A Comprehensive Look at Tendinitis:  Part II – Symptoms and Diagnosis

Boyd W. Haynes III, MD

Tendinitis is an inflamed tendon.  Tenosynovitis is a condition where the tendon sheath, but not the tendon, becomes inflamed.  The two conditions are not mutually exclusive, and may occur simultaneously.

The main symptom of Tendinitis is pain in the affected tendon that increases when the tendon is flexed or contracted.  There may or may not be swelling and the area may feel hot and/or look red.  The tendon may feel like it has a lump or a gap in it which can be felt upon examination.   If there is a gap, moving the tendon will be very difficult and may indicate a complete tendon rupture.  Some people feel a grating or rasping sensation or a crackling, creaky sound when moving their tendon.  That is because the tendon sheath has become thicker due to the inflammation.

When I see a patient in the office, I usually first get x-ray studies to rule out fractures or tumors and to show if there are bone spurs, calcium deposits or a foreign body.

I ask a lot of questions about their pain, such as;

  1. Show me where it hurts…can you move it?
  2. When did the pain start?
  3. Did it begin after an activity or sport?
  4. Does the pain come and go?
  5. At what time of day is it worse or better?
  6. Have you tried at-home treatment? What?  Did it help?

I will also get the patient to move for me and perhaps perform a series of physical diagnostic testing to further ascertain their condition.  These movement tests may be active, passive, resistance-based isometric exercises or joint play movement tests.  All of these tests are designed to provoke symptoms, differentiate between tissues, test for strength or weakness, and to determine if pain or movement restriction is the dominant factor at play.

Based on the imaging studies, asking specific questions and a physical examination, I can usually make a diagnosis of tendinitis easily.  However, some cases may warrant the use of ultrasound or MRI, so that soft tissues may be more easily visualized.  I will also be able to tell is the tendon sheath is inflamed alone or if both the tendon and its sheath are inflamed.

Armed with all of this information, I am able to prescribe the treatment best suited to the patient, their type of tendinitis, their lifestyle, activity level and their job.  All of these factors are weighed before I recommend treatment because I want my patients to comply with treatment and be able to do so without cumbersome changes to their daily routines.  If treatment is incompatible with someone’s life, then they are less likely to comply, take their medicine, do their exercises, adapt their behavior, change their form, modify their workstation or get better quickly.