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.