Tendinitis

Tendinitis

Inflammation of a tendon or tendons

NOTE: What is the difference between "Tendinitis" and "Tendinosis"?

The main difference between tendinosis and tendinitis is time. Tendinosis is a chronic (persistent or recurring) condition caused by repetitive trauma or an injury that hasn't healed. By contrast, tendinitis is an acute (sudden, short-term) condition in which inflammation is caused by a direct injury to a tendon (from Google search)

Another Link regarding this difference HERE 

Okay, From here below, informations are taken from Rattray textbook!

Tendon: Made of regularly arranged, dense collagen fibrils.

It appear in 2 shapes: Cord-like structures and broad, sheet-like structures called aponeuroses

Limited blood supply compared to Mxl and that makes it slow down of healing process

Cause

Chronic overload of the tendon leading to micro tearing and inflammatory response in the tendon

Contributing factors

Mxl imbalance, Poor biomechanics, Lack of flexibility,Improper equipment, Improper training 

Types of Tendon overuse injury

Tendinitis: Microscopic tearing of tendon fascicles d/t overloading of the tendon with resulting inflammatory response

Grade1: Pain only after activity 

Grade2: Pain at the beginning of activity, disappears during activity and pain comes back after the activity

Grade3 : Pain at before, during and after activity

Grade4: Pain with ADL and it gets worse

Paratendinitis

Inflammation of paratendon or tendon sheath irritated by the tendons as it rubs over a body prominence

This is also called "Tenosynovitis" (Inflammation of the inner surface of the tendon sheath by the roughened surface of the tendon) or "Tenovaginitis" (Irritation and thickening of the sheath itself)

Tendinosis

Degenerative change occurring with chronic overuse tendon injuries such as with tennis elbow.

There is NO signs of inflammation in the tendon itself

The injury may progress from degeneration to micro tearing to a partial or complete tendon rupture

Common location and cause of Tendinitis

Supraspinatus tendon

Client seated, Tendon is palpated immediately inferior to the acromioclavicular joint (Check textbook P433)

Infraspinatus tendon

In prone position, humerus flexion at 90 degrees and horizontal adduction at 10 degrees, externally rotate 20 degrees

(Check textbook P.433)

Subscapularis tendon

Client seated and keep the humerus at the side and the elbow is flexed to 90 degrees

Tendon is palpated inferior to the clavicle, lateral to the coracoid process(Check textbook P.433)

Biceps long head tendon

Long head of biceps brachialis tendon: Seated position, Internal rotation of humerus at 20 degrees, tendon is palpated inferior to the clavicle, lateral to the coracoid process in the same area as the subscapularis tendon(Check textbook P.434)

Common extensor tendon

Elbow at slightly flexed, tendon is located distal to the lateral epicondyle(Check textbook P.434)

Common flexor tendon

Abductor pollicis longs and extensor policies braves tendon, slight elbow flexion with supination of hand, tendon is located distal to the medial epicondyle

(Check textbook P.435)

Adductor pollicis longus and extensor pollicis brevis tendons

DeQuervain's tenosynovitis is inflammation of the abductor pollicis longus and extensor pollicis braves tendon sheaths

The sheaths are palpated at the radial side of the wrist,

Activities requiring repetitive thumb use, repetitive radial and ulnar deviation and forceful gripping cause this condition

Pain is located 1cm Proximal to styloid process of radius

(Check textbook P.435)

Patellar tendon

Pain localized to the tendon immediately inferior to patella

Running, jumping are the causes

Popliteus tendon

This tendon is palpated directly posterior to the LCL and biceps femurs tendon

Running, downhill walking combined with foot pronation cause this tendinitis

Pain is felt at the lateral knee, either in front of or behind the LCL

Tibialis posterior tendon
Pain felt along the medial border of the tibia and along the course of the tendon
Running and excessive pronation can cause this tendinitis

Achilles tendon

Pain felt along the tendon

Cause

Running, poor footwaer, tight gastrocnemius-soles mxl

Other pathologies

Impingement syndrome

Inflammation, pain and edema in the tissues within the coracoacromial arch and between the acromioclavidular and GH jt

Tendon impingement may also occur against the coracoacromial ligament and coracoid process
Biceps tendon and the subacromial bursa may be also affected 

Rotator cuff tears

Overuse impingement and normal aging can lead to painful tearing of this condition

Tx: Open rotator cuff repair surgery, Acromioplasty, Removal of portions of acromion

Remex: ROM, Strengthening of Rotator cuff mxl

 Calcific tendinitis

Degenerative process

Common in 30-60YOA

Late-occuring stage of rotator cuff tendinitis, usually developing in the supraspinatus tendon

Tx: ROM, strengthening exercises, U/S

Rx: NSAIDs, Steroids have not been found toe useful

 Trigger finger

Overuse of flexor tendons (It could be any finger) may develop thickened, nodular swelling

Stuck in flexion

Tx: Rest, NSAIDs and stretching

ACUTE

SXS: gradual onset usually 1-2days after the activity

tenderness is local to the tendon

inflammation & heat & swelling along the tendon or tendon sheath, crepitus may develop with tenosynovitis and paratendinitis

Decreased ROM of affected mxl

Observation: Antalgic posture or antalgic gait may be present

Swelling and redness may be noticeable if tendon is superficial 

Palpation: Tenderness is palpated over the tendon

Heat and swelling

Hypertonicity and TrP are present in the affected mxl and its antagonist

Testing for both Acute and Chronic:ROM (AROM, PROM)

Speed's test, Yergason's test, Mill's test, Finkelstein test, Painful arc, Neer impingement test, Tinel's sign

Bursitis differentiation test to rule out tendonitits (Shoulder bursitis as an example)

Contraindication: Friction are avoided if the client is on anti-inflammatory medication

Treatment plan

Cold hydrotherapy on affected tendon

Initial TP is to decrease edema, lymphatic drainage

diaphragmatic breathing could be applied to almost anything

Trunk and unaffected limbs are treated using effleurage and slow petrissage (palm kneading, fingertip kneading, C-scooping)

Treatment

Lymphatic drainage to reduce edema

Proximal limbs are treated to reduce hypertonicity

TrP, GTO, PROM, gentle jt play

Self care

Cold hydrotherapy immediately after the activity for 5-20minutes

Pain free stretch to regain flexibility

CHRONIC

SXS

Pain during and after activity

Chronic inflammation, fibrosis, adhesions

Chronic swelling, thickening of tendon

Reduced ROM

Flare-up to the acute stage may occur with repetitive overuse

Tendon may degenerate to such a degree that tendon rupture occurs

Observation

Postural assessment to determine any imbalance

Thickening of tendon may be observed

Mxl wasting and disuse atrophy occur with complete tendon tears

Palpation

AROM, PROM, Isometric testing (Painful on contraction of the mxl of affected tendon)

Testing for both Acute and Chronic:ROM (AROM, PROM)

Speed's test, Yergason's test, Mill's test, Finkelstein test, Painful arc, Neer impingement test, Tinel's sign

Bursitis differentiation test to rule out tendinitits (Shoulder bursitis as an example)

Contraindication: Friction are avoided if the client is on anti-inflammatory medication

Treatment plan

Hydrotherapy proximal to tendinitis, contrast heat/cold

Reduce hypertonicity, TrP, Reduce adhesion, Friction may be applied, PROM, passive stretch

Self care

Hydrotherapy, self massage, eccentric exercise (the muscle contracts as it lengthens), isotonic exercise (slow gradual increase in speed over a week. 3 sets of 15 repetitions)

Goal is to reach out to the pain free stage

Routine exercise such as stretching should be maintained

Treatment frequency and expected outcome 

3tx/wk for 2-3wks followed by 2tx/wk, then 1tx/wk

Outcome is depending on each individual's condition

as an example, achilles tendinitis may respond within 4-8 wks

Longer standing tendinitis may require tx for up to 6months