tendonitis

Chronic overuse of tendons leads to microscopic tears within the collagen matrix, which gradually weakens the tissue. Swelling in a region of microdamage or partial tear can be detected visually or by palpation. Increased water content and disorganised collagen matrix in tendon lesions may be detected by ultrasonography or magnetic resonance imaging.

Due to their highly specialised ultrastructure and slow collagen turnover, tendons and ligaments are very slow to heal if injured, and rarely regain their original strength. Partial tears heal by the rapid production of disorganised type-III collagen(*), which is inferior in strength to normal tendon. Recurrence of injury in the damaged region of tendon is common.

(*)A fibrous scleroprotein in bone and cartilage and tendon and other connective tissue; yields gelatin on boiling. Scleroprotein is a simple protein found in horny and cartilaginous tissues and in the lens of the eye.

Recent research adds weight to a line of evidence suggesting that nitric oxide (NO) plays an important role in tendon healing (Xia et al, 2006). And inhibition of NO synthesis impairs tendon healing (Darmani et al, 2004). Such findings may lead to improved modes of treatment for this sometimes chronic condition. For example, NO is synthesized in the body from the amino acid arginine, supplementation of which boosts NO levels (UC Berkeley, Wellness Guide).

Standard treatment of tendon injuries is largely palliative. Non-steroidal anti-inflammatory drugs combined with rest and gradual return to exercise is a common therapy. However, some evidence suggests that tendonitis is not an inflammatory disorder and that anti-inflammatory drugs are not effective (Khan et al, 2002). Perhaps the most promising avenue of therapy is indicated in a line of research finding dramatic rates of recovery including complete remodeling of chronically damaged tendon tissue with eccentric loading exercise (see for example: Alfredson et al 1998; Mafi et al, 2001; Fahlstrom et al, 2003; Roos et al, 2004; Öhberg et al, 2004; Jonsson & Alfredson, 2005; Wilson & Best, 2005; Rees et al, 2006).

Preliminary research suggests that the injection of stem cells might promote tendon-injury healing (see: Future Treatments). Completely ruptured tendons may be sutured together with or without grafted material.

Achilles tendonitis is a common injury, particularly in sports that involve lunging and jumping.

A veterinary equivalent to Achilles tendonitis is bowed tendon, tendonitis of the superficial digital flexor tendon of the horse.

Symptoms can vary from an achy pain and stiffness to the local area of the tendon, to a burning that surrounds the whole joint around the inflamed tendon. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiffer the following day.

Common areas of tendon inflammation

The most common tendon areas that become inflamed are the elbow, wrist, biceps, shoulder (including rotator cuff attachments), leg, knee (patellar), ankle, hip, and Achilles. Of course, tendonitis will vary with each person, as it strikes the areas you use most. For example, many swimmers develop tendonitis in their shoulders(a.k.a. swimmer's shoulder.)

See also

• repetitive strain injury
• stenosing tenosynovitis
• tenosynovitis
• Tendinosis
• Calcific Tendonitis
• orthopedic surgery

External links

• Tendinitis/Bursitis provided by the American College of Rheumatology
• Tendonitis Information Website
• eMedicine Health Tendinitis
• Tendonitis Fact Sheet
• Overview on causes, treatment and avoidance
• Tendonitis & Carpal Tunnel with new baby
• Tendonitis and Musculoskeletal Disorders
• How achilles tendonitis occurs
• Overuse Tendon Injuries, Where Does The Pain Come From?
• Over 20 professional stretches for stopping computer-related RSI (tendonitis included)