Getting to the Root of Stubborn Tendonitis: Causes, Symptoms and Treatments

Tennis player with racket in one hand, grabs his shoulder in pain with the other hand. - Dr. Herrick Siegel
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Tendonitis is a common culprit behind nagging joint pain but its precise causes often prove elusive. This complex condition arises from multiple factors – overuse, poor movement patterns, tissue degeneration, and more. When tendonitis becomes a recurring or chronic problem that resists basic treatments, confusion and frustration may set in. But expanding medical knowledge brings growing hope via new therapies like platelet-rich plasma and regenerative options still in early testing phases.

If tendon troubles have you feeling like you’re at the end of your rope, take heart. Under the guidance of an experienced orthopedic specialist, even the most stubborn tendonitis cases often find lasting relief through a personalized, multi-pronged treatment approach. But first, understanding the basics behind this nuanced diagnosis is key.

What Makes Tendons Vulnerable to Injury?

Tendons are thick, fibrous cords that anchor muscles to bones. When muscles contract, tendons transmit the pulling force that makes joints move. The high tensile strength of healthy tendons enables them to withstand extreme tension – estimates reach up to 30,000 pounds per square inch for the Achilles tendon.

But a balancing act keeps tendons’ structural integrity intact. The tissues require adequate nutrition and blood flow for normal maintenance and repair functions in the face of microtears from everyday wear and tear. Overdoing activities without giving tendons proper recovery periods raises injury risk. Weakness in muscles connected to tendons also overloads these tissues.

Poor movement patterns that strain joints abnormally may also predispose tendons to damage. And natural degenerative processes slowly alter tendon composition in everyone as they age – explanations why tendonitis most often strikes patients over 40.

Common Signs of Tendon Trouble

The earliest tendonitis hallmark is pain focused on the affected tendon, especially with joint use. Morning stiffness and discomfort after periods of inactivity are also typical. You may feel a dull ache or sharp, sudden pains if calcium deposits are present around damaged tendon fibers.

As tendonitis progresses untreated, simple movements become increasingly painful and challenging. Narrowed joint range of motion and weakness eventually set in too. Swelling, tenderness, inflexibility and visible redness may accompany advanced cases.

Rotator cuff tendons in the shoulders, wrist flexors, elbow extensors, patellar tendons in the knees, and Achilles tendons in the ankles are frequent sites of overuse-related tendonitis.

Pinpointing Precise Diagnoses

Untangling the numerous potential causes of stubborn tendonitis takes time and close collaboration between patient and orthopedic specialist. Thorough physical exams assess joint mechanics while collecting details on symptoms and medical history aids customized treatment planning.

Advanced imaging techniques like ultrasound and MRI scans help build the full picture – distinguishing between tendonitis, tendinosis (degeneration and microtearing), and partial tears. Presence of calcium deposits or related arthritic changes also influence the treatment approach. Blood work screens for inflammatory arthritis, diabetes, and other diseases linked to tendon problems.

Conservative Therapies: The First Line of Defense

Casting a wide net works best when taming recurring tendon woes. An experienced specialist skillfully combines multiple nonsurgical options tailored to each patient’s unique needs:

  • Strict rest periods minimize further damage while natural healing processes activate. Protective splints or slings may encourage compliance.
  • Icing treatments reduce swelling and discomfort during early inflammation stages. Alternating ice and heat provides varying therapeutic effects as healing progresses.
  • OTC anti-inflammatories temporarily alleviate pain and swelling. But extended usage risks gastrointestinal, kidney and cardiac side effects.
  • Targeted injection therapies show promise for some. Cortisone shots offer quick, but fleeting relief by reducing inflammation. Platelet-rich plasma introduces growth factors attempting to spark lasting tissue regeneration.
  • Physical therapy retrains movement patterns, aligns surrounding joints, and strengthens connective muscles utilizing gentle, gradual loading approaches. Massage, stretches and modalities like ultrasound or shockwave therapy provide adjunct benefits.
  • When irritation persists despite these efforts or full tendon tears occur, surgical options enter the equation.

Surgical Solutions for Worst-Case Scenarios

Advanced tendonitis almost always stems from progressive tendon damage accumulating over lengthy periods. Patients rarely recall a singular traumatic event igniting their symptoms. By the time surgical consults occur, underlying tendon tissue often appears frail, disorganized and extensively degenerated upon inspection.

In rare cases, sudden trauma partially or fully ruptures previously healthy tendons. Acute surgical repair becomes urgent to enable the ends to heal back together before scar tissue forms.

For degenerative tendinopathy, removing irritating calcium deposits or frayed tissue margins, releasing scar tissue adhesions, grafting to bridge gaps, or transferring healthy tendons to fill voids may provide relief when conservative care fails.

Meticulous post-op rehabilitation under an experienced therapist’s watch is mandatory following any tendon procedure – up to 6 months for larger tendons like the rotator cuff. Some residual stiffness or weakness often persists long-term even with successful surgeries.

Hope for the Future

True regeneration of robust, healthy new tendon tissue still lies ahead. Stem cell injections aim to achieve this but much work remains assessing optimal cell lines and prep techniques. Technology allowing surgeons to place sutures or implants into badly damaged tendons shows early promise stabilizing tears and guiding internal cell growth.

Gene and protein therapies attempting to restart normal developmental processes in aging tendons are also on the horizon. For now, skillfully combining current options offers the best bet for resolving recalcitrant cases. Patience through lengthy rehabs poses the final key.

Relief for Recurring Tendonitis is Within Reach

Skillful troubleshooting to pinpoint tendonitis’s root causes, customized treatment plans, and consistent patient participation together build the foundation to overcoming stubborn cases. If tendon problems have you questioning your options, find reassurance in the breadth of therapies available today.

Under guidance from premiere orthopaedic specialists, even long-standing tendonitis often improves dramatically without resorting to surgery. But for worst-case scenarios, advanced surgical techniques can provide a critical lifeline on the road to recovery.

To explore your options in treating complex tendon troubles, contact orthopaedic surgeon Dr. Herrick J. Siegel today and start mapping out your path to pain-free movement once again. With over 20 years of experience, Dr. Siegel has helped thousands regain active lifestyles when orthopaedic conditions appeared to limit their possibilities. Leverage his expertise as you seek to overcome nagging joint irritation for good.