as you are better, you can return to your activity, but take it easy for a while. Don't start activity at the same level as before your injury. Build back to your previous level slowly, and stop if it hurts. Warm up before you exercise, and do some gentle stretching afterward. After the activity, apply ice to prevent pain and swelling. If these steps don't help, your doctor may suggest physical therapy. If the injury is severe or long-lasting, your doctor may have you use a splint, brace, or cast to hold the tendon still. See a picture of a night brace used for an Achilles tendon injury. It may take weeks or months for a tendon injury to heal. Be patient, and stick with your treatment. If you start using the injured tendon too soon, it can lead to more damage and, over time, make the tendon more likely to tear or to rupture.

To keep from hurting your tendon again, you may need to make some long-term changes to your activities.

• Try changing your activities or how you perform them. If running caused the injury, try swimming some days. If the way you use a tool is the problem, try switching hands or changing your grip.
• Take lessons or ask a trainer or pro to check your technique if exercise caused the problem.
• Take time always to warm up before and to stretch after you exercise.
• Ask your human resource department if there are other ways to do your job if your work caused the tendon injury.

Sprain and Strains:

A sprain refers to a sudden twist or pulling of a ligament (connective tissue that attaches bone to bone). It results in the stretching or tearing of the ligament. A strain refers to an injury that involves stretching, twisting, or tearing muscles or tendons (connective tissue that join muscles to bones). Most people suffer sprains due to some trauma such as: an automobile accident; body contact in sports like football; or falls. Strains are due to excessive tension or over use. These injuries commonly affect the body joints like the neck, back, knees, wrists, fingers, and ankles. The ankle joint is highly susceptible to injury due to its location and role of supporting the body. Risk factors include: living a sedentary lifestyle (no exercise), obesity; wearing high-heeled shoes; participating in contact sports; and skating (skateboarding, ice skating and roller blading). For the most part, sprains and strains are treated the same because it is hard to tell them apart.

Symptoms of Sprain and Strain:

• Pain and swelling of the injured joint
• Tenderness to touch
• Limited movement or inability to move the joint
• Redness, discoloration, or bruising to skin
• Deformity of the joint and possible dislocation (bones of the joint move out of place)

What Your Doctor Can Do:

• Diagnose the injury by asking about your symptoms, completing a physical exam, and ordering joint x-rays.
• Order special imaging studies that include a CT-scan or MRI (special radiology pictures that are able to show more details of muscle, ligament and tendon damage).
• Immobilize a joint with a splint, elastic wrap, or cast. This limits movement and allows the tissues time to heal. You will receive crutches to avoid bearing weight on the injured ankle or knee joint.
• Prescribe medication to reduce pain, muscle spasms, and inflammation.
• Recommend surgery to repair torn tissues
• Recommend physical therapy to strengthen muscles, ligaments, tendons, and joints.

What You Can Do:

• Immediately after the injury immobilize the injury with an elastic bandage wrapped snugly.
• Avoid wrapping too tightly; you do not want to restrict blood flow.
• Do not use heat at this time because it will increase inflammation (swelling, tenderness, and warmth).
• Do not try to manipulate the joint.
• Apply ice packs to the injured joint for fifteen to twenty (15-20) minutes every hour during the first twenty-four to forty-eight (24-48) hours after an injury. Always cover ice packs with a hand cloth or a towel to limit frostbite injuries to skin.
• Keep the injured site elevated above the level of your heart

Remember the "RICE" Pneumonic during Recovery:

R- Rest the injured area..

I - Ice the injured area for 15 to 20 minutes every hour.

C- Compress. Immobilize the injury with a snug elastic bandage. Do not wrap too tightly; you do not want to restrict blood flow.

E - Elevate. Keep the injured site above the level of your heart to reduce swelling.

LVPRC strongly recommends against heat in most cases even though generally after twenty-four (24) hours, it is recommended to apply heat. When heating; place hot compresses or a moist heating pad on the joint for 15-20 minutes at a time. Talk to your doctor about cold verses hot therapies for your condition.