Wednesday, August 19, 2020

An Hour

“An hour of pain is as long as a day of pleasure.” (English Proverb)

Tendonitis happens when a tendon becomes inflamed or irritated. It can be a painful condition which can occur anywhere in the body, but is more common in the wrist, elbow, shoulder, knee, and heel. Tendonitis is usually caused by overuse and repetitive movements, but it can also be from an injury, structural abnormalities, or diseases, such as arthritis and diabetes. Tendinitis often develops in people whose jobs or hobbies involve repetitive movements as this aggravates the tendons.

A tendon is tissue that attaches muscle to the bone. It is flexible, tough, fibrous, and can withstand tension. A ligament extends from bone to bone at a joint while a tendon extends from muscle to bone. Tendons and muscles work together and exert a pulling force.

Symptoms of tendonitis can include pain that is made worse with movement, pain during the night, tenderness, a lump on the tendon, a cracking or grating feeling as the tendon moves, and swelling, redness, and heat in the area. It can occur at any age, but it is more common among adults who do a lot of sports. Older people are also susceptible, because the tendons tend to lose elasticity and become weaker with age. The most common types of tendonitis include:

Achilles Tendonitis-Achilles Tendonitis is a common injury in runners, and is often caused by overuse. It affects the tendon that connects the calf muscles to the heel bone. Symptoms include heel pain and tenderness, which can increase when walking or running. Severe cases of Achilles Tendonitis can lead to tendon tears.

The Achilles tendon is between the heel and the calf muscle. Achilles tendinitis is a common sports injury. It may also be caused by shoes that fit badly, or do not properly support the foot. It is more likely among patients with rheumatoid arthritis. Achilles tendonitis causes pain and swelling in the back of the heel. People with this condition often complain of pain and stiffness and feel a lump behind the ankle joint.

 Achilles pain often loosens up with some gentle activity but tends to worsen as activities are increased. Understanding this common problem can help with treatment and help to avoid serious complications such as Achilles Tendon Rupture.  Achilles Tendonitis is often treated with rest, ice application, and physical therapy.

Patellar Tendonitis-The patellar tendon connects the kneecap to the shinbone in the lower leg. Symptoms can include pain and tenderness at the base of the kneecap, swelling, and a burning sensation. It can lead to small tears in the tendon which can cause it to become damaged and weaken over time. Patellar Tendonitis, or inflammation of the patellar tendon, is a condition often called Jumper's Knee.

This condition causes pain and swelling directly under the kneecap and is a common problem in basketball players and other athletes who perform repeated jumping activities. Treatment of Patellar Tendonitis usually consists of rest and anti-inflammatory medication. The most challenging part for many athletes is avoiding activities that specifically aggravate this condition.

Posterior Tibial Tendonitis- Occurring not far from the location of Achilles Tendonitis, Posterior Tibial Tendonitis is less common, but should be considered in people with symptoms of pain on the inner side of the ankle. Posterior Tibial Tendonitis typically causes pain with walking, and can make it almost impossible to stand up on your toes.


Left untreated, Posterior Tibial Tendonitis can result in a flat foot. Usual treatments for Posterior Tibial Tendonitis include temporary immobilization and physical therapy. Changes in footwear such as supportive shoes and orthotics can be helpful for prevention.


Rotator Cuff Tendonitis- Many patients who have pain are told by their doctor they have shoulder bursitis or rotator cuff tendonitis. This common cause of shoulder pain is the result of irritation to the tendons that help to lift the arm away from your side as well as inflammation of the bursa that surrounds those tendons. Treatment of rotator cuff tendonitis can almost always be accomplished with non-surgical treatments although in some rare situations surgery may become necessary.


Tennis (or Golfer’s) Elbow Tendonitis -Tennis Elbow Tendinitis occurs where the tendons of the forearm muscles attach to the bones in the elbow. As the name suggests, playing a racquet sport such as tennis is a common cause of the condition. The repeated motions of the backhand and forearm stroke or a serve with poor athletic form can cause chronic stress to the forearm and cause the tendon to get injured. Symptoms can include severe burning pain and tenderness at the outer side of the elbow and forearm, stiffness, muscle weakness, and aching.

 Pain may gradually increase over weeks or months and when movement or pressure is applied to the outer elbow area. The tendon condition occurring in patients with tennis elbow typically is characterized by micro-tears of the tendon called tendinosis.  Avoiding aggravating activities is clearly the most important aspect of treatment, and some physical therapy strengthening exercises can be helpful. Injections for tennis elbow are controversial but often used for treatment.

Golfer’s Elbow Tendinitis is pain more common among golfers. Pain is more acute when trying to lift against a force. The pain sometimes radiates down to the wrist. This most frequently happens during repetitive motions such as those used during a golf swing or work activities. The main symptoms of golfer’s elbow include pain that radiates down the forearm and tenderness at the inner side of the elbow that increases during grasping motions and when bending the palm towards the wrist.

Wrist Tendonitis- Wrist Tendonitis is a common problem that can cause pain and swelling around the wrist joint. Wrist tendonitis is due to inflammation of the tendons and often involves fluid accumulation in the tendon sheath. Limiting wrist movement with short-term splinting is often helpful in treatment of this condition. One of the most important aspects is to identify the tendon or tendons that are causing the problem so that treatment can be targeted to the problem. Splinting will not be effective if the problematic tendons are not being rested. Treatment of Wrist Tendonitis usually does not require surgery. This can affect badminton players and production line workers, who repeatedly use the same motion with their wrist.


Tendonitis can’t always be prevented, but you can reduce your chances of developing it by:

·         Exercising safely to keep your muscles strong and flexible

·         Stretching properly before exercising

·         Regularly resting the tendon if you are prone to repetitive movements or overuse (such as while playing sport or due to your occupation).

Treatment aims to relieve pain and reduce inflammation. In many cases, the following will be enough. They include resting the joint, hot and cold treatment, pain relievers (such as ibuprofen or acetaminophen available over-the-counter), or splinting of the affected joint. Corticosteroid injections around the tendon may help alleviate symptoms. Repeated injections may weaken the tendon, significantly increasing the risk of a rupture. Physical therapy, which involves manipulating and massaging the affected area may provide relief and accelerate the healing process.

If tendinitis persists, and there are calcium deposits around the tendon, extracorporeal shock wave therapy (ESWT) may help. A shock wave is passed through the skin, breaking up the calcium deposits. The deposits may also be removed surgically. Without proper treatment, tendinitis can more easily result in a tendon rupture. This is a more serious condition that may need surgery.


“It is our suffering that brings us together. It is not love. Love does not obey the mind, and turns to hate when forced. The bond that binds us is beyond choice. We are brothers. We are brothers in what we share. In pain, which each of us must suffer alone, in hunger, in poverty, in hope, we know our brotherhood. “(Ursula K. Le Guin)[i]




[i] Sources used:

·        “6 Types of Tendonitis Prone to Irritation” By Jonathan Cluett

·        “Tendinitis: Symptoms, causes, and treatment” by Yvette Brazier


·       
“Types of Tendonitis” by the Bone & Joint Center
 

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