| By Dr. Charles Ruotolo

The term “tendonitis” refers to an inflammation or damage to the fibrous bands of tissue that connect muscles to the surrounding bones. Depending upon where the muscle is located, the tendons can be thick and resemble a rope (like those in the calf and thigh) or small and resemble a rope (like those in the hands). Typically, while it is called tendonitis, the true term is tendinosis, which is degenerative fraying or tearing of the tendons as the tendons are rarely inflamed as tendonitis implies.

Most cases of tendon injuries arise in one of two ways: The first is due to repetitive strain injuries. With a repetitive strain injury, small microtraumas can cause small tears in the tendon, which develops into tendinosis and causes it to become painful and weakened over time.

The second way this injury can occur is due to a sudden overload of the tendon. For instance, pushing or pulling a heavy object with improper form can cause the tendon to be severely damaged as it partially or completely tears. If the tendon does not properly heal, continuous use will increase the damage over time.

Below are the most common areas affected by tendonitis/tendinosis as well as the causes of the injury. 

Shoulder tendonitis
This form of tendonitis often affects athletes whose sports require repetitive overhand motions, such as tennis, baseball and football. This is also commonly seen in weight lifters. The reason that this overhand throwing motion can damage the tendon is most often due to overuse, but can be compounded by improper form and lack of strengthening of the tendons.

Many tennis players have recently adopted a form attributed to Rafael Nadal, which emphasizes a large amount of topspin on the ball. Although this style may be effective against your opponent, it can place significant force on the shoulder ligaments. As a result, players may find the overhand position to be painful and are no longer able to exhibit a full range of shoulder motion. This loss of shoulder internal rotation has been shown in many studies to increase risk for more significant shoulder injuries, including superior labral tears. For those with loss of shoulder internal rotation, a specific stretching program has been shown to decrease pain and the incidence of more severe shoulder injuries.

Knee tendonitis
This form of tendonitis (more often referred to as “patellar tendonitis”) affects the area surrounding the kneecap. The patellar tendon connects the kneecap to the shin bone and allows for the extension of the knee needed for running and changing direction. Athletes whose sports require consistent running or jumping are often at risk for this injury due to improper form or even shoes that are not appropriately fitted. In other cases, muscular imbalance can cause the patellar tendon to be pulled much harder in one direction than another, causing increased stress and damage to the tendon.

Identifying the cause of the injury with activity modification is the most important first step in the treatment of patellar tendonitis. Eccentric strengthening programs have been shown to decrease pain and return function in patients with patellar tendonitis. For those with chronic patellar tendonitis who have failed conservative treatment, a minimally invasive arthroscopic technique has been shown to have a high success rate in returning athletes to their pre-injury performance.

Elbow tendonitis
This is the form of tendonitis that most are familiar with and is more commonly known as “tennis elbow” or “golfers elbow.” However, despite being named after sports, athletes make up only a small portion of those who suffer elbow tendonitis as any repetitive motion can cause this condition.

The tendons of the elbow also help control the ability to grip objects, especially for the thumb and first two fingers. Over time, repetitive motions that use the elbow tendons, like gripping or swinging an object, can cause strain on these tendons.

Treatment of elbow tendonitis includes physical therapy, and injections including platelet rich plasma which can aid in healing the tendon injury. For those who have failed conservative treatment, a minimally invasive surgery can repair the torn tendon and has a high success rate for returning to sports and performance.

The most common symptoms of tendonitis will include:

Hearing a “pop” sound
Immediate pain in the area
Swelling of the affected area
Reduced range of motion

Dr. Charles Ruotolo

<p>Dr. Charles Ruotolo is a Board-Certified Orthopedic Surgeon and the founder of Total Orthopedics and Sports Medicine with locations in Massapequa, East Meadow and the Bronx, N.Y. Dr. Ruotolo completed his orthopedic residency program at SUNY Stony Brook in 2000. After his residency, he underwent fellowship training in sports medicine and shoulder surgery at the prestigious Sports Clinic of Laguna Hills, Calif. He is also a fellow of the American Academy of Orthopedic Surgeons. As an Associate Master Instructor of Arthroscopy for the Arthroscopy Association of North America, Dr. Ruotolo actively teaches other orthopedic surgeons advanced arthroscopic skills in shoulder surgery. As an avid researcher he has also published multiple articles on shoulder injuries and shoulder surgery in the peer review journals of Arthroscopic Surgery and of Shoulder and Elbow Surgery. For more information, visit <a href="http://www.totalorthosportsmed.com" onclick="window.open(this.href, 'wwwtotalorthosportsmedcom', 'resizable=no,status=no,location=no,toolbar=no,menubar=no,fullscreen=no,scrollbars=no,dependent=no'); return false;">www.totalorthosportsmed.com</a>.</p>