Symptoms
Disease of the tendons or tendon sheaths often manifests as dull or stabbing pain, usually on one side and with movement, strain, or pressure. Other complaints include weakness, limited range of motion, and an audible crunching sound. The wrists and forearms are often affected. At a later stage, the pain may also be present at rest.
Causes
The cause is often overuse of tendons and tendon attachments, those structures that connect muscles and bones. The trigger is frequent repetition of a certain activity, for example, working at the computer, in the household, playing music, gaming or sports. This leads to irritation and a structural change in the collagen fibers. According to the literature, however, inflammation is present only rarely or to a minor extent, which is why the colloquial term “tendonitis” is actually incorrect for these complaints. It is generally referred to as tendopathy or tendovaginopathy, which is a disease of the tendons or tendon sheaths.
Diagnosis
The diagnosis is made in medical treatment based on the patient’s history and with a physical examination. A visit to the physician is especially recommended in cases of prolonged duration (> 2 weeks), severe pain, and a local inflammatory reaction (swelling, redness).
Nonpharmacologic treatment
The most important measure is to take it easy on the affected region. Activities that trigger the pain should be reduced or avoided. This often poses a problem for those affected, because neither work nor hobbies are willingly interrupted or abandoned. Complete immobilization is not recommended because muscle atrophy may occur.
- Special bandages and support dressings relieve the damaged structures. Tennis arm bandages are available for the elbow.
- Cold or heat can relieve the pain in the short term.
- Physiotherapy: stretching, training
- Occupational therapy, adaptation of the workplace
- Other physical therapies, e.g. ESWT, iontophoresis.
- Alternative treatment options such as acupuncture
- Surgical intervention as a means of 2nd choice after conservative therapy.
Drug treatment
Gels and ointments:
- Such as a diclofenac gel, arnica ointment, or comfrey ointment, provide short-term pain relief and have anti-inflammatory properties. NSAID patches and rubs are also used.
Painkillers:
- Such as acetaminophen, ibuprofen, diclofenac or naproxen can be used in the short term to treat the pain. A problem is the possible adverse effects of NSAIDs, which can occur especially with long-term use.
Glucocorticoids:
- Have anti-inflammatory and analgesic properties and are injected directly locally in medical treatment. The drugs are approved for short-term therapy. They reduce symptomatology but do not appear to affect progression.
Nitrates:
- The literature additionally mentions the use of nitroglycerin, which is administered in the form of a patch. However, nitroglycerin is not approved by the authorities for this indication (off-label use).
