Tendonitis: symptoms, relief and a video doctor visit

Tendons are the bands that connect muscles to bones. When they are overused, injured or lose elasticity with age, they become inflamed and painful: that is tendonitis (also spelled tendinitis). It can also come with conditions such as rheumatoid arthritis or diabetes.

The most common sites are the elbow, shoulder, wrist, thumb, knee and heel. If your shoulder hurts, see shoulder pain; for the knee, see knee pain; and if you rolled your ankle and it swelled, see sprained ankle.

• Tennis elbow: pain on the outside of the elbow that runs down the forearm when you grip or twist, with a weaker grip. It is not just for tennis players: it is common in painters, plumbers, construction workers, cooks, butchers and people who type and use a mouse a lot. It usually affects people aged 35 to 54.
• Golfer’s elbow: the same problem on the inside of the elbow.
• De Quervain tendonitis: pain on the thumb side of the wrist when you make a fist, grab something or turn your wrist. Lifting babies and toddlers all day can cause it.
• Achilles tendonitis (ankle): pain in the heel and along the tendon when walking or running, with morning stiffness. It is common after a sudden jump in exercise, running on hard surfaces or wearing shoes without good support. If the pain is on the bottom of the heel, see plantar fasciitis.

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The most common symptoms are:

• Pain and tenderness along a tendon, usually near a joint
• Pain that gets worse when you move the joint
• Pain at night
• Morning stiffness
• Swelling or warmth in the area
• A weaker grip (elbow or wrist)

MedlinePlus recommends:

• Rest: stop or cut back the activity that causes pain for 2 or 3 weeks.
• Ice: 15 to 20 minutes, 2 or 3 times a day, wrapped in a towel.
• A splint or strap: a wrist-and-thumb splint for De Quervain, or a forearm strap for tennis elbow.
• Over-the-counter anti-inflammatories such as ibuprofen or naproxen, as the label directs. Check first if you have high blood pressure, heart, liver or kidney disease, or past ulcers or bleeding.
• Exercises to stretch and strengthen once the pain eases.
• At work: adjust your keyboard, mouse or tools, and take breaks.

After the acute pain settles, and once the doctor says you can exercise, a general routine of gentle mobility exercises can help you stay active; see mobility vs flexibility. It does not replace the specific exercises for your tendon.

Achilles tendonitis can take at least 2 to 3 months to improve. If the pain does not settle, the doctor can consider other options, such as a prescription NSAID (meloxicam, for example, is approved for osteoarthritis), and, if an injection or a specialist is needed, we refer you. If several joints hurt at once or rheumatoid arthritis is suspected, she gives you a lab order for a lab near you.

Some antibiotics, the fluoroquinolones (such as ciprofloxacin and levofloxacin), raise the risk of tendonitis and of a tendon tearing, during treatment and for up to several months afterwards. This is an FDA boxed warning in the medicine’s information. The risk is higher after age 60, with steroids, after a transplant or with rheumatoid arthritis.

If you are taking one of these antibiotics and a tendon becomes painful, swollen or stiff, stop taking it, rest and call your doctor right away. If you feel a snap in the tendon or cannot put weight on the leg, get emergency care. Read more about antibiotics.

For your safety, get seen in person the same day, or call 911 if it is severe, if you have any of these signs. See when to go to the ER.

• Sudden heel pain, as if you were kicked or hit with a stick, with a snap and trouble walking or standing on your toes (possible Achilles tendon rupture)
• A tendon that hurts or swells while you are taking a fluoroquinolone antibiotic
• A red streak running up your hand, wrist or foot, or fever with swelling after a cut (possible tendon infection)
• You cannot move your wrist, hand or a finger, or they look deformed