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Tendon inflammations
07 Jun 2019
Tendon inflammations

What are tendon inflammations?

Tendons are bands of fibrous tissue that connect the muscles to the bones, thereby allowing the contractile apparatus to function properly. These essential fibrous structures with a pearly white colour transform the force created by muscular contraction into movement.

Although they have a robust structure and are able to take significant loads, they are not immune to degenerative phenomena that over time can take place more and more easily.

Tendon pathologies are frequent, above all for athletes or those who engage in sports activities on a regular basis, because of the intense loads to which the tendons are subjected.
As regards tendon lesions, these occur at the point of connection between the tendon and the bone tissue – in these cases the term insertional pathology is used.

Tendinopathies or Tendon pathologies

The term tendinopathy covers all pathologies affecting:

  • The tendons
    • Tendonitis
    • Tendinosis
  • The synovial sheath or tendon sheath.
    • Tenosynovitis
    • Paratenonitis
  • The bursae
    • Bursitis

The areas most subject to these inflammations are:

  • The Foot – Achille’s heel (located at the back of the ankle),
  • The knees
  • The elbows
  • The cuff of the shoulder rotator muscles.

Tendonitis and Tendinosis

Tendonitis is an inflammatory condition that affects the numerous fibrous tendon structures of our body.

It can be either chronic or acute and is brought on by the repetitive movement of a joint that in the long term can cause inflammation of the tendon by overexertion.

If a tendon is stressed beyond its natural limit the fibrils that make it up are damaged to a greater or lesser extent. These will be repaired naturally creating a more vascularised fibrous structure which is consequently less resistant and with a smaller cell structure (hypotrophy).

If the tendon degeneration takes place without inflammation it is called tendinosis.

Tenosynovitis or Paratenonitis

Tenosynovitis, more commonly known as “tennis elbow” is an inflammation of the synovial sheath that covers the tendon structure.

It can be caused by overexertion, but also by systemic pathologies or by the invasion of pathogenic agents that can cause infection.

Bursitis

Bursitis is an inflammation that affects a bursa, i.e. one of the fluid-filled sacs that acts as a cushion between the bone and the tendon and it too can be caused by repetitive movements, trauma, infection or persistent pathological situations.

What are the symptoms of tendon inflammations?

Tendonitis and Tendinosis

Tendonitis generally results in mild pain when the affected area is touched and or moved.

Chronic tendonitis can cause oedemas around the tendon sheaths, swelling, burning and a reduction in the function of the muscle connected to the tendon.

When the sheaths are inflamed and dry, the condition is called cracking tendonitis because cracks can be heard in the joint movements.

Tenosynovitis or Paratenonitis

This occurs with pain and a reduction in the function of the affected area, in the case of Stenosing Tenosynovitis it can lock the tendon.

This type of inflammation can also cause tumefaction (swelling) generated by the build-up of synovial fluid or friction that can be heard simply with the aid of a stethoscope.

Bursitis

Symptoms of this condition may include irritation, pain and swelling.

Treatment of tendon inflammations

Problems with the tendons can be difficult to treat because they can last for months or, in the most severe cases, for years. The treatment can last from six to nine months, but although the therapy may be successful, the pain can reoccur.

A specialist will certainly recommend the use of non-steroidal anti-inflammatory drugs (NSAIDs) to help to control the inflammation and the pain. For tendon problems, NSAIDs are normally used for only brief periods, especially in elderly patients suffering from multiple comorbidities (where several pathologies exist at the same time).

The use of corticosteroid injections in the tendons is very controversial because medical practitioners do not agree with it, even if systemic therapy with corticosteroids can be effective in cases in which a severe inflammatory process is in progress; the right treatment does in any case depend on which tendon is affected.

A physiotherapeutical approach is also important as it will provide exercises to help the tendon to heal and regain its strength. Depending on the type of damage and the tendon affected, the patient may be requested to try using special devices such as insoles, splints or silicone orthoses to relieve the pressure on the tendon.

Where it is not possible to manage the pain, even after several months, surgery can be very effective in relieving the pain of chronic tendonitis.

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