Anatomy Review
A tendon is a fibrous connective tissue that attaches muscle to bone.
Tendons let us move our limbs. They also help prevent muscle injury by absorbing some of the impact your muscles take when you run, jump or do other movements. Your body contains thousands of tendons.
The tendon plays an extraordinary role in mechanics and movement. They transmit the force produced by the muscular contraction to the skeletal levers, thus allowing the movement and the maintenance of the body posture.
The primary cell types of tendons are the spindle-shaped tenocytes (fibrocytes) and tenoblasts (fibroblasts). Tenocytes are mature tendon cells that are found throughout the tendon structure, typically anchored to collagen fibers. Tenoblasts are spindle-shaped immature tendon cells that give rise to tenocytes. Tenoblasts typically occur in clusters, free from collagen fibers. They are highly proliferative and are involved in the synthesis of collagen and other components of the extracellular matrix.
Tendon sheath is a membrane like structure surrounding the tendon, which separates the tendon from surrounding tissue and allows tendon to glide smoothly inside the sheath.
Tendons are stiffer than muscles, have greater tensile strength and can withstand very large loads with minimal deformations. They differ from ligaments because ligament are fibrous connective tissue that connects bones to other bones and tendinosis – a chronic condition that causes the tendons to break down over time.
Common Types of Tendonitis
- Achilles tendonitis is a common sports injury. Additionally, people with rheumatoid arthritis are at a higher risk of Achilles tendinitis.
- Tennis elbow – Tennis elbow (lateral epicondylitis) is a painful condition that occurs when tendons in your elbow are overloaded, usually by repetitive motions of the arm and wrist. Wrist tendonitis can affect anyone who repeatedly performs the same movements with their wrists. It is common in people who do a lot of typing, writing, and sports like tennis.
- Golfer’s elbow – Medial epicondylitis is also known as golfer’s elbow, baseball elbow, suitcase elbow, or forehand tennis elbow. It’s characterized by pain from the elbow to the wrist on the inside (medial side) of the elbow
- Pitcher’s shoulder – When a muscle or tendon is overworked, it can become inflamed. The rotator cuff is frequently irritated in throwers
- Swimmer’s shoulder – Swimmer’s shoulder, also called shoulder impingement, is a condition where swimmers often aggravate their shoulders while they swim due to the constant joint rotation. In supraspinatus tendonitis the tendon at the top of the shoulder joint becomes inflamed. This causes pain when moving the arm
- Jumper’s knee – Jumper’s knee, also known as patellar tendonitis, is a condition characterized by inflammation of your patellar tendon
Causes of Tendonitis
Tendinitis can be caused by a sudden injury, the condition is much more likely to stem from the repetition of a particular movement over time.
- Strain – stretching or tearing of a muscle or a tissue connecting muscle to bone (tendon).
- Overuse of the tendons or excessive exercises
- Injury or trauma.
Risk factors
- Age – in elderly the tendons get less flexible.
- Sports and exercises
- Diabetes
- Rheumatoid arthritis
- Antibiotics like quinolones ( Cipro , levofloxacin ) • Trauma or injury
Pathophysiology
The cause of inflammation is irritation of the sheaths by prolonged or abnormal use of the tendons. These sheaths are composed of thin, filmy tissue that permits the sliding motion of tendons within them. Less often it may follow invasion of the tendon sheaths by bacteria with subsequent infection.
Inflammation in the sheath of the tendon produces swelling, redness, and pain along the course of the involved tendon, and motion of the tendon produces severe pain. Swelling of the sheath narrows the space through which the tendon may slide, causing stiffness in the involved area. A grating sensation may be felt as the tendon moves.
Signs and symptoms
★ Redness and Hotness at the site.
★ Pain often described as a dull ache, especially when moving the affected limb or joint. It increases when you move the injured area.
★ Tenderness – The area will be tender, and you’ll feel increased pain if someone touches it.
★ Mild swelling
★ feeling a grating or crackling sensation when you move the tendon
★ Tightness that makes it difficult to move the area
Diagnostic management
- Physical examination.
- MRI scans to help determine tendon thickening, dislocations and tears
- X ray
- Ultrasound
Pharmacological / Medical Management
- NSAIDs to relieve pain
- Platelet-rich plasma (PRP) – PRP treatment involves taking a sample of your own blood and spinning the blood to separate out the platelets and healing factors. The solution is then re-injected into the area of chronic tendon irritation.
- Corticosteroid injections to reduce inflammation – Corticosteroids are not recommended for chronic tendinitis (lasting over three months), as repeated injections may weaken a tendon and increase your risk of rupturing the tendon.
- Treat underlying conditions like rheumatoid arthritis and diabetes.
Surgical management
For chronic tendon inflammation, focused aspiration of scar tissue (FAST) is a minimally invasive treatment option using ultrasound guidance and very small instruments designed to remove tendon scar tissue without disturbing the surrounding healthy tendon tissue.
Nursing interventions (specific)
★ Enough rest from activities
★ Encourage the patient to use heat or cold therapy as prescribed. Teach the patient to use a barrier between the skin and heat or to use cold therapy to prevent burning or frostbite.
★ Wrapping the area in a compression bandage until swelling subsides
★ Applying heat or ice – Teach the patient how to apply ice and heat properly to prevent burning or chilling.
★ Fluid removal by aspiration and physical therapy to prevent “frozen” joints and preserve motion constitute supplementary treatment
★ Resting or elevating the tendon
★ supports such as splints, braces, or a cane
★ Explain the importance of anti-inflammatory medications, and teach the patient to take them with milk to minimize gastrointestinal (GI) distress.
★ You may be advised to wear a shoe insert that will place your foot in the correct position for walking and running.
★ Physical therapy – Stretching , Massage , Ultrasound , Strengthening exercises
★ Stretches and exercises to build strength and improve mobility in the area
Complications
- Contractures (or tightening) of the tendon
- Scarring (called adhesions)
- Muscle wasting
- Disability.