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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)
Differences between tendinitis and tendinosis
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)
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)
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














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