Tendonitis or Tendinitis

Tendonitis is the inflammation or irritation of a tendon. 

Tendinitis can occur in any of your body’s tendons, it’s most  common around your shoulders, elbows, wrists, knees and  heels.

tendon anatomy tendonitis

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


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 


  • Contractures (or tightening) of the tendon 
  • Scarring (called adhesions) 
  • Muscle wasting
  •  Disability.
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