American Medical Association Family Medical Guide - American Medical Association [687]
Tendons
Tendons are strong, flexible bands or cords of tissue that join muscles to bone. Tendons are made up mostly of bundles of collagen (a fibrous protein) and contain some blood vessels.
Tendinitis
Tendons are strong, elastic bands of tissue that connect muscles to bones. Tendinitis is inflammation of a tendon caused by injury or overuse. Tendons are usually slow to heal because they have a limited blood supply and because the muscles most often affected by tendinitis are constantly in use. Tendinitis can occur anywhere a tendon joins muscle to bone, but usually occurs at the shoulders or heels or on the outside or inside of the elbows (golfer’s elbow or tennis elbow; see page 979).
Symptoms
In tendinitis, the affected area is swollen, tender, and painful. When the tendon heals, inflamed fibers may leave a painful scar. The pain usually goes away in a few weeks or months, but it can persist and become worse, especially in older people whose tissues heal more slowly and sometimes imperfectly.
Treatment
If you have tendinitis, your doctor will recommend resting the affected arm or leg by putting the arm in a sling or asking you to stay off the leg for a few days. Take aspirin, ibuprofen, naproxen, or ketoprofen to help relieve the pain and reduce inflammation and swelling (acetaminophen has no effect on inflammation). After a few days, exercise the joint gradually to prevent it from getting stiff. If the pain persists or gets worse, your doctor will recommend X-rays of the arm or leg to rule out a fracture. He or she may also inject a corticosteroid drug and a local anesthetic into the affected area to reduce inflammation and relieve pain. Treatment may consist of other measures, such as applying ice to the area or using ultrasound (high-frequency sound waves) to reduce inflammation and speed healing. Doing gentle, controlled exercises that stretch and strengthen the muscles will also help relieve the pain and inflammation.
Tenosynovitis
Tendons are strong, elastic bands of tissue that connect muscles to bones. Some tendons in the hands, wrists, feet, and ankles are enclosed in a fibrous tissue called a tendon sheath, which allows the tendon to slide over a joint. Tenosynovitis is inflammation of the inner lining of the tendon sheath. When the inner lining of the sheath becomes inflamed, it can form a knot or cause swelling.
The exact cause of tenosynovitis is not known, but it usually results from overuse of a wrist or finger, primarily from using the fingers repeatedly with the same motion, such as when using a computer keyboard. People who have rheumatoid arthritis (see page 918), gout (see page 1004), or diabetes (see page 889) seem to develop tenosynovitis more often than others. Tenosynovitis is sometimes caused by an infection from a puncture wound.
The synovial membrane
Some tendons, such as those in the hand, are covered by a membrane called the synovial membrane. The synovial membrane secretes a fluid (synovial fluid) that lubricates tendons and joints.
Symptoms and Diagnosis
You may hear a grating noise or feel a crackling sensation when you bend or straighten the tendon. The area over the tendon may become tender and swollen. In one form of tenosynovitis called trigger finger, a tight tendon sheath makes it hard to straighten the finger once it is bent. The tendon becomes jammed for a few moments before it suddenly pushes past the swelling and the finger straightens with a sudden jerk.
A doctor can usually diagnose tenosynovitis by examining the affected area and asking questions about the pain. Call your doctor immediately if the tenosynovitis may have been caused by an infection from a wound or if the affected area is warm, increasingly painful, and difficult to move.