Brief Outline of Extensor and Flexor Tendinitis

The tendons attached to the muscles that are responsible for flexing and extending the toes and foot can become inflamed and irritated just like any other tendon. Overuse, tightness is opposing muscles, or foot deformities can cause this condition. Extensor tendinitis is more common that flexor, but flexor tendinitis tends to be more painful and debilitating. Dancers are most commonly associated with injury to this tendon group.

Anatomy and physiology

Foot Muscles

The extensor hallucis longus and extensor digitorum longus are the main extensor muscles of the toes. The tendons of these muscles run over the front of the ankle, over the foot and attach to the toes. These muscles dorsiflex the foot and work in opposition to the flexor muscles. When the calf muscles are tight, or the muscles are worked beyond their exertion level, inflammation of the tendon may occur.

The flexor group of muscles, the flexor hallucis longus and the flexor digitorum longus, have tendons that run down the inside of the ankle and under the foot, attaching to the toes. These muscles plantar flex the foot and toes.

Cause of Injury

Extensor tendinitis: Tight calf muscles, over-exertion of the extensor muscles, or fallen arches.

Flexor tendinitis: Repetitive stress to the tendon from excessive dorsiflexion of the toes.

Signs and symptoms

Extensor tendinitis: Pain on the top of the foot, pain when dorsiflexing the toes, some strength loss may be experienced.

Flexor tendinitis: Pain along the tendon, in the arch of the foot, and along the inside back of the ankle.

Complications if left unattended

Tendinitis when left unattended can cause strains to the attached muscle and could lead to a complete rupture of the tendon. The pain may become severe enough to limit all activity.

Treatment

Rehabilitation and prevention

While resting the foot, it is important to identify the conditions that caused the problem. Stretching the calf muscles and the tibialis anterior muscle will help relieve the pressure on the tendons. Warming-up and gradually increasing workloads will help prevent tendinitis. Orthotics may be required when returning to activity to correct any arch problems.

Long-term prognosis

Most people recover completely from tendinitis with simple rest and correction of the cause(s). In some rare cases, surgery may be required to reduce the pressure on the tendons and relieve the inflammation.

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Brief Outline of Quadriceps Tendinitis

Quadriceps Tendonitis

Quadriceps tendinitis, like other versions of tendinitis, involves inflammation of the tendon. This can be a result of repetitive stresses to the quadriceps, or excessive stress before the muscle is conditioned. Pain just above the patella (knee cap), especially when extending the knee, usually accompanies this injury.

Anatomy and physiology

The quadriceps tendon attached to, and covers the patella, becoming the patellar (tendon) ligament below this and attaching to the tibia. The patella runs in the groove of the femur at the knee flexes and extends, which results in the tendon passing over this bone as well. Repetitive stress can cause inflammation of the tendon, especially under contraction, such as when accelerating or decelerating. Minor tears may also occur int he tendon as well when the stress is too much for the tendon to handle.

Cause of Quadriceps Tendinitis Injury

Repetitive stress to the tendon, e.g. running or jumping. Repetitive acceleration and deceleration, e.g. hurdling or football. Untreated injury to the quadriceps.

Signs and symptoms

Pain just above the patella. Jumping, running, kneeling, or walking down stairs may aggravate the pain.

Complications if left unattended

The quadriceps muscles may become inflamed, and the tendon will become weak if left untreated. This could lead to a rupture of the tendon. A change in gait or landing form can lead to other injuries as well.

Treatment

  • Rest and ice
  • Anti-inflammatory medication
  • Injection
  • Physiotherapy
  • Shockwave

Rehabilitation and prevention

Rehabilitation should include stretching and strengthening exercises for the quadriceps. Activities such as swimming can be helpful to reduce the stress on the tendon during rehabilitation. Return to a normal activity schedule should be delayed until pain subsides completely and strength is restored. Keeping the quadriceps flexible and strong will help prevent this condition.

Long-term prognosis

A full recovery with no long-term disability or lingering effects can be expected in most cases of tendinitis, and surgery is only necessary in extremely rare cases.

Joint Pain

Brief Outline of Bicipital Tendinitis

Bicipital tendinitis results from irritation and inflammation to the biceps brachii tendon, which has lies on the front of the shoulder and allows bending of the elbow and supination of the forearm. Overuse can lead to inflammation and is a common affliction in golfers, weight lifters, rowers, and those engaged in throwing sports.

Anatomy and physiology

Tendons are tough, resilient bands of fibrous tissue, connecting muscle to the bone. Irritation of the tendon due to overuse occurs as it passes back and forth in the intertubercular (bicipital) groove of the humerus, and can cause inflammation of the tendons (known as tendinitis) as well as the tendon sheaths or paratenons. The musculo-tendinous junction of the biceps brachii is highly susceptible to injuries brought on by overuse, particularly following repetitive lifting activities.

Cause of Bicipital Tendinitis

Poor technique, particularly in weight lifting. Sudden increase in duration or intensify of training. Impingement syndrome.

Signs and symptoms

Pain over the biceiptal groove where the tendon is passively stretched, and during resisted supination and elbow flexion. Pain and tenderness along the tendon length. Stiffmess following exercise.

Complications if left unattended

Bicipital tendinitis, left without care and treatment, generally worsens as the biceps brachii tendon becomes increasingly irritated and inflamed. Movement and the ability to perform athletically without pain will be furthered hampered. Exercising without adequate healing rehabilitation can lead to tearing of the tendon and tendon degeneration over time.

Treatment

Rehabilitation and prevention

The condition is self-limiting given rest and minimal medical attention. Following full recovery, exercises directed at improving flexibility, propioception, and strength may be undertaken. Thorough warming-up and stretching exercises and a steady athletic regimen that avoids sudden, unprepared increases in activity can help avoid this injury, as can attention to proper sports technique.

Long-term prognosis

A full return to athletic activity may generally be expected,  given adequate time for tendon recovery and reduction of inflammation. However, the injury is frequently recurrent. Surgery is generally not required. Injections of anti-inflammatories are sometimes used to reduce pain and inflammation.

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Brief Outline of Rotator Cuff Tendinitis

Rotator cuff tendinitis results from the irritation and inflammation of the tendons of the shoulder in the area underlying the acromion. The condition is sometimes known as pitcher’s shoulder though it is a common injury in all sports requiring overhead arm movements, including tennis, volleyball, swimming and weight lifting, in addition to baseball.

Anatomy and physiology

The shoulder (or glenohumeral) joint is a ball-and-socket structure formed by the top portion of the arm bone (humerus) associated with the scapula or shoulder-blade. The rotator cuff aligns the head of the humerus into the scapula. Occasionally, following repetitive use of the rotator cuff, the humerus can ride up to pinch the cuff and irritate the fluid-filled subacromial bursa that acts to cushion the rotator cuff and acromion/humerus.

Cause of Rotator Cuff Tendinitis

Inflammation of the tendons of the shoulder from tennis, baseball, swimming, etc. Irritation of the bursa of the rotator cuff from repetitive overhead arm motion. Pre-existing disposition including anatomical irregularity.

Signs and symptoms

Weakness or pain with overhead activities, brushing hair, reaching, etc. Popping or cracking sensation in the shoulder. Pain in the injured shoulder, particularly when lying on it.

Complications if left unattended

Rotator cuff tendinitis can worsen without attention as the tendons and bursa become increasingly inflamed. Motion becomes more limited and tendon tears can cause further, in some cases, chronic pain. Further, the acromion may react to prolonged irritation with the production of bone spurs, which contribute to further irritation.

Treatment

Rehabilitation and prevention

Following the rest and healing of the injured shoulder, physical therapy should be undertaken to strengthen the muscles of the rotator cuff. Occasionally, injections are required to reduce pain and inflammation. Moderation of rotator cuff use, adequate recovery time between athletic activities, and strength training can all help avoid the injury.

Long-term prognosis

Given proper rest as well as physical therapy and (where needed) injections, most athletes enjoy a full recovery from this injury. Should a serious tear of the rotator cuff tissue occur, surgery may be required, although a recovery to pre-injury levels of activity is usually expected.

Rotator Cuff Tear

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Brief Outline of Wrist Tendinitis

Wrist tendinitis is due to irritation and inflammation of one or more tendons around the wrist joint. Wrist tendinitis tends to occur in areas where the tendons cross each other or pass over an underlying bony structure, and affects individuals involved in strenuous and repetitive training.

Anatomy and physiology

The joint of the wrist is formed at the proximal end by the distal surfaces of the radius and ulna and a disc of fibrocartilage, and at the distal end by the scaphoid, lunate, and triquetral bones. The wrist helps orient and support the hand. Tendons of the wrist are encased in tendon sheaths known as the tenosynovium. Such sheaths provide for the smooth, friction-free sliding of tendons in the wrist. Swelling, irritation, and inflammation of the tenosynovium causes a thickening of the sheath, which constricts proper movement of the tendons, resulting in pain and a related affliction, tenosynovitis. Most wrist tendinitis occurs where a tendon passes through constricted tunnels of fascia. Four common sites of tendinitis are the first dorsal compartment (De Quervain’s tenosynovitis), digital flexors (trigger finger), flexor carpi radialis tendinitis, and lateral epicondylitis, (the latter associated with tennis elbow). The abductor pollicis longus and extensor pollicis brevis are also commonly affected.

De Quervain's Disease

Cause of Wrist Tendinitis

Sports involving wrist overuse, including all ball sports, racket sports, rowing, weightlifting, gymnastics, etc. Repetitive stress from typing. Other wrist overuse, as is common to nursing mothers.

Signs and symptoms

Pain in the wrist, particularly at the joint. Inflammation in the region of the affected tendon(s). Limited mobility in the affected wrist.

Complications if left unattended

If the activity causing tendinitis is continued and the condition left untreated, the inflammation and associated pain can worsen. The condition can also lead to permanent weakening of the tendon(s).

Treatment

  • Injection
  • Physiotherapy
  • Surgery

Rehabilitation and prevention

Often, a physician will use a splint or brace to prevent movement of the injured wrist. In athletic events, tendinitis sometimes results from improper technique. the best therapy for tendinitis is to restrict or temporarily discontinue the activity causing tendon inflammation.

Long-term prognosis

Most enjoy a full recovery from tendinitis, providing the affected wrist is permitted proper recuperation from inflammation.

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