The definition of a tendon is that it is a tough band of connective tissue that connects muscle to bone and is capable of withstanding tension [Wikipedia].
Tendon disorders are ubiquitous among Baby Boomers. Together with bursitis, ligament injuries, and muscle disorders, afflictions of these areas are termed "soft tissue arthritis."
In a future article I will discuss the treatment of this condition. In this article I will talk about what tendonitis is. Tendons consist of a matrix of collagen and proteoglycans (complexes of proteins and sugars). Within this matrix are cells called fibroblasts which are the cells that manufacture tendon tissue.
Tendons have a unique structure. Tendon fibers are wavy, stretchable, and strong. Tendons act as springs transmitting forces of muscle to bone and provide stability and efficiency.
Tendon disorders arise as a result of repetitive activity, exertion, exposure to vibration, mechanical stress, and prolonged static posture.
Tendon problems occur through a sequence of events including an initial injury, followed by degeneration of tendon fibers. Inflammation is rarely seen in chronic tendon injury. As a result the term "tendonitis" is a misnomer. The proper term is "tendinosis."
Tendons prone to injury have "watershed areas", areas with poor blood supply. Examples are the Achilles tendon, the lateral epicondyle of the elbow, the rotator cuff, and the posterior tibial tendon of the ankle.
Other common sites for tendinopathy are the biceps tendon in the shoulder, the outside of the wrist, fingers, and hips.
Some tendons have a sheath around them. The tendons move inside the sheath. The sheath is lined by synovial tissue, the same tissue that lines the inside of joints. What this means is that sometimes the sheath can become inflamed. This is called "peritendonitis" or "tenosynovitis". The tendon is not inflamed but the sheath is. The problem here is that if the sheath gets inflamed, the tendon cannot move freely inside the sheath; it gets "stuck". An example of this would be a condition like trigger finger, where inflammation of the tendon sheath causes the finger to get stuck.
One complication of tendinopathy is tendon rupture which can be catastrophic. Risk factors for tendon rupture are: kidney disease, steroid therapy, rheumatoid arthritis, gout, and the use of fluoroquinolone antibiotics. This latter risk factor is one that few people know about. These antibiotics are frequently used to treat upper respiratory and urinary tract infections. Examples would be drugs like Cipro or Levaquin. Unfortunately, they are also a risk factor for tendon problems.
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