Tendonitis is an inflammatory condition characterized by pain at tendonious insertions on bone. The term tendinosis refers to tendon degeneration observed histopathologically. The term tendinopathy is generic and describes a common clinical condition affecting the tendons, which cause pain, swelling and impaired physical performance. Because the pain of the tendon’s condition is not of an inflammatory nature, tendinopathy is a more contemporary term than tendonitis, but tendonitis is well known by everyone.
Common locations of tendonitis include the shoulder rotator capacity and the tendons, insertion of the wrist extensors and elbow flexors, patellar tendons, posterior tibial tendon insertion, Achilles tendon in heel.
Tendons transmit the muscles force to the skeleton. Thus they are subject to repeated mechanical loading, a major causative factor in the development of tendonitis. Histological elements include tendon inflammation, mucous degeneration and fiber necrosis in the tendon. Tendonitis exact pathogenesis is not yet clear. Chronic tendonitis leads to the weakness and the rupture of the tendon.
The trigger factors of tendonitis include the usage, intense exercise, repeated and sustained, sustained extreme positions, insufficient recovery after physical activity, vibration and cold temperatures. Tendonitis develops in some patients after several days to six months after the completion of a course of therapy with quinolones. Pathological mechanisms of the tendonitis after fluoroquinolone are multi factorials. Studies show ischemic, toxic and degenerative changes.
Tendonitis – classification and clinical manifestations
Tendons are subject to repeated mechanical loading, a major causative factor in the development of tendonitis. Middle-aged adults are most often affected. The pain on the sides of the elbow is a characteristic sign of tendonitis. The patient may present a history of practicing tennis or manual labor.
Medial epicondylitis is associated with practicing golf, carpet sawing, bowling. The pain is on the medial side of the elbow. Shoulder tendonitis is associated with activities such as painting, and swimming. The typical symptoms are cramps in the shoulder and painful motion. Pain at palpation of the great tuberosity occurs where muscles insert. Jobe test for supra spinals position: both arms up to 90 degrees, maintained in front of the body and on the arms in pronation a resistance are applied to compare the presence of pain. Failure to keep the arms or the presence of pain is suggestive for cuff tendonitis cape.
Patellar tendonitis manifest through sensitivity at the patellar insertion into the lower pole. Patellar tendonitis is associated with insidious onset of pain well localized in previous knee. Patellar tendonitis is common to those who practice basketball, volleyball and runners. Pain gets worse with changing the position from sitting to standing, walking or climbed on. Another type of tendonitis is associated with lateral knee pain. Running down a hill is a trigger for this tendonitis. Sensitivity is located in the posterior lateral line joints. With the patient’s knee flexed at 90 degrees and the leg internally rotated, external rotation cause pain.
Pain is localized on the lateral femoral condyle. With the patient’s knee flexed at 90 degrees the patient will extend the knee laterally exerted pressure on the femoral condyle. Pain on flexion of 30 degrees is suggestive meaning that the Rennie-test is positive. The Ober test: the patient is lying on the unaffected side and the unaffected thigh and knee are up to 90 degrees. If that will bring pain in the patient tendons when he tries to bring the leg over the midline that means he has tendonitis. The condition is common by usage of the knee. It is observed in cyclists, dancers, long-distance runners, football players and soldiers. Pain typically begins after running or a few minutes after starting the running. It is exacerbated by running down the hill or prolonged sitting position with knees flexed.
Sensitivity is located at 6 cm proximal from the insertion of the tendon on the heels. Pain appears in the plantar flexion and heel. Runners and other athletes have a higher incidence of Achilles tendonitis. Surface modification and the bad running shoes are factors associated with the Achilles tendonitis.
Calcified tendonitis is a morphological condition. It can be discovered by accident and does not cause any symptoms. It affects especially the shoulder and it is characterized by macroscopic deposits in either cape cuff tendons. Calcified tendonitis can be presented as follows:
Chronic pain and flashing episodes of worsening, similar to blockage shoulder syndrome; it is believed to indicate the training phase of the pathology
Mechanical symptoms may occur through increased calcium storage which block the lifting of the shoulder
Severe acute pain is attributed to the inflammatory response of the reabsorption phase.
Stages of evolution of calcified tendonitis:
The formative phase. As a result of an unknown trigger factor a portion of the tendon tissue calcification suffers a transformation fiber cartilaginous and thus it appears the calcified of the transformed tissue. The deposit increases like limestone.
The resting phase. Once formed, the limestone deposit enters in the rest phase. The deposits may be painful or not. If they are large enough they determines some mechanical symptoms.
Reabsorption phase. After a variable period appears also an inflammatory reaction. Vascular tissue develops at the periphery of the deposit. Macrophages and the giant cells absorb the deposits in this phase. Deposits are like toothpaste and occasionally they leak into the bursas with very painful symptoms.
Post calcified phase. Once the deposits were absorbed the fibroblasts are reconstituting the collagen of the tendon.