Muscles are connected to bones via tendons and these structures are often placed under tremendous strain during physical activity, especially during sporting activities. Some of these structures, such as the tendons of the rotator cuff in the shoulder run over bony ridges or through bony canals, which may cause friction or impingement, leading to recurrent micro-trauma, which may lead to a tendon tear. When a tendon becomes irritated, it undergoes an inflammatory reaction, which results in pain and swelling around the structure and its surrounding sheath. This is often experienced by a patient as insertional muscle pain with an associated inability to perform sporting or other physical activities. Once this condition settles, the tendon heals with some scarring in the affected area. Recurrent episodes of tendonitis may result in tendon rupture through the scar. While tendon inflammation may be caused by various bacteria and systemic conditions, by far the most common cause of tendinitis is overuse, as described above.
Tendon pathology will often not show up on routine X-rays and may be investigated more effectively with ultrasound scanning or an MRI scan.
Common tendon pathology treated by the surgeons at the Cape Joint Surgery include tennis elbow, De Quervain’s tenovaginitis, patella tendonitis, Achilles tendonitis, biceps tendonitis, extensor tendon synovitis in rheumatoid patients as well as various tendonopathies around the hip.
Treatment of these conditions is initially conservative with rest, physiotherapy and non-steroidal anti-inflammatory medication use. This may be supplemented by bracing and local anaesthetic and steroid injections, although one must be careful not to inject directly into the tendon, due to the fact that this may cause complete tendon disruption in the short term.
If these conservative measures prove to be unsuccessful, surgical debridement of the tendon and is sheath, as well as repair of any tears in the tendon structure is carried out. Although this was done as an open procedure in the past, many tendons are accessible through an arthroscopic and/or minimally invasive route.
