Traumatologist-orthopedist (adults and children)
Bogatov
Victor Borisovich
21 years of experience
Highest qualification category. Doctor of Medical Sciences, Professor of the Department of Traumatology and Orthopedics, First Moscow Medical University. I.M. Sechenov.
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Tendonitis is a disease that manifests itself as an inflammatory process in the tendon area. Pathology can occur in acute or chronic forms. In the second case, degenerative processes develop in the affected tendon. In most cases, the source of inflammation is localized in the tissues adjacent to the bone. Symptoms of tendonitis are nonspecific: the patient suffers from pain when moving the limbs and local fever. The formation of mild edema and a zone of moderate hyperemia is possible. Treatment of pathology in the initial stages involves the use of conservative techniques. An advanced inflammatory process may require surgical intervention.
General information
Tendonitis occurs in patients of all ages. The risk group includes professional athletes and people engaged in monotonous physical labor. The source of inflammation is formed due to excessive stress to which the human tendons are exposed. Tissue microtraumas cause pain and increased local temperature.
Most often, the pathology affects the tendons located next to the elbow, knee and hip joints. Less commonly, inflammation develops in the ankle and wrist joints. Age-related changes in joint tissues lead to weakening of ligaments - the likelihood of developing inflammation increases. Patients over 60 years of age may suffer from the deposition of calcium salts, leading to the appearance of a calcifying form of the disease.
Achilles tendonitis
Achilles tendonitis (ICD 10 code in adults – M76.6) develops for the following reasons:
- Excessive load on the Achilles tendon (overstrain of the calf muscle, frequent running uphill or downhill, a sharp increase in the amount of physical activity);
- Using uncomfortable running shoes;
- Frequently wearing high-heeled shoes and changing heels to flat soles every night.
The patient experiences pain along the Achilles tendon, usually closer to the heel. Swelling and local redness of the skin appear in the tendon area. The pain intensifies when standing on your toes and jumping on your toes. Pain may occur within the first few minutes of walking in the morning. Mobility of the ankle joint is limited.
Reasons for the development of pathology
Symptoms of tendinitis identified by an orthopedist during an examination of the patient may indicate the causes of inflammation in the tendon. Often tissue microtraumas result from a high level of human motor activity. The pathology is common among professional tennis players, golfers, javelin throwers and skiers. The monotonous movements typical of gardeners, carpenters or painters often cause inflammation of the tendons.
A quarter of clinically diagnosed cases of tendonitis develop under the influence of other factors: rheumatic pathologies or diseases of the thyroid gland. Inflammation of the tendons can be a consequence of gonorrhea, intoxication of the body or abnormalities of the bone skeleton (different lengths of limbs, etc.).
Tendonitis in pregnant women and its features
This disease is a frequent “guest” of women who are expecting a child. If there are suspicions, then it is preferable not to do an x-ray or computed tomography during the examination. Any medications that a pregnant woman will take must be prescribed by the attending physician and also agreed with the gynecologist. In this case, self-medication will be dangerous not only for the patient, but also for her unborn child.
When the first symptoms of tendinitis appear, doctors advise limiting yourself to physical therapy, rest, and applying cold compresses to the affected area. If you need to relieve inflammation and reduce pain, ointments based on painkillers are prescribed.
If the problem enters an acute phase, the doctor may resort to immobilization of the joint. Antibiotics may be prescribed, but only if a bacterial infection is found and other treatments have been ineffective. In the most extreme cases, surgery is performed on the joint.
Pathogenesis
Tendons are formed in the form of dense, inelastic cords consisting of bundles of collagen fibers. Thanks to them, muscle tissue connects to bones. Tendons provide the transmission of movement from muscles to the skeleton and maintain stable joint function. Intense and monotonous movements interfere with the process of natural restoration of collagen fibers - the first signs of tendinitis appear.
The tendon structures swell and individual strands of collagen begin to break down. If the load remains high, foci of fatty degeneration, necrosis and deposition of calcium salts form in the tissues. Hardened calcifications lead to re-injury of the previously damaged area. The inflammatory process gradually spreads to the entire tendon.
Causes and risk factors
Common reasons include:
- sudden injury;
- heavy physical activity;
- constant (same) movements for a long time.
Tendonitis often develops in people whose activities involve repetitive movements.
Other risk factors include:
Age : Tendons become less flexible as adults age and are more susceptible to injury.
Profession : A person whose work involves repetitive movements, work in uncomfortable and uncomfortable positions (painters, production workers), heavy loads, suffers most from the disease.
Sports : Some sports involving repetitive movements can lead to tendonitis, for example:
- run;
- tennis;
- swimming;
- basketball;
- golf;
- bowling;
- baseball.
Diseases
: People with diabetes and rheumatoid arthritis are more likely to develop tendonitis.
If the pain suddenly intensifies or the joints become suddenly stiff, the person should seek medical help immediately.
Types of pathology
Tendinitis can affect tendons of any size - inflammatory processes develop in the tissues of the finger, hand, foot, elbow or knee. The classification of pathology used by orthopedists takes into account the localization of the source of pathology. Doctors distinguish the following forms of the disease:
- lateral,
- medial,
- inflammation of the patellar tendon,
- inflammation of the tendon of the shoulder joint.
The lateral type of pathology develops in the tendons adjacent to the wrist muscles (extensor brevis and longus, brachioradialis muscle, etc.). The patient experiences pain spreading along the outer surface of the elbow joint. Over time, professional and amateur athletes develop hand weakness. A person begins to experience difficulty performing basic actions: twisting clothes, lifting a cup of drink, shaking hands.
The medial form of the disease affects the tendons adjacent to the flexor muscles of the forearm, elbow and palm. The pathology is diagnosed 7–10 times less frequently than lateral tendonitis and develops in individuals who regularly perform rotational movements of the arms. Those at risk include golfers, seamstresses, professional scorekeepers, gymnasts, tennis players and baseball players. The main symptom of the disease is acute pain localized on the inside of the elbow joint.
Inflammation of the patellar tendon is diagnosed in people who frequently perform jumps. Microtrauma is caused by short-term intense loads on the quadriceps muscle. In the initial stages of development of the pathology, pain occurs after the patient completes physical activity. Later, pain appears during exercise or at rest.
Inflammation of the shoulder tendons affects the tissue adjacent to the rotator cuff muscles. Pain occurs during any activity that requires hand mobility. Acute attacks can develop at night. An increase in the size of the focus of inflammation leads to the formation of pronounced edema.
Symptoms of tendinitis
This disease comes with several different symptoms. But the most obvious of them is pain. At the initial stage, discomfort may be noticeable only after physical exertion or hard work. Over time, they visit a person with enviable regularity. The sensation can be described as a dull pain, which is concentrated at the site of tissue inflammation. At the same time, it appears only during the movement. When the joint is at rest, the discomfort disappears. If you press on the area of the body where the disease has begun to develop, the pain becomes stronger.
If the inflammation is in an advanced state, then a symptom of tendonitis is redness of the skin around the affected tendon, as well as a local increase in temperature. The joint loses mobility, in some cases a characteristic crunch appears when the body moves.
Elastic nodules in the tissue that can be palpated are also a symptom of tendinitis. They occur after prolonged treatment. There may be one or several nodules. They are an accumulation of fibrous tissue that appears in place of inflammation.
A symptom of shoulder tendonitis may be the appearance of calcifications. These are denser nodules that represent an accumulation of salt deposits. Very often, tendinosis ends in tissue rupture, which leads to longer treatment and rehabilitation.
Symptoms
Symptoms of the disease appear gradually. In the early stages, the patient experiences pain at the time of maximum physical exertion. The rest of the time, the injured tendon does not cause any discomfort to the child or adult. Over time, the pain syndrome becomes more intense: discomfort occurs with minimal physical activity. If left untreated, the patient may be unable to perform everyday activities such as washing dishes, putting on clothes, fastening buttons, tying shoelaces.
The skin next to the source of inflammation turns red and swelling forms. Local temperatures may rise. Palpation of the tendon increases the pain. With sudden movements of the injured limb, the patient may hear a crunching or crackling sound.
Stages of tendinitis
Modern medicine distinguishes several stages of this disease. These include:
- Acute phase. The damaged area of the body causes severe pain. If a person feels discomfort in a calm state, then with physical activity it develops into unbearable acute pain;
- Subacute phase. The pain persists and is accompanied by swelling. Movements become difficult and limited;
- Chronic phase. Tissue degeneration occurs. Pain becomes a constant “guest”, as does stiffness.
Diagnostics
Diagnosis of tendinitis is performed by an orthopedist. The doctor examines the patient and collects data for anamnesis. Confirmation of the primary diagnosis is carried out through radiography, ultrasound and magnetic resonance imaging of the injured tendon.
X-rays can reveal foci of calcification that have formed in collagen fibers. Ultrasound imaging of tendons demonstrates tissue thickening and decreased echogenicity. MRI is used to determine the location of the inflammation and its size.
Treatment
The treatment strategy for tendinitis is determined by the orthopedist, taking into account the data obtained during diagnostic procedures. In case of severe pain, the patient is advised to undergo short-term immobilization of the limb. Drug therapy includes anti-inflammatory drugs. Tissue swelling is eliminated through phonophoresis and electrophoresis.
Relief of the pain syndrome will allow the patient to begin therapeutic exercises. If acute pain persists, the child or adult receives glucocorticosteroid drugs by injection. The ineffectiveness of conservative therapy becomes an indication for surgical intervention.
During the operation, surgeons can perform complete or partial cutting of the tendons from the muscles for the purpose of subsequent lengthening. The postoperative rehabilitation period can last several months.
Features of the development of tendinitis in children
This disease does not occur as often in children as in adults. The most “popular” place where tendinosis occurs is the knee joint. At the first symptoms of tendonitis in a child, you need to contact a pediatric traumatologist. He will conduct an examination and make an accurate diagnosis. After this, the little patient will be prescribed the necessary medications. Most often, the list includes muscle relaxants and non-steroidal anti-inflammatory drugs, both for oral administration and in the form of ointments.
For a certain period of time, you will have to limit your mobility and remove all physical activity. If the pain is very severe, the joint is immobilized. Treatment includes a variety of physical therapy, including electrophoresis. As soon as the acute phase of the disease has passed, a course of massages is carried out and physical therapy is added.
Prognosis and prevention
Timely initiation of treatment for inflammatory processes in the tendons allows doctors to form a favorable prognosis for most patients. When the pathology is advanced, systematic relapses and severe injuries to the extremities are likely. Surgical treatment allows for complete restoration of limb mobility in 85–90% of cases.
Prevention of tendinitis is based on avoiding excessive stress on the tendons. Amateur and professional athletes should do a thorough warm-up before starting training or competition.
Complications after tendinitis
Like any other disease, tendon tendinitis can have complications. It is not difficult to avoid them if you start the right treatment on time. However, it may happen:
- tissue ruptures;
- chronic course of the disease, which is accompanied by constant pain;
- processes of bone tissue proliferation, which lead to inflammation of various types.
Timely examination by a doctor and compliance with all his instructions will minimize the likelihood of complications.
