Tendonitis, Trigger Finger, Tears, De Quervain’s Tenosynovitis, and Rotator Cuff Syndrome


Tendonitis

Tendonitis is an overuse injury of the tendons, usually caused by newly implemented exercise regimes or prolonged repetitive movements of a certain body part.  There are hundreds of tendon structures in the body, each of which connect specific muscles to nearby bones.  However, tendonitis does not systematically strike all the tendons, but the one or few that are close to the area of the injury.  These areas are typically low on blood supply and, as a result, do not obtain the necessary oxygen and nutrients for rapid healing.  The condition is especially prevalent in people aged 40 to 60, since the tendons in this population are less elastic and heal slower than the tendons of younger people.  The most common symptoms of tendonitis are tenderness, pain with movement, and swelling in the area of the tendon.  If left untreated, long-term inflammation may lead to serious complications and a chronic status of the condition.

The following are different types of tendonitis:

•   Wrist tendonitis – This condition results from the inflammation of the tendon sheath and causes pain and swelling around the wrist.

•  Achilles tendonitis – The pain and swelling in this condition is present in the back of the heel.  If left untreated, this type of tendonitis may lead to Achilles tendon rupture.

•  Posterior tibial tendonitis – This type affects the inner side of the ankle near the Achilles.  Although it is the less common type, if left untreated it may result in flat foot.

•  Patellar tendonitis – The inflammation of the patellar tendon causes a condition known as jumper’s knee.

•  Rotator cuff tendonitis – Also known as shoulder bursitis.

•  Lateral epicondylitis – More commonly known as tennis elbow, the condition causes pain outside of the elbow.

The initial treatment for tendonitis conditions involves a lot of rest, icing, and protection of the affected area.  Movements that aggravate the pain should be avoided.  Instead, the patient can concentrate on milder activities, such as swimming, for example.  For chronic tendonitis or people wishing to continue regular movements, splints and braces are strongly recommended.  Anti-inflammatory medications may also aid in reducing pain and swelling.  For cases of pain that do not easily go away with rest, cortisone or prolotherapy injections directly into the site of inflammation may become necessary.  However, such injections may not be suitable to all types of tendonitis, especially Achilles tendonitis, where cortisone may trigger tendon rupture.  Tendonitis caused by underlying conditions, such as gout or arthritis may present additional challenges in treatment.  After the rest period, a physical therapy regimen is recommended to prevent relapse of the condition.

Trigger Finger

Trigger Finger is the name given to a condition which is  marked by inflammation of the finger or thumb tendons.  Tendons are body tissues that connect muscles to bones, and are covered by a sheath; they normally slide naturally through this sheath due to the lubrication around the joint, which is called the synovium.  Finger and thumb tendons contribute to the bending and strengthening in the hands.  In certain cases of inflammation, the tendon is pulled through a narrow opening of the tendon sheath as the finger or thumb bends.  This process is accompanied by a snapping sound and pain, which are primary symptoms of trigger finger.  Other symptoms include soreness at the base of the finger or thumb, and requiring additional help to straighten the bent finger..  Without treatment, complications, such as bowstringing, digital nerve injury, and continued triggering may arise.

Trigger finger occurs due to repetitive and forceful movements in the hands, as well as conditions, such as rheumatoid arthritis, gout, and diabetes.  Often, farmers, industrial workers, musicians, and even smokers, may suffer from trigger finger due to repeated hand movements.  Also, the condition strikes more women than men, and is most common in people aged 40 to 60.

When affected by trigger finger, the recommended treatment includes avoidance of the activities that caused the injury in the first place, wearing of splints for padding and protection, anti-inflammatory medications, cortisone or prolotherapy injections and, in extreme cases, surgery.

De Quervain’s Tenosynovitis

De Quervain’s tenosynovitis is an inflammatory condition that affects the tendons (extensor pollicis brevis and abductor pollicis) located at side of the wrist at the base of the thumb.  The etiologies (causes) of the inflammation include heavy lifting, direct injuries to the thumb, and inflammatory diseases, such as rheumatoid arthritis.  Typical symptoms of De Quervain’s tenosynovitis include swelling, redness and tenderness and can be exacerbated (worsened) when pinching, grasping and through the application of direct pressure to the thumb.  Pain may often extend into the lower arm.  Women are at a greater risk than men to develop this disease.

Treatment for De Quervain’s tenosynovitis may include wearing a splint and applying ice. Anti- inflammatory medications including cortisone injections are effective at minimizing swelling.  In rare cases where injections prove ineffective, surgery is the next available option. If left untreated, De Quervain’s may become chronic, which may lead to an overall resistance in treatment.

Rotator Cuff Syndrome

The rotator cuff is the group of four tendons that stabilize the shoulder joint. Additionally, there are four muscles whose tendons form the rotator cuff: the subscapularis muscle, the supraspinatus muscle, the infraspinatus muscle, and the teres minor muscle. The four tendons of the rotator cuff muscles join together to form one larger tendon, called the rotator cuff tendon.

Rotator cuff disease may stem from many different causes, including injury, repetitive strain, degeneration from aging, or inflammation due to tendonitis, bursitis, or arthritis of the shoulder. Rotator cuff disease is the most common type of shoulder injury.

The most common symptom of rotator cuff syndrome is shoulder pain. The pain is typically felt on the anterior aspect (front) of the shoulder and is usually painful at night or when lying on the shoulder. Pain is typically at its worst when using the arm for activities above shoulder level.

The way in which rotator cuff syndrome is treated depends on the severity of the injury. Minor rotator cuff injuries may benefit from rest, ice, anti-inflammatory medications, pain killers, steroid or cortisone injections, and exercise and rehabilitation. More serious cases may require surgery.

In all cases, it is important to speak with your health care provider for proper diagnosis and treatment of your shoulder pain. Remember that without treatment, the shoulder can permanently lose full function. Minor rotator cuff injuries cause mild to moderate dysfunction. Severe rotator cuff injuries can cause complete dysfunction of the shoulder joint. In many circumstances, prevention is the best measure. Keeping the tendons in the shoulder strong will help to prevent injury.

We offer ultrasound guided joint and tendon injections with cortisone, prolotherapy, PRP (platelet-rich plasma) injections, autologous blood injections, medication, physiotherapy, acupuncture, active exercises, psychotherapy, biofeedback, and assistive devices such as braces, TENS/MET devices, and orthotics for patients who suffer from these conditions.

Sources: http://orthopedics.about.com/cs/sportsmedicine/a/tendonitis.htm

http://www.drugs.com/health-guide/tendonitis.html

http://www.mayoclinic.com/health/de-quervains-tenosynovitis/DS00692

http://www.webmd.com/rheumatoid-arthritis/de-quervains-disease

http://www.medicinenet.com/trigger_finger/article.htm

http://my.clevelandclinic.org/orthopaedics-rheumatology/diseases-conditions/hic-trigger-finger-and-dequervains-disease.aspx

http://www.patient.co.uk/health/Rotator-Cuff-Injury-and-Inflammation.htm

http://www.medicinenet.com/rotator_cuff/article.htm

http://www.emedicinehealth.com/rotator_cuff_injury/page2_em.htm

 

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