shoulder bursitis treatment

Is surgery ever necessary for shoulder bursitis treatment?
The simple answer to this question is yes, but the caveat is that surgery is rarely needed to treat impingement syndrome. Patients with shoulder bursitis almost always respond to non-surgical treatments. Usually these treatments begin to work quickly with resolution of symptoms over a period of one to three months.
How do I know I'm ready for surgery for shoulder bursitis?Patients who are considering surgery should have attempted nonsurgical treatments for at least 3 to 6 months without improvement in symptoms. The symptoms should be causing difficulty with the patient's activities, and/or interfering with sleep at night.
How is surgery for shoulder bursitis performed?The procedure used in the treatment of shoulder bursitis is called a subacromial decompression.
This is an arthroscopic procedure performed using instruments inserted through small incisions. One of the instruments inserted is a video camera about the size of a pencil. Another instrument called a shaver is inserted through another incision. The shaver is used to remove the inflamed bursa. Once the bursa is removed, the rotator cuff is inspected to look for any signs of a tear.
Depending on the bone above the rotator cuff, a burr may be used to remove some bone to create more space for the rotator cuff tendons. Often there is a bone spur in this region that can pinch against the rotator cuff--thus the name impingement syndrome.

When is a cortisone injection appropriate?

If the symptoms are not adequately treated, the next step is usually a cortisone injection, or steroid shot, into the area of inflammation. If the symptoms are significant, your doctor may opt to perform this cortisone injection on an initial visit. The cortisone injection places medication to treat the inflammation directly in the problem area. The most significant downside is that cortisone injections can weaken tendons, and repeated cortisone injections should be carefully considered.

What is the best shoulder bursitis treatment?

The first step of shoulder bursitis treatment is to decrease the inflammation. This is best done by avoiding the problems that cause inflammation. The best rule of thumb to follow: 'If it causes pain, don't do it!' This includes simple activities such as reaching high objects or reaching behind yourself.
How is shoulder inflammation treated?Inflammation can also be treated with anti-inflammatory medications such as Motrin, Advil, Aleve, Celebrex, or one of many others. These all fall within the category of 'non-steroidal anti-inflammatory medications.' Taken by mouth, these medications help with the inflammation of the tendons and bursa, and also help treat the pain.
Once the initial pain subsides with oral medications, some simple exercises or physical therapy may help you return to normal activities without pain.

These exercises help to strengthen the rotator cuff and help the shoulder move more effeciently. In addition, it is important to avoid activities that irritate the rotator cuff tendons. These include:
Overhead weight lifting (such as military press, etc)
Throwing activities
Sleeping with the arm over or behind your head

The symptoms of shoulder bursitis

What are the symptoms of shoulder bursitis/impingement syndrome?Common symptoms include:
o Pain with overhead activities (arm above head height)
o Pain while sleeping at night
o Pain over the outside of the shoulder/upper arm
Impingement syndrome and a rotator cuff tear are different problems, and although they are related, the treatment is different. Impingement syndrome is a problem of inflammation around the rotator cuff tendons. A rotator cuff tear is an actual tear within the tendons. The best signs that differentiate these problems area the strength of the rotator cuff muscles. Your orthopedic doctor will be able to specifically isolate these muscles to better determine if a rotator cuff tear is present. A MRI can also show the tendons of the rotator cuff and help determine if a tear is present.

Impingement syndrome

Impingement syndrome is a descriptive term of pinching of the tendons and bursa of the rotator cuff between bones. In many individuals with this problem, the shape of their bones is such that they have less space than most others. Therefore, small thickenings of the tendons or bursa can cause symptoms. Often there is an initial injury that sets off the process of inflammation. Thereafter, the problem can be self-exacerbating. Once there is an initial injury, the tendons and bursa become inflamed. This inflammation causes a thickening of these structures. The thickening then takes up more space, and therefore the tendons and bursa become are pinched upon even more. This causes more inflammation, and more thickening of the tendons and bursa, and so on.

Where is the problem that causes shoulder bursitis?

The shoulder is interesting in that several bones, muscles, and ligaments contribute to this complex joint.
Impingement syndrome, or shoulder bursitis, occurs when there is inflammation between the top of the humerus (arm bone) and the acromion (tip of the shoulder). Between these bones lies the tendons of the rotator cuff, and the bursa that protects these tendons.
Normally, these tendons slide effortlessly within this space. In some people this space becomes too narrow for normal motion, and the tendons and bursa become inflamed. Inflammation leads to thickening of the tendons and bursa, and contributes to the loss of space in this location. Eventually, this space becomes too narrow to accommodate the tendons and the bursa, and every time these structures move between the bones they are pinched--this is the impingement.

'shoulder tendonitis'

Many patients seek medical attention for shoulder pain, and a common diagnosis given is 'shoulder bursitis,' or 'shoulder tendonitis.' The doctor will then often state that identifying which of these diagnosis is the true cause of pain is not important because the treatment is the same.
This is true. Shoulder bursitis and rotator cuff tendonitis are all ways of saying there is inflammation of a particular area within the shoulder joint that is causing a common set of symptoms. The best terminology for these symptoms is 'impingement syndrome.' Impingement syndrome occurs when there is inflammation of the rotator cuff tendons and the bursa that surrounds these tendons.

Flip-flops, although in style right now, have no arch support of any kind. Manufacturers are starting to add some arch raise to flip-flops, but even with an arch, they offer no stability for the foot.This means the foot will move when walking, especially at the end of gait when coming off the toes, instead of remaining stable. As a result, blisters or pain on the ball of the foot can develop.Ballet-style flats are just as bad as flip-flops because they also have inadequate foot support.Repeated wearing of any type of shoe without support can lead to plantar fasciitis, which is pain in the arch support system of your foot.

The pain will generally confine itself to the bottom of the heel. Pain will be worse when waking up in the morning or getting up from sitting.It can occur with as little as one day of wearing of non-supportive shoes, and the pain can last for up to a year. Five to 10 percent of patients need surgery to try and correct the problem. For those in the baby boomer age range, it can also lead to a form of chronic tendonitis and pain along the inside of the ankle and foot

Tendinitis and other chronic tendinopathies LC Almekinders
Department of Orthopaedics, University of North Carolina School of Medicine, Chapel Hill, USA.
Chronic tendon problems are common in orthopaedic patients. Relatively little is known about the etiology of these common problems and the efficacy of available treatments. It is believed that the cause of many injuries is repetitive mechanical trauma followed by an inflammatory response. Other factors, such as age-related degeneration and relative avascularity in the tendon, may play an important etiologic role as well. Histopathologic studies have generally revealed degenerative lesions consistent with tendinosis and/or inflammation of the peritendinous tissues consistent with peritendinitis. Initial treatment should focus on patient counseling and correction of associated mechanical factors, if present. Nonsteroidal anti-inflammatory drugs can give pain relief, but there is no convincing evidence that they alter the natural history. Corticosteroid injections can be used selectively in resistant cases, but recurrences are frequent. Surgery can be very successful when the affected tendon is treated directly.

Brief description of types of tendonitis

· Wrist TendonitisWrist tendonitis is a common problem that can cause pain and swelling around the wrist. Wrist tendonitis is due to inflammation of the tendon sheath. Treatment of wrist tendonitis usually does not require surgery.
· Achilles TendonitisAchilles tendonitis causes pain and swelling in the back of the heel. Understanding this common problem can help with treatment and help to avoid serious complications such as Achilles tendon rupture.
· Patellar (Kneecap) TendonitisPatellar tendonitis, or inflammation of the patellar tendon, is a condition often called Jumper's Knee. Treatment of patellar tendonitis usually consists of rest and anti-inflammatory medication.
· Rotator Cuff TendonitisMany patients who have pain are told by their doctor they have shoulder bursitis or rotator cuff tendonitis; learn more about rotator cuff tendonitis and available treatments.

What is needed to diagnose tendonitis

How is tendonitis diagnosed?
Tendonitis is almost always diagnosed on physical examination. Findings consistent with tendonitis include:
Tenderness directly over the tendon
Pain with movement of muscles and tendons
Swelling of the tendon
Are X-rays or MRIs needed to diagnose tendonitis?Studies such as x-rays and MRIs are not usually needed to make the diagnosis of tendonitis. While they are not needed for diagnosis of tendonitis, x-rays may be performed to ensure there is no other problem, such as a fracture, that could be causing the symptoms of pain and swelling. X-rays may show evidence of swelling around the tendon.
MRIs are also good tests identify swelling, and will show evidence of tendonitis. However, these tests are not usually needed to confirm the diagnosis; MRIs are usually only performed if there is a suspicion of another problem.

Basic Questions, Basic Answers

What is tendonitis?

Sometimes the tendons become inflamed for a variety of reasons, and the action of pulling the muscle becomes irritating. If the normal smooth gliding motion of your tendon is impaired, the tendon will become inflamed and movement will become painful. This is called tendonitis, and literally means inflammation of the tendon.
What causes tendonitis?

The most common cause of tendonitis is overuse. Commonly, individuals begin an exercise program, or increase their level of exercise, and begin to experience symptoms of tendonitis. The tendon is unaccustomed to the new level of demand, and this overuse will cause an inflammation and tendonitis.
Another common cause of symptoms of tendonitis is due to age-related changes of the tendon. As people age, the tendons loose their elasticity and ability to glide as smoothly as they used to. With increasing age, individuals are more prone to developing symptoms of tendonitis. The cause of these age-related changes is not entirely understood, but may be due to changes in the blood vessels that supply nutrition to the tendons.
Sometimes, there is an anatomical cause for tendonitis. If the tendon does not have a smooth path to glide along, it will be more likely to become irritated and inflamed. In these unusual situations, surgical treatment may be necessary to realign the tendon.

Watch Your Step When The Going Gets Rough

Placing your foot accurately is a complicated process. If something moves where you plan to place your foot then you can adjust your step while your foot is swinging through. Experts thought previously that if nothing changed in the path, or in your plans, then the place where your foot will land is fixed before it even leaves the ground. In this case, you would make no use of immediate visual information during each step.

Researchers monitored the accuracy with which subjects could step onto a target. In 50% of the attempts they blocked subjects' vision just at the point when they were lifting their foot off the ground. On the occasions when vision was blocked, the subjects were less able to step accurately on the target.

"Because vision was blocked only after the foot had left the floor, this research shows that we use visual information to adjust our footfall while our foot is moving forwards -- it is not simply predetermined at the beginning of the step," says Dr Raymond Reynolds, who along with Dr Brian Day conducted the work at the Institute of Neurology, Queen Square, London. The research is published this week in the Journal of Physiology.

This research models the sort of situation people encounter when rambling over rough terrain, where they need to accurately place their feet on well defined targets. Getting it right may avoid your slipping or twisting an ankle. "This visual guidance mechanism could also help gymnasts on the beam, or acrobat walkers on a tightrope, as in these situations accurate foot placement becomes crucial," says Reynolds.

General information about tendonitis

A tendon is a tough yet flexible band of fibrous tissue. The tendon is the structure in your body that connects your muscles to the bones. The skeletal muscles in your body are responsible for moving your bones, thus enabling you to walk, jump, lift, and move in many ways. When a muscle contracts it pulls on a bone to cause movements. The structure that transmits the force of the muscle contraction to the bone is called a tendon.
Tendons come in many shapes and sizes. Some are very small, like the ones that cause movements of your fingers, and some are much larger, such as your Achilles tendon in your heel. When functioning normally, these tendons glide easily and smoothly as the muscle contracts.

About.com

What is Achilles tendonitis?

Achilles tendonitis is a condition of irritation and inflammation of the large tendon in the back of the ankle. Achilles tendonitis is a common overuse injury that tends to occur in middle-age recreational athletes. The overuse causes inflammation that can lead to pain and swelling. Furthermore, Achilles tendonitis can lead to small tears within the tendon, and make it susceptible to rupture.

The main complaint associated with Achilles tendonitis is pain over the back of the heel. This is the point where the tendon inserts on the heel bone. Patients with Achilles tendonitis usually experience the most significant pain after periods of inactivity. Therefore patients tend to experience pain after first walking in the morning and when getting up after sitting for long periods of time. Patients will also experience pain while participating in activities, such as when running or jumping. Achilles tendonitis pain associated with exercise is most significant when pushing off or jumping.

Great tips!

Below is some advice for tendonitis treatment and avoiding recurrences of this problem. As with any treatment program, talk with your doctor before you begin tendonitis treatment! In order to aid healing you should:
Rest and Protect The AreaTendonitis treatment must begin by avoiding aggravating movements. This may mean taking a break from a favorite activity for a period of time, but this is a necessary step to allow the inflamed tendon to heal. It is also recommended in tendonitis treatment to try alternative activities; for example, if you are a runner who is experiencing knee pain due to tendonitis, try incorporating swimming into your workout schedule. Often a splint or brace will be prescribed to help protect the area.
Apply an Ice Pack
Icing the area of inflammation is an important aspect of tendonitis treatment. The ice will help to control the inflammation and decrease swelling. By minimizing inflammation and swelling, the tendon can return to its usual state and perform its usual function.
Take Anti-Inflammatory MedicationsNonsteroidal anti-inflammatory medications (NSAIDs) include a long list of possibilities such as Ibuprofen, Motrin, Naprosyn, Celebrex, and many others.
Tendonitis treatment can be improved by these medications that will decrease pain and swelling. Be sure to talk to your doctor before starting these medications.
Cortisone InjectionsIf the symptoms of tendonitis are persistent, an injection of cortisone may be considered. Cortisone is a powerful anti-inflammatory medication, but instead of being given by mouth, it is injected directly to the site of inflammation. This can be extremely helpful for situations that are not improved with rest.
Not all types of tendonitis can be addressed with cortisone injections! For example, Achilles tendonitis is rarely injected with cortisone because of concerns about possible rupture of the tendon.
To prevent the return of tendonitis symptoms:
Strengthening and Physical TherapyProper strengthening technique can help you avoid tendonitis by using your muscles in a safe, more efficient manner. For example, patients with rotator cuff tendonitis can learn ways to move the shoulder that will not cause inflammation. Do not begin exercises until the inflammation of tendonitis has resolved!
Take BreaksAlternate repetitive tasks with breaks to relieve stress on the tendons. Don't perform one activity continuously for hours at a time. For those with exercise-related tendonitis, try to vary your workouts to relieve the repetitive stress of one exercise activity.
Protect the TendonsSome patients who have chronic tendonitis will find relief by protecting the affected area when performing certain activities. For example, wrist splints can be worn while gardening, or Chopat straps (patellar tendonitis) can be worn while playing sports.
The steps listed above are usually adequate tendonitis treatment, and most patients have resolution of their symptoms. Learning to avoid activities that may cause a tendonitis flare-up can also be important.
Tendonitis due to underlying conditions such as arthritis and gout are more difficult to treat and recur more frequently. The best management in these situations is to do your best to avoid flare-ups of gouty attacks or arthritic episodes, and to avoid activities which you have learned cause tendonitis.
source-orthopedics.about.com

Transmission

Transmission from Person to Person
Athlete's Foot is caused by a parasitic fungus and is a communicable disease. It is typically transmitted in moist environments where people walk barefoot, such as showers, bath houses, and locker rooms. It can also be transmitted by sharing footwear with an infected person, or less common, by sharing towels with an infected person.

Transmission to Other Parts of the Body
The various parasitic fungi that cause Athlete's Foot can also cause skin infections on other areas of the body, most often under toenails (Onychomycosis) or on the groin (Jock Itch).

Why Is It Called Athlete's Foot?

Athlete's foot gets its name because athletes often get it. Why? The fungus that causes it can be found where athletes often are. The fungus grows on the warm, damp surfaces around pools, public showers, and locker rooms. People walk barefoot on these surfaces and fungus ends up on their feet. Or they might use a damp towel that has the athlete's foot fungus on it.
But just having the fungus on your feet isn't enough to cause the infection. The infection happens if conditions are right for the fungus to grow. The fungus likes it wet, so:
Dry your feet properly after swimming, showering, or bathing.
Do not wear tight shoes when your feet are sweaty.
Do not wear the same pair of shoes or socks day after day.

What are the complications of Achilles tendon repair?

The most common and worrisome complications following an Achilles tendon repair are problems with wound healing. The skin over the Achilles tendon sometimes does not heal well. Therefore, careful wound management is of utmost important following surgical repair of an Achilles tendon rupture. Other potential problems include infection, ankle stiffness, and rerupture of the tendon.

What is the rehab following Achilles tendon repair?

Rehabilitation following Achilles tendon repair is a controversial topic. Traditionally, patients were casted after surgery for a period of 4 to 8 weeks and after that time, patients were allowed to gently move the ankle.
More recently, studies have shown that patients do well and heal faster with more rapid mobilization. If a solid repair is attainable, patients may not be casted at all, and allowed to begin motion immediately after surgery. These patients will use a removable boot when walking for several weeks.

AT Rupture

What is the treatment for Achilles tendon rupture?

Achilles tendon rupture is most often treated surgically to reattach the tendon to its normal position.
Nonoperative management can be undertaken, generally people who live sedentary lifestyles or who may have problems with wound healing. Nonsurgical treatment of an Achilles tendon rupture is accomplished by casting the Achilles tendon for several months. In these patients, the number of reruptures is higher compared to those patients who have surgical repair. In patients who have surgery for an Achilles tendon rupture, less than 3% experience a rerupture of the tendon.
How is surgery done for treatment of an Achilles tendon rupture?

The surgery to treat an Achilles tendon rupture involves an incision along the back of the ankle. Usually the incision is made just to the side of midline so shoes will not rub on the site of the scar. The torn ends of the Achilles tendon are identified and strong sutures are placed in both ends of the tendon. These strong sutures are then tied together to repair the tendon.

Achilles tendon ruptures

Which patients sustain Achilles tendon ruptures?

Achilles tendon ruptures are most commonly seen in men who are around the age of 30-40 years old. About 15-20% of patients have symptoms of Achilles tendonitis prior to sustaining an Achilles tendon rupture, but the vast majority of patients have no history of prior Achilles tendon problems.
Over 75% of Achilles tendon ruptures are associated with playing ball sports (commonly basketball or tennis).
Other risk factors that are associated with Achilles tendon rupture include:
o Cortisone injections into the tendon
o Gout
o Fluoroquinolone antibiotic use
Fluoroquinolone antibiotics are used very commonly in medicine for treatment of respiratory infections, urinary tract infections, and other bacterial infections. These antibiotics, such as Cipro, Levaquin, and others, are associated with Achilles tendon rupture. Exactly why this is the case is unclear, but patients on these medications should consider an alternative medication if Achilles tendon pain develops.

What is an Achilles tendon rupture?

An Achilles tendon rupture occurs when the tendon attaching the calf muscle to the heel is ruptured. This is a common injury, most often seen in middle-age, male, "weekend warriors."
What are the symptoms of an Achilles tendon rupture?An Achilles tendon rupture is a traumatic injury that causes sudden pain behind the ankle. Patients may hear a 'pop' or a 'snap,' and will almost always say they feel as though they have been kicked in the heel (even though no one has kicked them). Patients have difficulty pointing their toes downward, and may have swelling and bruising around the tendon.

Treatment and treatment Options

Achilles tendonitis can develop into a chronic problem if treatment is not initiated in a timely manner. Over time, inflammation can lead to degenerative changes within the tendon, and may even contribute to a higher chance of Achilles tendon rupture. Therefore, it is important to initiate treatment for symptoms of Achilles tendonitis.
What are the treatment options for Achilles tendonitis?The best treatment of Achilles tendonitis is prevention. Stretching the Achilles tendon before exercise, even at the start of the day, will help to maintain flexibility in the ankle joint. Problems with foot mechanics can also be treated with devices inserted into the shoes. Products such as heel cups, arch supports, and custom orthotics can be used to correct for abnormalities such as overpronation and help prevent Achilles tendonitis.
Shoe inserts for foot and heel pain
The treatments of Achilles tendonitis include:
RestResting the painful Achilles tendon will allow the inflammation to subside and allow for healing. A period of rest after the onset of symptoms is important in controlling Achilles tendonitis.
ImmobilizationIn patients who have more significant symptoms, a period of immobilization can help. Either a removable walking boot, or sometimes even a cast, can allow the inflamed tissue to cool down quickly.
Heel WedgeA heel wedge can be inserted into the shoe to minimize the stress on the Achilles tendon. These can be placed in both athletic shoes and work shoes.
Ice the InjuryApplying ice to the area of inflammation can help stimulate blood flow to the area, and relieve the pain associated with inflammation. Apply ice after exercise, as well as several other times over the course of the day.
Anti-Inflammatory MedicationsNonsteroidal anti-inflammatory medications (NSAIDs) include a long list of possibilities such as Ibuprofen, Motrin, Naprosyn, Celebrex, and many others.
Achilles tendonitis treatment can be improved by these medications that will decrease pain and swelling. Be sure to talk to your doctor before starting these medications.
Physical TherapyPhysical therapists can help formulate a stretching and rehabilitation program to work on flexibility of the Achilles tendon.
Cortisone injections are infrequently used in patients with Achilles tendonitis because studies have shown an increased incidence of Achilles tendon rupture after cortisone injections.

Achilles Tendonitis - Symptoms and Diagnosis

What are the symptoms of Achilles tendonitis?

The main complaint associated with Achilles tendonitis is pain over the back of the heel. This is the point where the tendon inserts on the heel bone. Patients with Achilles tendonitis usually experience the most significant pain after periods of inactivity. Therefore patients tend to experience pain after first walking in the morning and when getting up after sitting for long periods of time. Patients will also experience pain while participating in activities, such as when running or jumping. Achilles tendonitis pain associated with exercise is most significant when pushing off or jumping.
How is Achilles tendonitis diagnosed?

Diagnosis of Achilles tendonitis is accomplished by history and physical examination. The symptoms associated with this condition are typical and can be elicited by a thorough history. A physical examination is used to determine the location of the problem.
X-rays are usually normal in patients with Achilles tendonitis, but are performed to evaluate for other possible conditions. Occasionally a MRI is needed to evaluate a patient for tears within the tendon. If there is a thought of surgical treatment a MRI may be helpful for preoperative evaluation and planning.

Achilles Tendonitis

What is Achilles tendonitis?
Achilles tendonitis is a condition of irritation and inflammation of the large tendon in the back of the ankle. Achilles tendonitis is a common overuse injury that tends to occur in middle-age recreational athletes. The overuse causes inflammation that can lead to pain and swelling. Furthermore, Achilles tendonitis can lead to small tears within the tendon, and make it susceptible to rupture.

What causes Achilles tendonitis?

The two most common causes of Achilles tendonitis are:
Lack of flexibility
Overpronation Other factors associated with Achilles tendonitis are recent changes in footwear, and changes in exercise training schedules. Often long distance runners will have symptoms of Achilles tendonitis after increasing their mileage or increasing the amount of hill training they are doing. As people age, tendons, like other tissues in the body, become less flexible, more rigid, and more susceptible to injury. Therefore, middle-age recreational athletes are most susceptible to Achilles tendonitis.

WT treatment and surgery

What is the treatment for wrist tendonitis?
· Immobilization

Placing the wrist in a splint or a cast is usually the first treatment step. Wrist tendonitis is due to recurrent irritation of the tendon and its sheath. By resting the tendon, the inflammation should decrease.
o Find a Wrist Splint
· Ice the Injury

Applying an ice pack intermittently to the area of inflammation may also be beneficial. Icing wrist tendonitis can help to cool inflammation and also stimulates blood flow to the area of tendonitis.
· Anti-Inflammatory Medications

Nonsteroidal anti-inflammatory medications will help control symptoms of pain, but more importantly they help in the treatment of wrist tendonitis to decrease inflammation and swelling of the soft-tissues. These treatment medications will decease the inflammatory response which is the cause of the pain.
· Cortisone Injection

Cortisone is a more powerful anti-inflammatory treatment option that is given by injection directly to the site of inflammation. Cortisone injections are safe, but can weaken tendons over time if too many injections are given.
· Surgery

Surgery is only done when these other treatment methods have failed to solve the problem. If that is the case, the area of tight tendon sheath that cause the painful and difficult tendon movements can be released. The inflammatory tissue can also be removed in an effort to create more space for the tendon to move freely.

The answer to this question:

What are the symptoms of wrist tendonitis?

The most common and consistent complaint of patients diagnosed with wrist tendonitis is pain over the area of inflammation.
Swelling of the surrounding soft-tissues is also quite common.
How is the diagnosis of wrist tendonitis made?Diagnosis of wrist tendonitis is a made by looking for the characteristic signs of this problem. In addition, depending on the tendon that is inflamed, the physician can perform tests that stretch the area of concern to locate the precise source of inflammation.
For example, one type of wrist tendonitis is called DeQuervain's tenosynovitis. This is inflammation of the tendon at the base of the thumb. Often seen in new mothers, DeQuervain's tenosynovitis is diagnosed by a specific test called 'Finkelstein's test' where the patient makes a fist and the wrist is pulled away from the thumb. Pain from this maneuver is diagnostic of this type of wrist tendonitis.

What is wrist tendonitis

Wrist tendonitis, also called tenosynovitis, is a common condition characterized by irritation and inflammation of the tendons around the wrist joint. Many tendons surround the wrist joint. Wrist tendonitis usually affect one of the tendons, but it may also involve two or more. Often wrist tendonitis occurs at points where the tendons cross each other or pass over a bony prominence.
The wrist tendons slide through smooth sheaths as they pass by the wrist joint. These tendon sheaths, called the tenosynovium, allow the tendons to glide smoothly in a low-friction manner.
When wrist tendonitis becomes a problem, the tendon sheath or tenosynovium, becomes thickened and constricts the gliding motion of the tendons. The inflammation also makes movements of the tendon painful and difficult.

Treatment of Tendonitis- Quick Tips

What is the treatment of tendonitis?
Below is some advice for tendonitis treatment and avoiding recurrences of this problem. As with any treatment program, talk with your doctor before you begin tendonitis treatment! In order to aid healing you should:
Rest and Protect The Area

Tendonitis treatment must begin by avoiding aggravating movements. This may mean taking a break from a favorite activity for a period of time, but this is a necessary step to allow the inflamed tendon to heal. It is also recommended in tendonitis treatment to try alternative activities; for example, if you are a runner who is experiencing knee pain due to tendonitis, try incorporating swimming into your workout schedule. Often a splint or brace will be prescribed to help protect the area.
Apply an Ice Pack

Icing the area of inflammation is an important aspect of tendonitis treatment.
The ice will help to control the inflammation and decrease swelling. By minimizing inflammation and swelling, the tendon can return to its usual state and perform its usual function.
Take Anti-Inflammatory MedicationsNonsteroidal anti-inflammatory medications (NSAIDs) include a long list of possibilities such as Ibuprofen, Motrin, Naprosyn, Celebrex, and many others.
Tendonitis treatment can be improved by these medications that will decrease pain and swelling. Be sure to talk to your doctor before starting these medications.
Cortisone InjectionsIf the symptoms of tendonitis are persistent, an injection of cortisone may be considered. Cortisone is a powerful anti-inflammatory medication, but instead of being given by mouth, it is injected directly to the site of inflammation. This can be extremely helpful for situations that are not improved with rest.
Not all types of tendonitis can be addressed with cortisone injections! For example, Achilles tendonitis is rarely injected with cortisone because of concerns about possible rupture of the tendon.
To prevent the return of tendonitis symptoms:
Strengthening and Physical TherapyProper strengthening technique can help you avoid tendonitis by using your muscles in a safe, more efficient manner. For example, patients with rotator cuff tendonitis can learn ways to move the shoulder that will not cause inflammation. Do not begin exercises until the inflammation of tendonitis has resolved!
Take BreaksAlternate repetitive tasks with breaks to relieve stress on the tendons. Don't perform one activity continuously for hours at a time. For those with exercise-related tendonitis, try to vary your workouts to relieve the repetitive stress of one exercise activity.
Protect the TendonsSome patients who have chronic tendonitis will find relief by protecting the affected area when performing certain activities. For example, wrist splints can be worn while gardening, or Chopat straps (patellar tendonitis) can be worn while playing sports.
The steps listed above are usually adequate tendonitis treatment, and most patients have resolution of their symptoms. Learning to avoid activities that may cause a tendonitis flare-up can also be important.
Tendonitis due to underlying conditions such as arthritis and gout are more difficult to treat and recur more frequently. The best management in these situations is to do your best to avoid flare-ups of gouty attacks or arthritic episodes, and to avoid activities which you have learned cause tendonitis.

What is athlete's foot?Athlete’s foot is a common fungal infection of the skin of your feet. The fungus, tinea pedis, is contracted from public environments. The fungus then grows in the warm and moist environment of your footwear, and can be difficult to eradicate.

Where did I get a athlete's foot from?Many cases of athlete’s foot can be traced to use of a public recreational facility, such as a spa, swimming pool, or locker room shower. The fungus, which grows in warm, moist environments, likes to live in the outer layers of your skin. However, for short periods of time, the fungus can live in warm puddles on the tile floor, awaiting another foot to hop onto.

What are the symptoms of athlete’s foot?Most commonly, people experience the typical symptoms of athlete’s foot:
Itching, most notably in the creases between your toes
Redness and scaling of the skin in affected areas
Cracked or blistered skin.

Common Types of Tendonitis

· Wrist TendonitisWrist tendonitis is a common problem that can cause pain and swelling around the wrist. Wrist tendonitis is due to inflammation of the tendon sheath. Treatment of wrist tendonitis usually does not require surgery.
· Achilles TendonitisAchilles tendonitis causes pain and swelling in the back of the heel. Understanding this common problem can help with treatment and help to avoid serious complications such as Achilles tendon rupture.
· Patellar (Kneecap) TendonitisPatellar tendonitis, or inflammation of the patellar tendon, is a condition often called Jumper's Knee. Treatment of patellar tendonitis usually consists of rest and anti-inflammatory medication.
· Rotator Cuff TendonitisMany patients who have pain are told by their doctor they have shoulder bursitis or rotator cuff tendonitis; learn more about rotator cuff tendonitis and available treatments.

Diagnosis of Tendonitis

How is tendonitis diagnosed?
Tendonitis is almost always diagnosed on physical examination. Findings consistent with tendonitis include:
Tenderness directly over the tendon
Pain with movement of muscles and tendons
Swelling of the tendon
Are X-rays or MRIs needed to diagnose tendonitis?Studies such as x-rays and MRIs are not usually needed to make the diagnosis of tendonitis. While they are not needed for diagnosis of tendonitis, x-rays may be performed to ensure there is no other problem, such as a fracture, that could be causing the symptoms of pain and swelling. X-rays may show evidence of swelling around the tendon.
MRIs are also good tests identify swelling, and will show evidence of tendonitis. However, these tests are not usually needed to confirm the diagnosis; MRIs are usually only performed if there is a suspicion of another problem.

Quick Overview for the new ones

What is tendonitis?Sometimes the tendons become inflamed for a variety of reasons, and the action of pulling the muscle becomes irritating. If the normal smooth gliding motion of your tendon is impaired, the tendon will become inflamed and movement will become painful. This is called tendonitis, and literally means inflammation of the tendon.
What causes tendonitis?The most common cause of tendonitis is overuse. Commonly, individuals begin an exercise program, or increase their level of exercise, and begin to experience symptoms of tendonitis. The tendon is unaccustomed to the new level of demand, and this overuse will cause an inflammation and tendonitis.
Another common cause of symptoms of tendonitis is due to age-related changes of the tendon. As people age, the tendons loose their elasticity and ability to glide as smoothly as they used to. With increasing age, individuals are more prone to developing symptoms of tendonitis. The cause of these age-related changes is not entirely understood, but may be due to changes in the blood vessels that supply nutrition to the tendons.
Sometimes, there is an anatomical cause for tendonitis. If the tendon does not have a smooth path to glide along, it will be more likely to become irritated and inflamed. In these unusual situations, surgical treatment may be necessary to realign the tendon.

Tendons are:

A tendon is a tough yet flexible band of fibrous tissue. The tendon is the structure in your body that connects your muscles to the bones. The skeletal muscles in your body are responsible for moving your bones, thus enabling you to walk, jump, lift, and move in many ways. When a muscle contracts it pulls on a bone to cause movements. The structure that transmits the force of the muscle contraction to the bone is called a tendon.
Tendons come in many shapes and sizes. Some are very small, like the ones that cause movements of your fingers, and some are much larger, such as your Achilles tendon in your heel. When functioning normally, these tendons glide easily and smoothly as the muscle contracts.

A Sufferer's Experience

Tendonitis Prevention for Programmers
Thomas Wang

The Beginning
My occupation is computer programming. The job involves significant amount of typing. About 3 years ago, I started to develop symptoms of hand tingling and numbness. These symptoms are associated with long stretchs of typing on keyboards. Gradually, these symptoms got worse, until I have to seek a doctor for treatment.
The doctor said I have tendonitis. If it becomes worse, then it would develop to full carpel tunnel syndrome. My computer career would be in big trouble.
What follows is a course of treatment and trouble shooting of the work environment. I am glad to say that today I am completely symptoms free. If the work environment is correctly set up, then there should be good chance to avoid the problems of tendonitis, or carpel tunnel syndrome.
Treatment
First on treatment. My treatment involves putting cold packs on my wrists. After the cold pack, Cortizone cream is ultra-sounded in the wrists area. This is received from Doctor ordered physical therapy. Physical therapy folks treat athletic injuries and work place injuries.
I have heard some doctors will just issue some Advil tablets and call it a day. This by itself is ineffective except for the lightest form of tendonitis.
Bandages and Splints
The usages of bandages are doubtful, because they can restrict blood flow, and make the symptom worse. Splints are somewhat controversial. Tight fitting splints suffer the same disadvantages as bandages.
A somewhat loose fitting splints may be useful in office, where it is a good visual excuse for not typing so much. However, personally I feel I did not get too much out of splints.
Hand Usage Reduction
One basic measure is to reduce the amount work using the hand. They can include typing, mousing, holding books, digging in the garden, washing dishes, video games, carrying babies, and playing tennis.
Prevention
What I learned most however is in the area of prevention. The prevention steps are very detailed. That is why I decided to write this web page, so you can see what I learned, and to apply the knowledge to your situations.
Chair
The most basic item is the work place chair. The chair should have good back support. The height of the chair should be adjustable to a comfortable height for you. The arm rest design is important. It is very bad to have your elbows to rest on hard arm rests for a long time. If you do tend to rest your elbows on the arm rests, then chairs with removable arm rests or adjustable arm rests are ideal. Move the arm rests away from your body so you are less likely to rest the elbows on them.
Recently I bought an office chair without arm rests. It worked pretty well.
Keyboard Height
The next item is the keyboard height. Usually a desk designed for writing will be too high for typing. A good typing height is a few inches lower than writing height. Just a little above the lap is usually a good keyboard height. Put the keyboard on your lap, and put your fingers on the home row. You should notice the keyboard is roughly the same height or slightly lower than your elbow.
How to reduce this keyboard height when the table is too high? There are a few options. You can put the keyboard on your lap. Although the mouse will be more of a problem if you use this simple method. Some office table will have an optional extension keyboard surface that can be adjusted in height. You can custom make a specially shaped acrylic sheet for lowering the keyboard.
I made one at a plastic hobby shop called 'Tap Plastic'. You give them the specification, and they will construct it for you.

Posture
The correct posture for typing is for your arms to hang down naturally from your shoulders, with fore-arm and hand held in horizontal position. Move the chair forward until the fingers reach the home row.
If the keyboard is too high, it can lead to a typing style that I call 'frog swimming'. The frog swimming typing style is very bad for blood circulation. Imagine the keyboard is so high that it is almost up to your shoulders. Your arm is not dropping down, but stretched out horizontally. Your fore-arm is bent inward, so if your hands are straight they will touch each other. In order to type however, you have to bend the hands outward to span the keyboard. This resembles the frog swimming style, right? If you are typing like this, you are sure to develop tendonitis.
While typing, it is important not to lean forward. Typing while leaning forward is much more straining than typing while sitting straight. If the screen font size is set too small, you may lean forward unconciously.
Wrist Rests
How about wrist rests? A SOFT wrist rest can be useful when the keyboard is at the right height. You palm can touch lightly with the soft wrist rest while you are not typing. Resting your wrists on the wrist rest WHILE you are typing is very bad. This will cut off blood circulation to the hand, with negative effects even if the wrist rest is soft. Pressing the wrists against a hard table surface while typing is absolutely the killer- guaranteed tendonitis.
Reaching for Mouse
After these ergonomic changes, I still have right shoulder pain. I was puzzled, until I found out this is due to my reaching out for the mouse pointer device.
Today's keyboards are usually rather wide. Therefore the mouse will have to be positioned to the far right side of the keyboard. Constantly reaching out for the mouse caused my right shoulder to hurt.
My solution was to use a mini-keyboard without the numeric key-pad. Now the mouse can be moved in at least 4 inches. My shoulder pain disappeared within a month. I think an alternate solution is to use a keyboard with built-in touch pad at the center. This would be compatible with the keyboard on the lap approach, as a bonus. The design of touch pad varies, so you will have to see if a particular model is suitable for you.
One more way I dealt with the mouse is to put the mouse on the left hand side of the keyboard, and use my left hand for mousing. It only took a few days before I am used to it.
Monitor Height
I have received some comments that computer monitor located below eye level can reduce neck and shoulder strain. I think this is a sound advice. Certainly a monitor set above eye level can increase neck straining.
I have seen my co-workers construct 'glare shields' out of cardboard boxes. It is glued to the top or side of the monitor to reduce light glare. From what I have seen, it worked well when glare is an issue.
Conclusion
I was able to become tendonitis free with the ergonomic changes outlined in this article. I wish you too, are able to stay pain free. Of course, a few rest breaks per day never hurt!

Baby Your Arm

Even after you feel you have overcome a case of Epicondylitis, be sure to continue babying your arm. Always warm up your arm for 5 to 10 minutes before starting any activity involving your elbow. And if you develop severe pain after use anyway, pack your arm in ice for 15 to 20 minutes and call your doctor.

Relief of Golfer's Elbow

The best way to relieve Medial Epicondylitis is to stop doing anything that irritates your arm. A simple step for the weekend athlete, but not as easy for the manual laborer, office worker, or professional athlete.
The most effective conventional and alternative treatments for Epicondylitis have the same basic premise: Rest the arm until the pain disappears, then massage to relieve stress and tension in the muscles, and exercise to strengthen the area and prevent re-injury. If you must go back to whatever caused the problem in the first place, be sure to warm up your arm for at least 5 to 10 minutes with gentle stretching and movement before starting any activity. Take frequent breaks.
For most mild to moderate cases of Epicondylitis, aspirin or ibuprofen will help address the inflammation and the pain while you are resting the injury, and then you can follow up with exercise and massage to speed healing. For stubborn cases of Epicondylitis your doctor may advise corticosteroid injections, which dramatically reduce inflammation, but they cannot be used long-term because of potentially damaging side effects.

These are the SYMPTOMS

Symptoms Of Golfer's Elbow
Tenderness and pain at the medial epicondyle, made worse by flexing the wrist. The pain may spread down the forearm. Activities that use the flexor muscles like bending the wrist or grasping can make matters worse.
Pain caused by lifting or bending the arm or grasping even light objects such as a coffee cup.
Difficulty extending the forearm fully (because of inflamed muscles, tendons and ligaments).
Pain that typically lasts for 6 to 12 weeks; the discomfort can continue for as little as 3 weeks or as long as several years.

The Physiology Of Golfer's Elbow

The muscles of the forearm that pull the wrist down are called wrist flexors. They begin at a common tendon attachment on the inside bump of the elbow called the medial epicondyle (below). As the wrist is flexed or the hand made to grip, the muscles tense and pull against the tendons. Force placed on the flexor muscles during a golf swing pulls on the tendons at the medial epicondyle.
Golfer’s Elbow, is similar to its counterpart, Tennis Elbow. The primary difference between the two is the location of the pain and the activity that leads to injury. However, both conditions are caused by overuse of the muscles of the forearm leading to inflammation and pain around the elbow joint.
These problems, Tennis Elbow and Golfer’s Elbow, are forms of tendonitis. Tendons are the ends of muscles that attach to bone. Because of the force of the muscle, the points of insertion of the tendon on the bone are often pointed prominences.
The medical names of Tennis Elbow (lateral epicondylitis) and Golfer’s Elbow (medial epicondylitis) come from the names of these bony prominences where the tendons insert, and where the inflammation causes the pain. The pain of Golfer’s Elbow is usually at the elbow joint on the inside of the arm; a shooting sensation down the forearm is also common while gripping objects.

At his best, Jason Akermanis has sublime skills and breathtaking pace but at three-quarter time on Sunday, Western Bulldogs supporters would have been forgiven for thinking their club had bought a lemon.Akermanis had just six possessions next to his name, one of which was a lame left foot shot at goal which dribbled along the ground.And to add insult to injury, Melbourne ruckman Paul Johnson had succeeded effortlessly in making Akermanis look slow.That was on top of a shocking start to the season, one which had seen him already miss two games due to injury with the four he had played being far from the lofty standards he set in a 248-game career with Brisbane where he was one of the game's premier midfielders.

Intro to Golfer's Elbow

Medial Epicondylitis is usually referred to as "Golfer's Elbow", not because only golfers develop the ailment, but because that activity is a common cause of the problem.
There are many other activities that can result in Golfer's Elbow such as working out at the gym or simply working in front of a computer for prolonged periods. Each of these activities use the same muscles repetitively and can result in the inflammation of muscles, ligaments & tendons.
Two additional strains, Lateral Epicondylitis (more commonly known as Tennis Elbow) and Bursitis, are often mistaken for Medial Epicondylitis.

Reasons to call a Doc

If you have ennis elbow, call a docor if:
The pain persists for more than a few days; chronic inflammation of the tendons can lead to permanent disability.
The elbow joint begins to swell; tennis elbow rarely causes swelling, so you may have another condition such as arthritis, gout, infection or even a tumor.

Preventing a relapse

To prevent a relapse of tennis elbow:
Discontinue or modify the action that is causing the strain on your elbow joint. If you must continue, be sure to warm up for 10 minutes or more before any activity involving your arm, and apply ice to it afterward. Take more frequent breaks.
Try strapping a band around your forearm just below your elbow. If the support seems to help you lift objects such as heavy books, then continue with it. Be aware that such bands can cut off circulation and impede healing, so they are best used once tennis elbow has disappeared.

This is how to prevent tennis elbow

To prevent tennis elbow:
Lift objects with your palm facing your body.
Try strengthening exercises with hand weights. With your elbow cocked and your palm down, repeatedly bend your wrist. Stop if you feel any pain.
Stretch relevant muscles before beginning a possibly stressful activity by grasping the top part of your fingers and gently but firmly pulling them back toward your body. Keep your arm fully extended and your palm facing outward.

When you should consider seeing a doctor

If rest, anti-inflammatory medications, and a stretching routine fail to cure your tennis elbow, you may have to consider surgery, though this form of treatment is rare (fewer than 3 percent of patients). One procedure is for the tendon to be cut loose from the epicondyle, the rounded bump at the end of the bone, which eliminates stress on the tendon but renders the muscle useless. Another surgical technique involves removing so-called granulated tissue in the tendon and repairing tears.
Even after you feel you have overcome a case of tennis elbow, be sure to continue babying your arm. Always warm up your arm for 5 to 10 minutes before starting any activity involving your elbow. And if you develop severe pain after use anyway, pack your arm in ice for 15 to 20 minutes and call your doctor.

Relief Of Tennis Elbow

The best way to relieve tennis elbow is to stop doing anything that irritates your arm — a simple step for the weekend tennis player, but not as easy for the manual laborer, office worker, or professional athlete.
The most effective conventional and alternative treatments for tennis elbow have the same basic premise: Rest the arm until the pain disappears, then massage to relieve stress and tension in the muscles, and exercise to strengthen the area and prevent re-injury. If you must go back to whatever caused the problem in the first place, be sure to warm up your arm for at least 5 to 10 minutes with gentle stretching and movement before starting any activity. Take frequent breaks.
Conventional medicine offers an assortment of treatments for tennis elbow, from drug injections to surgery, but the pain will never go away completely unless you stop stressing the joint. Re-injury is inevitable without adequate rest.
For most mild to moderate cases of tennis elbow, aspirin or ibuprofen will help address the inflammation and the pain while you are resting the injury, and then you can follow up with exercise and massage to speed healing.
For stubborn cases of tennis elbow your doctor may advise corticosteroid injections, which dramatically reduce inflammation, but they cannot be used long-term because of potentially damaging side effects.

Tennis Elbow

Symptoms Of Tennis Elbow
Recurring pain on the outside of the upper forearm just below the bend of the elbow; occasionally, pain radiates down the arm toward the wrist.
Pain caused by lifting or bending the arm or grasping even light objects such as a coffee cup.
Difficulty extending the forearm fully (because of inflamed muscles, tendons and ligaments).
Pain that typically lasts for 6 to 12 weeks; the discomfort can continue for as little as 3 weeks or as long as several years.

The damage that tennis elbow incurs consists of tiny tears in a part of the tendon and in muscle coverings. After the initial injury heals, these areas often tear again, which leads to hemorrhaging and the formation of rough, granulated tissue and calcium deposits within the surrounding tissues. Collagen, a protein, leaks out from around the injured areas, causing inflammation. The resulting pressure can cut off the blood flow and pinch the radial nerve, one of the major nerves controlling muscles in the arm and hand.
Tendons, which attach muscles to bones, do not receive the same amount of oxygen and blood that muscles do, so they heal more slowly. In fact, some cases of tennis elbow can last for years, though the inflammation usually subsides in 6 to 12 weeks.
Many medical textbooks treat tennis elbow as a form of tendonitis, which is often the case, but if the muscles and bones of the elbow joint are also involved, then the condition is called epicondylitis. However, if you feel pain directly on the back of your elbow joint, rather than down the outside of your arm, you may have bursitis, which is caused when lubricating sacs in the joint become inflamed. If you see swelling, which is almost never a symptom of tennis elbow, you may want to investigate other possible conditions, such as arthritis, infection, gout or a tumor.

source-tennis-elbow.net

Treatment for kinds of tendonitis

For most mild to moderate cases of tendonitis, aspirin or ibuprofen will help address the inflammation and the pain while you are resting the injury, and then you can follow up with exercise and massage to speed healing.
For stubborn cases of tendonitis your doctor may advise corticosteroid injections, which dramatically reduce inflammation, but they cannot be used long-term because of potentially damaging side effects.Another attractive option for many sufferers, especially those who prefer to not ingest medication orally, is the application of an appropriate and effective topical anti-inflammatory.

The best way

The best way to relieve tendonitis is to stop doing anything that irritates the body part in question — a simple step for the weekend tennis player or morning jogger, but not as easy for the manual laborer, office worker, or professional athlete.
The most effective conventional and alternative treatments for tendonitis have the same basic premise: Rest until the pain disappears, then massage to relieve stress and tension in the muscles, and exercise to strengthen the area and prevent re-injury. If you must go back to whatever caused the problem in the first place, be sure to warm up for at least 5 to 10 minutes with gentle stretching and movement before starting any activity. Take frequent breaks.
Conventional medicine offers an assortment of treatments for tendonitis, from drug injections to surgery, but the pain will never go away completely unless you stop stressing the joint. Re-injury is inevitable without adequate rest.

All types of tendonitis

• Medial Epicondylitis (aka golfers elbow, baseball elbow, suitcase elbow)Caused by forceful wrist flexion and pronation injuring the tendons that attach to the medial epicondyle of the humerus.Symptoms: Pain in the flexor pronator tendons and medial aspect of elbow when the wrist is flexed or rotated outward against resistance.
• Lateral Epicondylitis (tennis elbow)Caused by continued stress on grasping muscles of the hand on rotation so the forearm faces upward or forward.Symptoms: Pain in the lateral epicondyle of the elbow when the wrist is extended against resistance.
• Rotator Cuff Tendonitis (swimmers shoulder, tennis shoulder, pitchers shoulder)Caused by sports that require movement of the arm over the head repeatedly causing inflammation on the rotator cuff—a group of muscles that control shoulder rotation.Symptoms: Pain initially when the arm is brought forward over the head, severe pain when bringing the arm across the chest.
• Peripatellar Tendonitis (jumpers knee)Caused by repetitive jumping, running, or cutting.Symptoms: Pain in the region of the kneecap during or after physical activity.
• Popliteus Tendonitis Caused by downhill running or walking.Symptoms: Pain in the side of the knee with downhill running.
• Achilles Tendonitis Caused by downhill running.Symptoms: Pain with dorsiflexion of foot usually while running.

Rotator Cuff and Achilles Tendonitis

Rotator Cuff Tendonitis
Shoulder
Cause & Symptoms
Often due to either a sudden violent movement of the shoulder or from chronic overuse. Sports commonly associated with this diagnosis include: Tennis, Swimming, Baseball, Softball and Football.

AchillesTendonitis
Ankle
Cause & Symptoms Excess Pronation (rolling over of the foot) causes extra strain on the tendon. Characterized by the slow onset of pain & swelling in the Achilles region that will worsen with physical activity. Pain will tend to be worse in the morning.

Tennis and Golfer's elbow

Tennis Elbow(lateral epicondylitis)Outside of Elbow
Cause & Symptoms
The onset of pain, on the outside (lateral) of the elbow, is usually gradual with tenderness felt on or below the joint's bony prominence. Movements such as gripping, lifting and carrying tend to be troublesome.

Golfer’s Elbow(medial epicondylitis)Inside of Elbow
Cause & Symptoms
The causes of golfer's elbow are similar to tennis elbow but pain and tenderness are felt on the inside (medial) of the elbow, on or around the joint's bony prominence.

Tendons?

Tendons themselves are cords of tough, fibrous connective tissue that attach muscles to bones. Tendonitis is an inflammation of the tendon. The condition may also involve the tendon sheath usually occurring close to where the tendon goes into the muscle.
Tendons are generally healthy structures that appear glistening white to the naked eye. If you've ever carved a turkey, the tendons are the tough bands you cut through to get the drumsticks apart.

Prognosis, Recurrence and Prevention of tendonitis

Expectations (prognosis)
Symptoms improve with treatment and rest. If the injury is caused by overuse, a change in work habits may be indicated to prevent recurrence of the problem.
Complications

Recurrence of tendonitis
Chronic inflammation of the tendon predisposes it to further injury, such as rupture.
Calling your health care provider
Call for an appointment with your health care provider if symptoms of tendinitis occur.

Prevention
Avoid repetitive motion and overuse of an extremity
Warm up by exercising at a relaxed pace before engaging in vigorous activity
Keep all your muscles strong and flexible

The facts on tendonitis treatment

The goal of treatment is to relieve pain and reduce inflammation.
Rest or immobilization of the affected tendons is helpful for recovery. This may be achieved using a splint or a removable brace. The application of heat or cold to the affected area can help.
Non-steroidal anti-inflammatory medications (NSAIDs), such as aspirin or ibuprofen, can also reduce both pain and inflammation. Steroid injections into the tendon sheath can also be very useful in controlling pain and allowing physical therapy to start.
Physical therapy that stretches and strengthens the muscle and tendon is essential. This can restore the tendon's ability to function properly, improve healing, and prevent future injury.
Rarely, surgery is needed to physically remove the inflammatory tissue from around the tendon.

Tendinitis overview

Definition
Tendinitis is inflammation, irritation, and swelling of a tendon, which is the fibrous structure that joins muscle to bone. In many cases, tendinosis (tendon degeneration) is also present.

Causes, incidence, and risk factors
Tendinitis can occur as a result of injury, overuse, or with aging as the tendon loses elasticity. It can also be seen in systemic diseases such as rheumatoid arthritis or diabetes. Tendinitis can occur in any tendon, but some commonly affected sites are the shoulder, the wrist, the heel (Achilles tendonitis), and the elbow.

Symptoms
Pain and tenderness along a tendon, usually in proximity to a joint (hip pain, knee pain, shoulder pain, elbow pain, wrist pain, or pain in other joints)
Pain is worse with movement or activity
Pain at night

Signs and tests
On physical exam, a doctor will look for tenderness along the affected tendon and pain when the muscle to which the tendon is attached is used against resistance. There are specific tests for specific tendons. The tendon can be inflamed and the overlying skin may be warm and red.

Medical research on tendonitis

Vitamin E may speed up the regeneration of tendons through action on fibroblasts. Research also suggests that nitric oxide plays an important role in tendon healing and inhibition of NO synthesis impairs tendon healing. A potential implication is the supplementing with arginine, the amino acid that the body uses to form NO. Other preliminary research suggests that the injection of stem cells might promote tendon-injury healing. Completely ruptured tendons may be sutured together with or without grafted material.

More remedies

Walk bowlegged. Okay, maybe you don't have to go that far. But for Achilles tendinitis, wearing cowboy boots or high heels some of the time is a fine idea, according to Dr. Percy. "It lifts the heel off the ground," he says, "and the muscles and tendons don't have to work as hard."

Go over-the-counter. Aspirin and other nonprescription, nonsteroidal, anti-inflammatory drugs are effective temporary pain relievers for tendinitis, Dr. Percy says. They also reduce inflammation and swelling.

Strengthen. "When we say strengthen, we're not asking people to be an Arnold Schwarzenegger," Mangine says, "just to get better defined muscles by working out at home with light weights. You can even use pennies in a sock to work arm muscles." And that's a lot cheaper than a set of weights.

Take breaks. This is a simple way to at least temporarily relieve physical stress at work, says Scott Donkin, D.C., a chiropractor in Lincoln, Nebraska, and author of Sitting on the Job. "If you work in an awkward position," he says, "tendinitis can develop quite easily. Especially in the arms or wrists if you're working at a keyboard or typewriter all day.''

5 more soothing remedies for tendonitis

Warm with stretching. You should always stretch before exercising at full speed, says Terry Malone, Ed.D., executive director of sports medicine at Duke University. Stretching prevents the shortening of muscles and tendons that goes along with exercise.
In addition, says Mangine, some studies suggest that people who are less flexible are more prone to develop tendinitis. So stretching should be a regular part of your routine.
Brace yourself. Even a little extra support and warmth from a flexible brace or wrap can help during exercise and afterward, Mangine says. "There is no truth to the old wives' tale that wearing a brace will weaken the tendons and muscles, provided," he stresses, "you continue exercising."
Deep-freeze the pain. After exercising, ice is great for holding down both swelling and pain, Mangine says. However, people with heart disease, diabetes, or vascular problems should be careful about using ice because ice constricts blood vessels and could cause serious difficulties in people with such problems.
Wrap it up. Another alternative for reducing swelling is to wrap your pain in an Ace bandage, says Dr. Percy. Just be careful not to wrap the inflamed area too tightly or to leave the area wrapped for so long that it becomes uncomfortable or interferes with circulation.
Elevate. Raising the affected area is also good for controlling swelling.

Three soothing remedies for tendonitis

I found these remedies online and I think that they are useful, so I post them here. Sorry, I forgot the page that I had found them in.

Switch instead of fight. If your tendinitis is exercise induced, a new exercise may be just what your inflamed tendon needs. Runners with tendon problems in the lower legs, for example, can stay on the road if you're willing to hop on a bicycle, which will still give you a good upper-leg workout.
Give it a whirl. Taking a whirlpool bath or just soaking in warm bathwater is a good way to raise body temperature and increase blood flow. Warming the tendon before stressful activity decreases the soreness associated with tendinitis, says Mangine.
Use the ballerina treatment. The New York Jets football team finds using this method (inspired by a ballet dancer who had tendinitis) successful. With tendinitis of the knee, for example, treatment involves placing a warm, moist towel over the knee, then a plastic bag, then a heating pad, and last, a loose elastic wrap just to hold everything in place. Keep it on from 2 to 6 hours. To avoid burning yourself, keep the heating pad on low, advises Bob Reese, head trainer for the Jets and president of the Professional Football Athletic Trainers Society. For maximum success, your injured body part should be kept at a level higher than your heart.

Earning a living with tendonitis

Of course, resting is easier said than done if you make your living washing windows and have tendinitis of the shoulder from constantly raising your arms over your head. But if tendinitis is a side effect of your job, it might not be a bad idea to save a day or two of vacation for those times when tendinitis is painfully persistent.
But don't give it too long a rest. Muscles will start to atrophy. And for athletes, "we never recommend absolute rest," adds Ted Percy, M.D., an associate professor of orthopedic surgery and head of the Sports Medicine Section at the University of Arizona College of Medicine, Health Sciences Center.

Yes, there is hope

Like simple muscle soreness from overuse, tendinitis—inflammation in or around, a tendon—can be painful. But where simple muscle soreness is temporary, tendinitis is tenacious—it's soreness that doesn't quit.
In fact, if chronic tendinitis had a credo, it might go like this: "Here today, here tomorrow, here to stay."
But does it really have to be so bleak, or is there hope for what, after all, sounds like a rather minor problem?
Yes, there is hope, says Bob Mangine, chairman of the American Physical Therapy Association's Sports Physical Therapy Section. "But if you continue to use the tendon in the same repetitive motion that triggered the problem in the first place, it's going to be very difficult to get better." And that applies to everyone from world-class marathoners to window washers and typists.
Still, it's possible to lessen the effects of tendinitis and prevent intense flare-ups, says Mangine, who is also administrative director of rehabilitation at the Cincinnati Sports Medicine Clinic. The key, he says, is unlocking your mind and freeing yourself to change some of your old ways.

Everything has a price

The Price of Ignoring Your Body's Warnings
If you only feel the pain of tendinitis during or after exercise, and if it isn't too bad, you may be thinking that you could run a race or swim laps with that same amount of pain—if you had to. Or maybe you already have.
In either case, you would be wise to realign your thinking. "You shouldn't play through pain unless your physician or physical therapist tells you otherwise," says the American Physical Therapy Association's Bob Mangine.
If pain is severe and you continue to abuse the tendon, it may rupture, says athletics trainer Bob Reese. And that could mean a long layoff, surgery, or even permanent disability.In other words, exercising through tendon pain today could mean staying on the sidelines for the remainder of your tomorrows.

PREVENTION

Tendonitis Prevention

Prevention of this condition requires stretching the muscle on a regular basis and thereby lengthening the tendon connection. This will allow less pulling and tractioning on the tendon attachment to the bone. When tendonitis does occur, it is important to treat it immediately, and thereby prevent it from reaching a stage that is more severe.

If only I would've known this sooner

With proper care for the area, the pain in the tendon should lessen over three weeks, but it should be noted that the healing of the area continues and doesn't even peak until at least six weeks following the initial injury. This is due to scar tissue formation, which initially acts like the glue to bond the tissue back together. Scar tissue will continue to form past six weeks in some cases and as long as a year in severe cases. After 6 months this condition is considered chronic and much more difficult to treat. The initial approach to treating tendonitis is to support and protect the tendons by bracing any areas of the tendon that are being pulled on during use. It is important to loosen up the tendon, lessen the pain, and minimize any inflammation.
This can be done topically if a pain reliever has the ability to penetrate the skin barrier and contains anti-inflammatory agents. A topical formula that contains natural menthol will not only relieve pain, but dilate the blood vessels. This allows for relief of the tendonitis, without causing any stiffening of the tissue. MSM, also known as Methyl Sulfonyl Methane is a natural supplement that is getting a lot of attention due to its role in tissue healing at a cellular level. It is a natural organic sulfur that comes from rain fall and is found naturally in the human body. It has been shown to have anti-inflammatory effects on the tissues. Ice can relieve inflammation, but will constrict the blood vessels and further stiffen the tendon. Cortisone injections can reduce inflammation, but unfortunately are very caustic and can cause a weakening of the tendon structure and a create more scar tissue.

After the scar tissue has begun to accumulate, it will be important to perform procedures which help break down the scar tissue in the tendon tissue, so as to let the tendon and muscle regain it's normal flexibility and lessen the chance of further injury. While exercise is appropriate for breaking down scar tissue once the area has healed, it may further irritate the area during the initial stages. Therefore, other methods that can be performed by your healthcare provider, such as ultrasound and massage, may be safely used to accomplish this early on in the injury. Ultrasound uses sound waves that vibrate a such a fast level, that it cannot be felt with normal use. Ultrasound will cause an increase in circulation to the tissue and soften the scar tissue to allow it to further break down. Ultrasound can also be used as phonophoresis to help topical pain and nutrient solutions reach further down into the tissues by transporting them with the sound waves. Light stretches may also be performed if they do not cause any further irritation to the area during the acute phase. During the sub-acute and chronic phases of Tendonitis, more aggressive stretches can be performed, however, it should be noted that stretches should focus on the muscle belly and not attempt to lengthen the affected tendon. Additionally, you should not feel any irritation in the tendon during these muscle stretches.

Quick Facts

Common Areas of Tendon inflammation
The most common tendon areas that become inflamed are the elbow, wrist, biceps, shoulder (including rotator cuff attachments), leg, knee (patellar), ankle, hip, and Achilles. Of course, tendonitis can will vary with each person, as it strikes the areas you use most.

Tendonitis Symptoms
Symptoms can vary from an achy pain and stiffness to the local area of the tendon, to a burning that surrounds the whole joint around the inflamed tendon. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiffer the following day.

Types of Tendonitis

Some common types of tendinitis include the following:
Rotator cuff tendinitis affects tennis players, swimmers, and anyone who frequently lifts their arms above the head and in a forward motion. This causes several shoulder tendons to rub together. Inflammation can set in and, if severe and untreated, may start to erode the tendons. Rotator cuff tendons hold the upper arm bone in the shoulder socket.
Achilles tendinitis involves the strongest tendon in the body, the one that connects the heel to the leg muscles. It's usually caused by running uphill or downhill, jumping, or engaging in sports that require sudden stopping and starting. Wearing shoes with either very soft-padded heels or very stiff soles, especially for someone whose ankles roll in, may also contribute to Achilles tendinitis.
Flexor digital tenosynovitis (trigger finger) may be seen in people with rheumatoid arthritis and diabetes. A protrusion or thickening of the tendon catches in the tendon sheath, causing the finger to bend and stick.
De Quervain's tenosynovitis (De Quervain's syndrome) affects the tendon sheaths extending from above the wrist to the thumb. The most common cause is excessive wringing of the wrist or other repetitive movements. In some cases, rheumatoid arthritis may be involved.

How Tendonitis Occurs

A tendon is the end part of a muscle that attaches the muscle to the bone. The normally very elastic and soft muscle tapers off at the end to form the much more dense and stiff tendon. While this density makes the tendons stronger, the lack of elasticity of the tendon and the constant pulling on its attachment to the bone with movement, makes it much more susceptible to a low level of tearing at a microscopic level. This tearing will produce the inflammation and irritation known as tendinitis. Often spelled tendonitis, either spelling is correct for this condition. Tendinitis is usually seen after excessive repetitive movement with which the tendon gradually becomes tighter until the fibers start to tear. For example, a person who plays tennis may over- use the muscles of the elbow through hitting the ball repetitively and cause tendonitis to the area.

Tendonitis

The most common tendon areas that become inflamed are the elbow, wrist, forearm, biceps, shoulder (including rotator cuff attachments), leg, knee (patellar), ankle, hip, and Achilles. Of course, tendonitis will vary with each person, as it strikes the areas you use most. For example, many rock climbers tend to develop tendonitis in their fingers and swimmers in their shoulders (a.k.a. swimmer's shoulder.)

15 and above

Tinea pedis or popularly known as athletes foot is a common a fungal infection of the skin of the footnormally found between the toescaused by parasitic fungi called trichophyton. This skin condition is considered common to people ages 15 and above. Although some symptoms may occur to children 12 years and below, experts say that these are not serious indications of athletes foot but skin allergy or any other skin condition.

You will face it, too

If you are an athlete, you will probably face tendonitis at some point during your playing days. If you're a regular human being, you'll most certainly face it. Really common areas that are affected include the wrist, the elbow (tennis or golfer's elbow), the shoulder (rotator cuff tendonitis), the hip, the knee (patellar tendonitis), the heel (Achilles tendonitis), and the ankle and foot.
When you break it down scientifically, you see that joints move by the power of muscles. Muscles attach to bones and joints by way of tendons. These tendons transfer the force from muscles across the joint and cause it to move. Tendonitis happens for a variety of reasons. When the normal smooth gliding motion of a tendon is impaired, it can become inflamed and movement in that joint becomes painful.
The most common cause of tendonitis -- by far -- is overuse. When you perform repetitious activities, increase the intensity level of an exercise program, or simply "overdo it," the tendon sometimes responds to the new level of demand by developing inflammation and thus, tendonitis.
Another common cause is due to age-related changes of the tendon. As the tendons age, they lose their elasticity and ability to glide. We are still doing research to better understand the causes of these changes, but hypothesize that the cause may lie in the fact that blood vessels supplying nutrition to the tendons change and decrease in effectiveness over time.
A tendon can also become inflamed or injured abruptly. An injury can range from a simple strain to a rupture or tear (this is generally when orthopedic surgeons such as myself are really needed to put the tendon back where it goes). Common tendons that can rupture include the rotator cuff, the biceps tendon, the patellar tendon, and the Achilles tendon.
Treatment of tendonitis tends to be conservative. Most physicians will recommend some simple treatments like rest, activity modification, bracing, anti-inflammatory medicine, and sometimes injections. Physical therapy and the appropriate rehab can also help you "mend" faster, as well as strengthen your muscles and improve flexibility to prevent recurrent flare-ups.

Overview

Tendonitis (also tenonitis or tendinitis) is an inflammation of a tendon. For example, patellar tendonitis (jumper's knee) is an inflammation of the patellar tendon, which connects the tibia to the patella.Recent research adds weight to a line of evidence suggesting that nitric oxide (NO) plays an important role in tendon healing (Xia et al, 2006). And inhibition of NO synthesis impairs tendon healing (Darmani et al, 2004). Such findings may lead to improved modes of treatment for this sometimes chronic condition. For example, NO is synthesized in the body from the amino acid arginine, supplementation of which boosts NO levels (UC Berkeley, Wellness Guide).
Standard treatment of tendon injuries is largely palliative. Non-steroidal anti-inflammatory drugs combined with rest and gradual return to exercise is a common therapy. However, some evidence suggests that tendonitis is not an inflammatory disorder and that anti-inflammatory drugs are not effective (Khan et al, 2002). Perhaps the most promising avenue of therapy is indicated in a line of research finding dramatic rates of recovery including complete remodeling of chronically damaged tendon tissue with eccentric loading exercise (see for example: Alfredson et al 1998; Mafi et al, 2001; Fahlstrom et al, 2003; Roos et al, 2004; Öhberg et al, 2004; Jonsson & Alfredson, 2005; Wilson & Best, 2005; Rees et al, 2006).

In this blog...

Tendonitis prevention is simple, much easier than treatment. In most cases tendonitis can be prevented simply by using your common sense. On this blog I've got a list of easy tendonitis prevention techniques. These techniques apply to work, sporting and leisure activities. I recommend you use some of the techniques mentioned on this page if you think you're at risk of developing tendonitis.

Preventing Tendonitis

These are some great tips that are easy to keep in mind, check them out!

Use proper form and posture
It's important that you use the proper form and posture during work and activities. For example, a tennis player should use proper form when playing a tennis stroke and have the correct racket size for his/her physique. In a job related example, a computer programmer must sit with correct posture and have a ergonomic working environment which includes the right height desk and chair, large monitor and suitable keyboard and mouse.

Ice stiff or sore joints after exercise
Placing ice on a joint or tendon helps reduce heat, swelling and inflammation. If you do apply ice, never apply the ice directly to the area, always wrap the ice in a towel and then apply.

Stay in good shape!
Staying in good shape is proberbly the best tendonitis prevention technique! Regular exercise (with the proper warm-ups and stretching of course) is recommended for individuals of any age. Regular exercise is not only good for your muscles and tendons but is an essential part of living a healthy life.
Preventing tendonitis is much better (and easier) than treating it. If you follow the prevention advice above you are limiting the possibility of developing tendonitis.

Preventing achilles tendonitis

Preventing achilles tendonitis is very simple. Your best defense against developing the condition is to warm up and stretch before activities and don't overdo it. Before you attempt any strenuous activity you should warm up for 5-10 minutes. Some light jogging or jumping on the spot will be enough.
During physical activity don't push yourself too hard. Know your limits. If you start feeling any pain in your achilles tendon stop the activity. Wearing the correct footwear is also important for preventing achilles tendonitis. Your shoes must be designed for your sport and have adequate heel support.

Athlete's foot at a glance

Athlete foot causes foot itching, burning, pain, and scaling.
Athlete foot is caused by a fungus and is treated with antifungal medications, many of which are available over-the- counter.
Keeping the feet dry by using cotton socks and breathable shoes can help prevent athletes foot.

Tinea Pedis

Athlete's foot is a skin infection in the foot caused by a fungus. The fungus that causes Athlete foot is called Trichophyton. When the feet, or other areas of the body, stay moist, warm and irritated, this fungus can thrive and infect the upper layer of the skin.

Athlete foot is caused by the ringworm fungus ("tinea" in medical jargon). Athlete foot is also called tinea pedis. The fungus that causes Athlete foot can be found on floors and in socks and clothing. The fungus can be spread from person to person by contact with these objects. However, without proper growing conditions (a warm, moist environment), the fungus will not infect the skin. Up to 70% of the population will have athletes foot at some time during their lives.

Short Overview of Athlete's Foot

Athlete's foot is a skin disease caused by a fungus, usually occurring between the toes.
The fungus most commonly attacks the feet because shoes create a warm, dark, and humid environment which encourages fungus growth.
The warmth and dampness of areas around swimming pools, showers, and locker rooms are also breeding grounds for fungi. Because the infection was common among athletes who used these facilities frequently, the term "athlete's foot" became popular.
Not all fungus conditions are athlete's foot. Other conditions, such as disturbances of the sweat mechanism, reaction to dyes or adhesives in shoes, eczema, and psoriasis, may mimic athlete's foot.

Oral treatment of athletes foot?

Oral treatment with griseofulvin was begun early in the 1950s. Because of the tendency to cause liver problems and to provoke aplastic anemia the drugs were used cautiously and sparingly. Over time it was found that those problems were due to the size of the crystal in the manufacturing process and microsize and now ultramicrosize crystals are available with few of the original side effects. Oral treatment provides long lasting mycologic cure.
If the fungal invader is not a dermatophyte but a yeast, other medications such as fluconazole may be used. Typically diflucan is used for candidal vaginal infections moniliasis but has been shown to be of benefit for those with cutaneous yeast infections as well. The most common of these infections occur in the web spaces (intertriginous) and at the base of the fingernail or toenail. The hall mark of these infections is a cherry red color surrounding the lesion and a yellow thick pus.

What are the symptoms of Athlete foot?

The symptoms of Athlete foot include itching and burning feet. The skin frequently peels and, in particularly severe cases, there may be some cracking, pain and bleeding as well.

When the skin is injured by the fungus, bacteria can also invade the skin. These bacteria can cause a bad smell. Bacterial infection of the skin and resulting inflammation is known as cellulitis. This is especially likely to occur in the elderly, individuals with diabetes, chronic leg swelling, or who have had veins removed (such as for heart bypass surgery), and patients with impaired immune systems.

Treatment

Treatment For Athlete's Foot

Fungicidal and fungistatic chemicals, used for athlete's foot treatment, frequently fail to contact the fungi in the horny layers of the skin. Topical or oral antifungal drugs are prescribed with growing frequency.
In mild cases of the infection it is important to keep the feet dry by dusting foot powder in shoes and hose. The feet should be bathed frequently and all areas around the toes dried thoroughly.

signs of athlete's foot

The signs of athlete's foot, singly or combined, are dry skin, itching, scaling, inflammation, and blisters. Blisters often lead to cracking of the skin. When blisters break, small raw areas of tissue are exposed, causing pain and swelling. Itching and burning may increase as the infection spreads.
Athlete's foot may spread to the soles of the feet and to the toenails. It can be spread to other parts of the body, notably the groin and underarms, by those who scratch the infection and then touch themselves elsewhere. The organisms causing athlete's foot may persist for long periods. Consequently, the infection may be spread by contaminated bed sheets or clothing to other parts of the body.

Growth environment of athlete's foot

Growth of the athlete's foot fungus is promoted by a dark, warm, moist environment such as that found inside shoes. The fungi persist for a long time in the environment, facilitating transmission of the disease in communal areas such as locker rooms and showers.

Athlete's foot can be a frustrating and annoying problem. Athelte's foot is causes by a fungus that lives in the warm, moist crevaces of the feet and toes. A few simple treatment measures can usually solve the problem of athlete's foot.
1) Athlete's Foot Cream
Over the counter creams work well to help in the treatment of athlete's foot. Usually these over the counter products, when used properly, and sufficient in athlete's foot treatment. Prescription treatments are usually not needed. Some of the most popular brand names include Lamisil and Lotrimin. Try these athlete's foot creams, but make sure you follow the instructions carefully.

2) Athlete's Foot Powders
A simple powder is an excellent treatment for athlete's foot. The fungus that causes athlete's foot likes to live in moist places. A powder will help keep the foot dry and prevent athlete's foot from becoming a problem. Many powder products are available to use in the treatment of athlete's foot--the brand is not particularly important.


3) Athletic Sandals
If you shower at a gym, locker room, or any other facility used by multiple people, wear a pair of athletic sandals in the shower. Locker room floors are the home of athlete's foot. They love steamy shower stalls, carpeted changing area, and just about anywhere else in the gym. Wear a pair of athletic sandals in the gym locker room at all times (including while showering!).

4) Athletic Socks
This is the simplest treatment of athlete's foot, and the most important in the prevention of athlete's foot. Get lots of pairs of socks, and change them often. Wear fresh socks to exercise, and change them immediately after exercise. Wash your socks after each use.