Why does tendonitis recur?

Written by Guan Yu Hua
Orthopedic Surgery
Updated on September 20, 2024
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Tendonitis, if not well-rested, can easily recur. It mostly occurs during activities, work, or exercise, presenting with pain, swelling, and limited mobility. Tendonitis primarily involves the tendons, which are very hard connective tissues connecting bones and muscles. Tendonitis is mainly caused by the excessive use of muscle fibers and repetitive strain leading to degenerative changes in tendon collagen fibers. This accumulation of degeneration in tendon collagen fibers is commonly referred to as tendinopathy. Examples include common types such as Achilles tendonitis, patellar tendonitis, quadriceps tendonitis, or injuries to the rotator cuff, and lateral epicondylitis of the humerus. Long-term repetitive friction and fatigue can easily cause repeated episodes in these areas. Strict immobilization, along with physical therapy, massage, electric stimulation, and heat application can help alleviate symptoms. Additionally, taking blood-activating and pain-relieving medications, and when necessary, undergoing injective treatments can effectively prevent recurrences and promote relief, reducing symptoms.

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How to treat tendinitis?

Treatment of tendonitis is divided into four types. The first is conventional treatment, which involves following the RICE principle during the acute phase. The second is medication, which includes the use of non-steroidal drugs and the option of local injections, but repetitive injections are not recommended as they can lead to tendon rupture, such as the rupture of the Achilles tendon often caused by such treatment. The third approach is for patients with chronic conditions where the affected area has developed adhesions and conservative treatment is ineffective. In such cases, surgical treatment should be considered, though the drawbacks include significant trauma, pain, and a long recovery period. The fourth method involves physical therapy, including heat therapy, ultrasound treatment, and microwave treatment. Thus, the basic treatments for tendonitis encompass these four approaches.

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Written by Na Hong Wei
Orthopedics
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Symptoms of tendonitis

The symptoms of tendonitis basically come down to three points. First, pain or a fixed tender point, generally located around joints or nearby areas, with severe cases possibly exhibiting numbness or tingling. Second, dysfunction, which is due to the stiffness of the joint associated with pain which limits joint movement, and occasionally there is mild swelling of the joint. Furthermore, if the tendon pain reoccurs from the originally damaged site and continues for a long time or recurs, it can lead to stiffness in the joint, subsequently resulting in limited joint mobility. The third point is the inflammatory response; tendonitis has specific signs of inflammation, including redness, swelling, heat, pain, and dysfunction.

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Written by Na Hong Wei
Orthopedics
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The difference between tendinitis and tenosynovitis

Actually, tendinitis and tenosynovitis are essentially two aspects of the same condition. The term tendinitis usually refers to the part where the muscle transitions into the tendon, whereas tenosynovitis generally refers to the fibrous sheath over the tendon surface. Thus, tendinitis and tenosynovitis often coexist; tendinitis can lead to tenosynovitis, and conversely, tenosynovitis can also affect tendinitis, causing or exacerbating it. Therefore, in clinical practice, there usually is not a clear distinction between tendinitis and tenosynovitis. It is common during surgeries for stenosing tenosynovitis to observe that the tendon is also congested and swollen, and even adhered to the tendon sheath. Thus, tendinitis and tenosynovitis are generally considered the same disease, merely referred to by two different names. However, if strictly distinguished, there is a certain difference, which lies in the location: tendinitis refers to the tendon itself, while tenosynovitis refers to the sheath outside the tendon.

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Written by Li Jie
Orthopedics
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Which location to massage for tendinitis

Since a tendon is a bundle that extends from the muscle belly and is elongated, during massage, one should not only focus on the painful area but should consider the entire muscle and tendon. Massaging only the painful area is similar to the notion of treating just the head for a headache or just the foot for foot pain. Therefore, when massaging, it is necessary to cover the entire muscle from its origin to its insertion, reaching the painful parts of the tendon. Also, one should avoid rough massage techniques; instead, gentle manipulations are encouraged. Otherwise, it could lead to counterproductive effects and not be beneficial. Gentle massage or heat application are both acceptable methods.

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Tendonitis

Tendonitis refers to a sterile inflammation of the tendon itself or its surrounding sheath caused by various reasons. The term "tendonitis" means that, firstly, the affected area is either the tendon or the surrounding tissue. Secondly, it is a sterile inflammation. The causes of tendonitis are generally the following four points: The first point is acute injury. The second point is chronic overuse. The third point is an increased load on the tendon itself, causing some micro-damage inside the tendon. This leads to inflammation due to bleeding and inflammatory irritation in the tendon or around the tendon. The fourth point involves prolonged exercise or excessive exercise load, which then leads to congestive hematoma around the tendon, ultimately leading to inflammation.