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TENDINITIS

The term "tendinitis" refers to an inflammation of the peritendinous tissues or synovial sheaths (tenosynovitis). Awareness of this distinction is not purely academic because the injection of corticosteroids into a tendon, particularly if repeated, may lead to its

An accurately placed injection of corticosteroids provides the quickest symptomatic relief. The simultaneous injection of a local anesthetic provides immediate confirmation that the correct anatomy has been injected. A knowledge of the relevant anatomy is essential to the

Tendons are not injected; rather the small space between the exterior surface of the tendon and the peritendinous sheath is infiltrated with the mixture of

To avoid snagging the tendon, it is important that the bevel of the needle be face downward and parallel to the long axis of the tendon. After injection, use of the tendon should be minimized for about 1 week. Local corticosteroids should not be

In competitive athletes, peritendinous injections should be avoided in relation to the infrapatellar tendon and the supraspinatus muscle, for similar reasons.

Unresolved tendinitis, which becomes chronic, eventually leads to weakening and sometimes disruption of the tendon (e.g., a ruptured rotator cuff). Both biomechanical causes (e.g., excessive repetitive wrist action in de Quervain's tenosynovitis) and anatomic causes (e.g., an acromioclavicular osteophyte irritating the supraspinatus tendon) should be sought and eliminated in chronic cases of tendinitis.

Physical therapy plays an important role in the rehabilitation of subacute and chronic tendinitis. Two phenomena need to be reversed, namely impaired blood supply and

The use of therapeutic ultrasound techniques both improves tendon perfusion and enhances tendon extensibility. This should be combined with an initial program of isometric exercises followed by

The patient should engage in progressive eccentric muscle contractions (i.e., muscle contraction while the