Tendinosis of the joint tendon: what is it, symptoms, treatment

Tendinosis of the joint is not a completely accurate diagnosis, since the pathology mainly damages the tendon fibers. A tendon is a structural part of the musculoskeletal system. It is necessary for attaching muscle and ligament tissue to bones. Consists of strong collagen fibers with a low degree of elasticity. Virtually no stretch. With increased physical activity and after exposure to traumatic factors, scars consisting of less durable tissue, fibrin, can form in the thickness of the tendon fibers.

Long-term tendinosis leads to degenerative tissue changes. It becomes less functional and prone to frequent injuries. In case of total damage to the tendons, at the moment of excessive physical force exerted on the muscle, which is attached with its help, a partial or complete rupture may occur. As a result, physical activity is lost, and secondary ankylosis of the joint may develop.

The most dangerous prognostically is ossifying tendinosis - a pathology during the development of which a gradual deposition of calcium salts occurs in the thickness of the tendon fiber:

at the initial stage, areas of tendon degeneration are subject to excessive stretching and loss of integrity;
at these points the process of scar tissue formation begins;
it does not have the same physiological properties as tendon fibers;
therefore, to strengthen the damaged area, the body triggers a calcification reaction (precipitation of calcium salts in areas of predominance of fibrin cells).

Tendon calcification is a very dangerous pathology, since the fixing and stabilizing function of this structural part is completely lost. The patient experiences severe mechanical pain that occurs with any physical activity. The amplitude of mobility in the area of the affected bone articulation is significantly reduced. Emergency medical care is required, since without it, complete contracture and loss of performance may develop.

Most often, tendinosis affects the large joints of the upper and lower extremities. Metacarpal, metatarsal, phalangeal, uncovertebral and facet joints are less commonly affected by these pathological degenerations.

Tendinosis can be successfully treated using manual therapy techniques. But it is necessary to consult an orthopedist when the first signs of trouble appear. In Moscow, you can make a free appointment with this specialist at our manual therapy clinic. The doctor will conduct an examination and examination, make a diagnosis and develop an individual course of therapy that will effectively and quickly restore the functionality of the damaged tendon.

Causes of tendinosis development

Pathogenic factors of influence are repeated monotonous physical loads on tendon tissue. For example, the disease is widely known as “tennis elbow.” When it occurs, the tendon in the elbow joint becomes deformed and calcified. This pathology develops in individuals who, due to the nature of their professional activities, are forced to systematically monotonously bend and straighten their arm at the elbow joint.

In addition to functional overload of the tendon fiber, the following factors can cause the development of tendinosis:

age-related degenerative changes that occur against the background of a decrease in the intensity of microcirculation of blood and lymphatic fluid in the lesion;
metabolic disorders and slowdown of metabolism, which entails degeneration of all tissues of the musculoskeletal system;
muscular dystrophy, leading to disruption of diffuse nutrition of tendon, ligament and cartilage tissue;
diabetic angiopathy and neuropathy, contributing to the development of dystrophic pathologies;
deforming osteoarthritis of the joint with impairment of its functionality;
injuries (sprains, microscopic tears of ligaments, tendons, ligaments, fractures and cracks of bones);
osteomalacia and osteoporosis - when bone tissue is thinned, the tendon gradually detaches from the head of the bone;
aseptic and infectious inflammatory processes in the joint capsule and surrounding tissues (arthritis, arthrosis, synovitis, hemarthrosis, bursitis, etc.).

Representatives of the following professions are at risk of developing tendinosis: turner, painter, plasterer, builder, loader, seamstress, hairdresser, cutter, cook, PC operator, etc.

Diagnosis of tendinosis

Before starting treatment, it is necessary to make an accurate diagnosis in order to differentiate tendinosis from other pathologies that have a similar symptomatic picture. Diagnosis begins with an external examination and interview of the patient by an orthopedic surgeon. The doctor finds out the nature, time and circumstances of the onset of symptoms, palpates (feeling) the tendon, auscultates - listens to it using a phonendoscope, checks the dynamic qualities of the joint.

Next, the patient is sent for laboratory and instrumental examination to clarify the diagnosis. A laboratory blood test can confirm the presence of an inflammatory process - this is indicated by an increased level of white blood cells, as well as a high erythrocyte sedimentation rate (ESR).

Instrumental diagnostic methods include:

X-ray - although at an early stage of development of the pathology the image cannot record changes, with ossifying tendinosis the calcium layer on the surface of the ligaments becomes clearly visible,
Ultrasound examination (ultrasound) shows the condition of the tendon and records the deformation of its structure - ruptures, thickenings,
Magnetic resonance imaging (MRI) allows you to record in color a picture of pathological changes occurring in the ligamentous apparatus,
Computed tomography (CT) allows the doctor to observe the picture of the pathology and monitor the development of the situation.

Interesting!
The doctor will be able to make a decision on how to treat tendinosis only after making a diagnosis. The examination is also carried out during the treatment of tendinosis to monitor the patient’s condition.

Clinical signs of tendinosis

The first clinical signs of tendinosis develop gradually. At a certain stage in the development of the disease, the patient may begin to feel extraneous sounds when performing certain movements. This could be a clicking knee or creaking ankle when walking, a cracking sound when raising your arm, etc. An extraneous sound when moving is the very first sign of trouble in the area of the affected tendon. Based on the amplitude and direction of movements, an experienced doctor will be able to tell where the tendon is damaged and how severe the pathological process is.

The localization of the disease influences the formation of the clinical picture. But there are a number of general signs by which tendinosis can be suspected. They include:

pain syndrome that appears only after physical activity and is completely absent at rest;
painful palpation in the area of the affected tendon;
crepitus upon palpation of this place (extraneous sound occurs due to friction of the fiber affected by the disease against the surrounding bone tissue);
redness of the skin, swelling of the soft tissues surrounding the joint can occur only in the case of the development of secondary arthritis or synovitis, tendinitis;
upon examination, no deformities of the diseased joint are visible;
at the initial stage, the amplitude of mobility is maintained within the physiological volume;
restriction of movements of a psychological nature (a person tries to unload the damaged joint, since any movements cause pain).

For diagnosis, an x-ray is taken in different projections. It shows areas of tendon fiber calcification. In difficult diagnostic cases, it is recommended to take an MRI image.

Next, we will briefly consider individual locations of the pathological process: shoulder, hip, knee, ankle joints. They are affected more often than others.

Treatment of tendinitis

Treatment of tendonitis, regardless of location, is prescribed taking into account the stage of the disease. Treatment has several components - restriction of movement, application of ice, painkillers and anti-inflammatory drugs (used both locally and by injection), physical therapy. The operation is used as a last resort for stage 3 tendonitis. During the recovery period, patients are prescribed a stay in sanatoriums that specialize in pathologies of the musculoskeletal system. In these specialized sanatoriums, tendinosis is treated using a course of mud applications and mineral baths.

Traditional medicine can double the effect of traditional treatments. For example, for inflammation of the ligaments, it is recommended to use an alcoholic infusion of walnut septa. To prepare the infusion, you need to mix 0.5 liters of alcohol with a glass of peeled walnut partitions. Place in a dark place for 3 weeks and consume a tablespoon 3 times a day. But before using the infusion, consult your doctor!

Shoulder tendinosis

Shoulder tendinosis can develop at the attachment of the serratus, trapezius, and rhomboid muscles near the cervicothoracic spine. This pathology develops in individuals who, due to their professional activities, are forced to excessively strain the muscles of the shoulder girdle.

Tendinosis of the biceps brachii muscle often develops; it is often associated with damage to the coracobrachialis muscle and leads to a significant limitation in the range of motion of the shoulder. The patient cannot freely raise his arm up and move it to the side. Any movements are accompanied by clicking and cracking sounds.

Post-traumatic tendinosis of the shoulder joint develops in the rotator cuff area. The cause of this pathology can be a dislocated shoulder, sprained ligaments and tendons. The rotator cuff includes four muscles (supraspinatus, teres minor, infraspinatus, subscapularis), which are attached by tendon fibers. It is responsible for holding the head of the humerus in the glenoid cavity.

Untimely diagnosis and treatment of the pathology leads to atrophy of the muscles of the upper shoulder girdle and the free upper limb. If you experience any unpleasant sensations or extraneous sounds in the area of the shoulder or elbow joint, you must make an appointment with an orthopedist as soon as possible.

Tendinosis of the hip and thigh

Let's figure out what it is - tendinosis of the hip joint and what negative changes the disease can lead to if you do not pay attention to its development. Hip tendinosis often affects the abductor tendons. These are the gluteus minimus and medius muscles, the tendons of which are located in the area of the greater trochanter. Pain in this type of pathology is localized in the trochanteric area. In the absence of timely treatment, a destructive process begins in the area of cartilage tissue. After 12–18 months, deforming osteoarthritis of the hip joint may develop, which will result in the patient’s disability.

Tendinosis of the thigh muscles can damage the adductor muscle groups. This entails a violation of the ability to make rotational movements with the hip, move the leg to the side and bring it back. If the short tendon that attaches the iliopsoas muscle is affected, pain may occur on the inner thigh and lower abdomen.

The treatment is carried out by an orthopedist. Diagnosis includes ultrasound, x-ray and MRI examination.

Tendinosis of the knee joint

Ossifying tendinosis of the knee joint - almost all representatives of athletics know what it is. Volleyball players, basketball players, jumpers, runners - they all systematically receive injuries in the area of the ligamentous and tendon apparatus. The knee suffers to a greater extent, since it bears the maximum physical and shock-absorbing load when moving.

The most common tendinosis is the cruciate ligament, which is located in a criss-cross pattern in front and back between the condyles of the tibia and femur. ACL sprains and tears are common types of sports injuries. During the scarring process, the deposition of calcium salts can be triggered. This leads to the development of tendinosis.

It manifests itself as pain when trying to make flexion and extension movements of the lower leg. When walking in advanced cases, clicking and crunching noises are heard. When going down stairs, you may feel like your knee is locked. There are no external deformations.

Symptoms of tendinosis

Symptoms of tendonitis include joint stiffness around the affected tendons, pain and swelling, sometimes accompanied by redness or inflammation. The pain intensifies with movement. Depending on the source of pain, forms of the disease are distinguished. So, if there is pain in the area of the instep of the foot and swelling of the tendon behind the inner malleolus, tendinitis of the posterior tibial muscle is diagnosed. If a person begins to limp and the pain gradually goes away after walking, but returns with stronger exercise, then it is most likely that he is developing tendonitis of the hip joint.

One serious form of tendinosis is inflammation of the synovial vagina, known as tenosynovitis. The disease can develop after an injury or as a result of a congenital anomaly, and can be of infectious or non-infectious origin. If a person, for example, has tenosynovitis of the knee joint, the symptoms will be as follows: pain increases significantly with movement, swelling is observed along the tendon.

Heel and plantar tendinosis

Calcaneal tendinosis is damage to the structure of the attachment points of the tibialis muscle in the area of the tubercle of the scaphoid bone. The cause of development is always repeated trauma to the tendon (stretching and ruptures, bruises and the formation of internal hematomas). The primary symptom is acute pain in the heel. It gets worse when trying to bend or straighten the foot.

Long-term plantar tendinosis can lead to functional flat feet. This entails a violation of the anatomical structure of the ankle, knee and hip joints. They quickly deform and collapse. There may be a negative shock-absorbing effect on the lumbosacral spine.

The greatest discomfort when walking can be caused by Achilles tendinosis. It is located in the area of the calcaneal tuberosity. The pain occurs when walking, but is absent at rest. When palpating the Achilles tendon, cords and deposits of calcium salts can be felt. In most cases, it develops in people suffering from improper foot placement (flat feet or club feet).

Symptoms

Although many patients with plantar fasciitis have heel spurs, heel spurs do not always result in pain. Almost 10% of the adult population has spurs, but only 5% have foot pain. And therefore, the treatment of heel pain, most often, does not require removal of the spur.

The most common symptoms of plantar fasciitis are:

Pain in the bottom of the foot near the heel
Pain from the first step after getting out of bed in the morning, or after a long period of rest, such as after a long car ride. Pain decreases after a few minutes of walking
Increased pain after (rather than during) exercise or physical activity.

Heel spurs often do not cause any symptoms. But heel spurs can lead to occasional pain or chronic pain - especially during walking or jogging if inflammation develops at the site of the spur formation. In general, the cause of pain is not the heel spur itself, but the injury to the soft tissues of this spur.

Many patients describe the pain of heel spurs and plantar fasciitis as feeling like a pin sticking into the bottom of their foot when they get up in the morning and this pain later transforms into a dull ache. Another common complaint is that acute pain also appears immediately upon standing up, after sitting for a long period of time.