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.
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. As you can see, tendonitis can literally strike anywhere in the human body, because all of our joints are moved by — you guessed it — tendons.
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 them 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 around the joint that the tendon controls can become painful.
Now that you have a background to work with, we can look at some of the causes.
The most common cause of tendonitis, by far, is overuse. When you perform repetitive 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. Tendonitis can also can also develop following a minor injury to the tendon that results in micro-tears that don’t quite heal, but just stay inflamed.
Another common cause is due to age-related changes of the tendon. As tendons age, they lose their elasticity and ability to glide. We are still doing research to better understand the causes of these changes, but we hypothesize that the cause may lie in the fact that blood vessels supplying nutrition to the tendons change and decrease in effectiveness over time – the tendons simply lose some of their resilience.
A tendon can not only get inflamed over time, but it can also be injured abruptly. An injury can range from a simple strain of the tendon to a complete rupture or tear (this is generally when orthopedic surgeons such as myself are needed to put the tendon back where it goes).
Common tendons that can tear include the rotator cuff, the biceps tendon, the patellar tendon and the Achilles tendon. Depending on the size and location of the tear, we may sew the tendon back together or anchor the tendon back to the area on the bone where the tendon pulled off. Over the last decade, there have been many advances in the way we fix tendons. Our suture is now extremely strong and most anchors that we use to fix tendons back to bone are bioabsorbable (they go away over time and are replaced by bone).
The initial treatment of tendonitis is always conservative.
Most physicians will recommend some simple treatments like rest, activity modification, bracing, anti-inflammatory medicine and, sometimes, cortisone injections. In addition, topical anti-inflammatory medications seem to work and have become quite popular over the past several of years.
Physical therapy is a mainstay of treatment and the appropriate combination of strengthening and stretching seems to stimulate a healing response in the tendon. Physical therapy also uses modalities such as ultrasound (sound waves penetrate the tendon) and iontophoresis (steroid cream is massaged into the tendon with the help of a gentle electrical current).
When it comes to prevention, a good maintenance program that works to keep your muscles strong and your joints flexible seems to help prevent recurrent flare-ups. If tendonitis does not respond to conservative measures as outlined above, surgery is sometimes indicated.
So what’s the “big buzz” in the treatment of tendonitis these days?
The answer is biologics. These biologics include PRP and stem cell therapy. PRP stands for platelet rich plasma. PRP is essentially a concentrated cocktail of platelets and growth factors that is extracted from your own blood by spinning it down in a centrifuge. It is then injected into an area of tendonitis or applied at the time of surgery to augment tendon or ligament healing.
Stem cell therapy is also gaining traction in the treatment of tendonitis, as well as other tendon and ligament injuries. Stem cells are most commonly taken from a patient’s own bone marrow (often from the iliac crest above the hip joint, where stem cells are plentiful) and then injected or applied at the site of tendonitis or injury. These stem cells seem to have remarkable ability to adapt, transform and aid in the healing cascade.
The bottom line is that the future is bright when it comes to biologics in the world or orthopedics. Traditionally, we have fixed tendons and ligaments with sutures and anchors and fixed bones with plates, screws, pins and rods. Over the next decade, you can count on advances in the “biologic augmentation” of tendon, ligament and bone healing using things like PRP, stem cells, bone glue and other healing factors.
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