Tendonitis

Definition
Tendonitis is the inflammation or irritation of a tendon — the fibrous structure that connects muscle to bone — resulting in pain, swelling, and impaired movement. It is typically caused by repetitive strain, overuse, or acute injury.

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Causes

• Repetitive movements (sports, occupational tasks, typing, lifting)

• Sudden increase in activity intensity

• Poor ergonomics or incorrect technique in physical activity

• Direct injury to the tendon

• Age-related tendon degeneration

• Secondary to underlying conditions (e.g., rheumatoid arthritis, diabetes)

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Common Sites

• Shoulder (rotator cuff tendonitis)

• Elbow (lateral or medial epicondylitis)

• Wrist (De Quervain’s tenosynovitis)

• Knee (patellar tendonitis)

• Achilles tendonitis (ankle)

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Risk Factors

• Age over 40 years

• Sports involving repetitive motion (tennis, golf, running, swimming)

• Jobs with repetitive overhead or gripping activities

• Poor posture or ergonomics

• Inadequate warm-up before activity

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Pathophysiology

• Microtears in tendon fibres from overuse

• Inflammatory cell infiltration and fluid accumulation in acute phase

• If chronic, may progress to tendinosis (degenerative changes without active inflammation)

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Clinical Features

• Localised pain at or near a joint

• Pain worsens with movement or pressure on the tendon

• Tenderness and swelling over affected tendon

• Decreased range of motion due to pain

• Possible crepitus (grating sensation) with movement

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Diagnosis

• Clinical history and examination

• Ultrasound to detect tendon thickening or tears

• MRI for chronic or complex cases

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Treatment

General Measures

• Rest from aggravating activities

• Ice packs for 15–20 minutes every 4–6 hours for first 48 hours

• Compression with an elastic bandage to reduce swelling

• Elevation of affected limb when possible

Medications

• NSAIDs (oral or topical) for pain and inflammation

• Topical diclofenac gel for local relief

Physiotherapy

• Stretching and strengthening exercises

• Eccentric loading programmes for tendon rehabilitation

Interventions

• Corticosteroid injections for short-term relief in resistant cases

• Platelet-rich plasma (PRP) injections for chronic tendon injury

• Surgical repair for severe or complete tendon tears

Doses (examples for adults)

• Ibuprofen: 400–600 mg orally every 8 hours as needed (max 2.4 g/day)

• Diclofenac gel: Apply 2–4 g topically 3–4 times daily

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Complications

• Tendinosis (chronic degeneration)

• Partial or complete tendon rupture

• Persistent pain and reduced function

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Quick-Reference Clinical Chart — Tendonitis

Feature	Details
Definition	Inflammation of a tendon due to overuse, injury, or strain
Common sites	Shoulder, elbow, wrist, knee, Achilles tendon
Symptoms	Localised pain, swelling, tenderness, reduced range of motion
Risk factors	Repetitive motion, poor ergonomics, sports, age >40
First-line treatment	Rest, ice, NSAIDs, physiotherapy
Drug therapy (adult dose)	Ibuprofen 400–600 mg PO q8h PRN; diclofenac gel 2–4 g topically 3–4× daily
Adjunctive options	Corticosteroid injections, PRP, surgery for tears
Prognosis	Good with rest and rehab; may recur if overuse continues