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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The difference between tendinitis and gout

The difference between tendinitis and gout is significant; these are two completely different diseases, although their symptoms are similar, including redness, swelling, heat, pain, and functional impairment. Tendinitis generally involves the muscles and tendons and is a type of aseptic inflammation caused by various reasons. In contrast, gout is due to abnormal metabolism of purines in the body, leading to the accumulation of gouty tophi in the joints, producing inflammatory symptoms. Therefore, tendinitis and gout are fundamentally different diseases.

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Written by Na Hong Wei
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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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Treatment of Tendonitis

The causes of tendinitis usually fall into the following three categories: The first is acute injury, commonly referred to as tendon strain. The initial step is to stop any activity, followed by immobilization of the affected tendon area. Immobilization typically involves allowing the part to be completely relaxed, under no pressure, and is usually for a period of three weeks. The second cause is chronic overuse, which is the most common reason for tendinitis. It frequently occurs at sites of bony protrusions or where there is a tunnel, and this can easily lead to constrictive tendinitis. Treatment might start with rest, followed by non-steroidal anti-inflammatory drugs if rest is ineffective. Then, injection treatments are considered, typically around three times; symptoms or pain from tendinitis will significantly reduce or even disappear. If there is no improvement after three injections, a fourth should not be attempted, and surgical treatment to release the tendon and alleviate the constriction may be considered. The last cause is due to a purulent infection. This condition requires symptomatic treatment, initially with antibiotics, followed by cultures and sensitivity tests of the effusion. If the infection occurs adjacent to the tendon or in the tendon sheath, surgery might be necessary to perform drainage again. In summary, the treatment of tendinitis largely depends on the specific cause and involves different approaches.

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Written by Na Hong Wei
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Can tendinitis be seen on an X-ray?

If you are referring to taking an X-ray, tendonitis can only be detected in one situation by X-ray, that is, if the tendonitis has caused calcification. Only then the calcification appears as a high density on the X-ray; otherwise, X-rays won’t show tendonitis. The best examination for tendonitis is magnetic resonance imaging (MRI) because MRI excels in viewing soft tissue disorders, a capability unmatched by other examinations. So, if you suspect you have tendonitis, an MRI should be the first choice, and taking X-rays is not very significant.