Tendonitis (also spelled tendinitis) is inflammation of a tendon. A tendon acts as the cable that attaches the muscle to the bone. If the tendon gets overly stressed and strained, it may get irritated and inflamed. We often hear of tendonitis involving the knees, elbows, wrists, shoulders, or heels such as, “tennis elbow,” “achilles tendonitis,” or “jumper’s knee.”
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Receiving an accurate diagnosis for a joint injury can involve:
- A complete and thorough physical assessment by a doctor or physiotherapist
- Having an x-ray depending on if there was trauma to cause the pain to rule out a fracture. If arthritis is suspected as the cause of pain, an x-ray can be useful to diagnose the presence or severity of cartilage loss (which occurs with osteoarthritis)
- Ordering an MRI to assess ligament or muscle damage if a major injury is suspected or if the person’s pain is lasting longer than expected
Why does an accurate diagnosis of joint conditions matter?
Receiving an accurate diagnosis for your joint condition can be the difference between healing quickly and having your acute injury turn into a chronic problem. An accurate diagnosis ensures that you are getting the correct and most effective treatment for the injury that you have.
Treatments are specialized for different injuries and conditions, targeting the exact issue that’s causing the pain. For example, treating a ligament tear with a cortisone shot instead of physical therapy might help manage symptoms but would not resolve the underlying issue.
Tendonitis versus a tear
It’s possible to tear tendons, ligaments, connective tissue or muscles around any of your joints. This type of injury can seem similar to tendonitis, as both can present with swelling and pain and can occur during or after physical activity.
It’s very difficult to differentiate between these 2 types of issues. One way that helps us to diagnose a tear is to determine if there was trauma to cause the injury. If someone fell or was hit and the person suffered an injury, then we’d suspect it was a tear and not tendonitis. Tendonitis is usually due to repetitive movements and not due to trauma.
How to identify a muscle, tendon or ligament tear versus tendonitis:
- If there was trauma and you felt or heard a “pop” or tear in the area of pain, then usually that’s a tear
- Bruising and significant swelling usually (but not always) indicates a tear, especially immediately after the injury has occurred. Tendonitis doesn’t usually have the severity of swelling that’s associated with a tear
- With a thorough and proper assessment, there are physical tests that we do that can help to determine if a ligament, tendon or muscle is torn
- If the pain persists beyond the expected and reasonable healing time-frame, it is likely a tear
- If there is a major tear of a muscle, then often there is weakness of that muscle
- Tears are definitively diagnosed through an ultrasound or more accurately through an MRI, which allows us to assess damage to the tissues
Tendonitis versus bursitis
Tendonitis is a painful condition where the tendons become inflamed. Bursitis is when the small sacs of fluid around a joint (called bursa) become irritated and inflamed. Both conditions can present with swelling and discomfort around the affected joints.
Bursae surround our joints to protect our tendons, bones, and muscles from the friction of these tissues rubbing against one another. Much like tendonitis, bursitis often occurs with repetitive movement. It usually appears in the shoulder, elbow, hip, or knee.
Bursitis and tendonitis can also be hard to differentiate, but if the inflamed bursa is close to the outside of the body, then there will usually be more visible swelling than with tendonitis. There is also special testing that physiotherapists can do during the assessment that can help to determine if the tendon or the bursa is the cause of pain. If the pain lasts longer than expected, then your doctor will often take steps to rule out any other conditions and may order an ultrasound or bloodwork.
Tendonitis versus sprain
A sprain is the painful stretching and/or tearing of ligaments at a joint. Tendonitis is an inflammation of the tendons. A tendon creates movement in a joint, while ligaments connect one bone to the other to hold the bones together to form the joints.
Sprains usually happen during some kind of accident. For example, rolling your ankle, falling onto your wrist, or twisting your knee during a fall. Tendonitis tends to occur after repetitive motion. You are more likely to develop tendonitis after playing a long golf game than if you fell on your knee while skiing.
Sprains are usually diagnosed by a proper physical exam, performed by a physiotherapist that can test the integrity of the ligament. If the injury is severe, or the amount of pain, swelling and disability is extreme, then ruling out fractures via x-ray or by assessing ligament damage via MRI may be required. Calcium deposits around the tendon can appear in an x-ray, and this. would indicate chronic tendonitis that has been around for a long time.
Common causes of tendonitis
Tendonitis is usually caused by excessive repetitive motion such as:
- Swinging a golf club
- Swimming
- Jumping
- Throwing a ball
- Swinging a racket
- Walking or running in improper footwear
- Painting walls or ceilings
- Shoveling snow
- Scrubbing or cleaning
- Skiing
- Gardening
- Using a keyboard and/or mouse
How to treat tendonitis
Since tendonitis is an inflammation of the tissues that connect muscle and bone, many of the physiotherapy treatments target that inflammation. Shockwave therapy increases blood flow and breaks up the irritating calcium deposits that can accompany chronic tendonitis. It’s a fast and easy treatment completed by trained physiotherapists, like those on the Summit team.
A proper exercise and stretching program is essential for full and quick recovery. A comprehensive assessment can reveal other factors that have contributed to developing tendonitis. Effective treatment addresses these issues directly.
Myofascial release can be very important in rehabilitating from tendonitis, as releasing the tension in the soft tissues of the affected tendon is extremely helpful. Our physiotherapists have also found IMS and acupuncture to be very beneficial.
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