Tendinitis

Tendinitis is an overuse syndrome, most commonly caused by chronic strain, overuse, or misuse of a muscle/tendon at its origin or insertion on bone. Different names are given to these conditions depending on the anatomic location: Biceps, Triceps, Medial epicondylitis (Golfers’ elbow), Lateral epicondylitis (Tennis Elbow) occur around the elbow; deQuervain’s, extensor or flexor tendinitis arise at the wrist. Medial Epicondylitis and Triceps tendinitis occur commonly in baseball players’ elbow.

Repetitive tasks with forceful muscle exertion without adequate relaxation would cause micro tears that heal with fibrosis and adhesions. There usually is not good blood supply locally, thus there is failure of repair of disrupted tissues. This is evidenced by irregular collagen, chaotically arranged mesenchymal cells, an excessive amount of matrix tissue, vascular buds with an incomplete lumen and insufficient elastin.

Clinically, short bursts of excruciating pain in the arm, back, shoulders, wrists, hands, or thumbs (typically diffuse – i.e. spread over many areas) are observed. The pain is worse with activity; there is weakness and lack of endurance.

The treatment initially is with rest, ice and anti-inflammatory medicines. Adequate relaxation of the involved muscles and enhancement of physical fitness are the keys for prevention of worsening. Occupational therapy initially deploys soft tissue mobilization, active release therapy, ultrasound, muscle stretches, and then strengthening. If the degenerated area progresses to a large tear surgical repair should be attempted.

In triceps tendinitis, tennis elbow, or golfers’ elbow surgery, we clean the degenerated area of irregular scar tissue and necrotic tissue. We prepare the bone for the tendon; and reattach the muscle and tendon on the bone using thick sutures. These sutures are passed through the bone and are quite strong, however the muscle and tendon tissue is weak and becomes even weaker after being torn. For this reason the elbow needs to be protected for tendon healing.

In the wrist, the tendons go through tight compartments that are formed by tight band-like structures around the wrist called the extensor retinaculum. The inflammation arises around the tendons within the compartments hence the treatment should be directed to these compartments. The tendinitis of the first extensor compartment, deQuervain’s tendinitis, is best treated with cortisone injections. If the treatment fails despite attempts of therapy and anti-inflammatory medication, surgery can be recommended. In surgery, the compartment is simply released: the band around the tendon is cut in a longitudinal fashion. Once the constricting pressures are released the inflammation around the tendons resolve.

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