Tendonitis

Definition/diagnostic criteria Tendonitis (tendinitis) is a common musculoskeletal condition characterised by inflammation of a tendon, the fibrous tissue that connects muscle to bone. The diagnostic criteria for tendonitis involve the presence of localised pain, tenderness and swelling at or near a specific tendon, often exacerbated by movement or pressure. Diagnosis relies on an assessment of these signs and symptoms, with consideration of patients’ medical history and risk factors, such as age, repetitive strain or underlying medical conditions.

Epidemiology Tendonitis is more prevalent among older adults and those involved in repetitive or strenuous activities. The most common sites for tendonitis are the shoulder, elbow, wrist, hip, knee and Achilles tendon.

The condition often occurs in individuals engaged in occupations that require repetitive motions, such as manual labourers, athletes, and musicians.

Diagnosis
Clinical features: Typical clinical features include localised pain and tenderness, often described as a dull ache or burning sensation, which may worsen with activity involving the affected tendon. Patients may also report swelling and stiffness around the affected joint. In some cases, there may be crepitus or a palpable nodule at the tendon site.

Investigations: Tendonitis is usually a clinical diagnosis and imaging is not routinely recommended in primary care. However ultrasound and MRI can provide detailed information about tendon integrity and inflammation when clinical diagnosis is uncertain or when surgical intervention is being considered.

Treatment The management of tendonitis involves a combination of conservative measures, such as rest, ice, physiotherapy and pain relief, with a focus on patient education and activity modification.

• Underlying causes such as fluoroquinolone antibiotics, diabetes mellitus or  hypercholesterolaemia should be addressed.
• Physiotherapy plays a vital role in tendonitis management, helping patients improve muscle strength and flexibility, correct biomechanical issues, and reduce strain on the affected tendon.
• Corticosteroid injections may be of benefit in certain types of tendonitis.
• Eccentric loading exercises, extracorporeal shockwave therapy and surgery to debride tissue may be used in secondary care for patients with chronic symptoms.

Prognosis Most patients experience significant symptom relief with conservative measures, and the condition often resolves within weeks to months. However, recurrence can occur, especially if underlying risk factors or biomechanical issues are not addressed.