T

Tendonitis - Tendinosis - Tendinopathy

These terms are used to indicate that there is some problem with a tendon. Tendons are the cord-like structures that attach muscles to bones. Occasionally, one can experience pain in the tendon or near the attachment of the tendon to the bone. Sometimes the cause can be fairly obvious as in overuse during an activity. At times, the cause of the pain is not so obvious. "Tendinopathy" is the most general term: it simply means that a tendon has been identified as the source of the problem. "Tendinosis" is a term that is used to indicate that the nature of the problem is more chronic or recurrent. "Tendonitis/Tendinitis" is the most commonly used term, implying inflammation. Recent studies however, do not support the process of inflammation. It is more likely dengenerative in nature.
Self-care is described by the acronym "PRICE":
Protect the injured part from further injury
Rest from activity that causes ilncreased discomfort
Ice the area that is painful
Compression in the form of an elastic wrap may be helpful
Elevate the injured part in order to help minimize swelling
Most often the condition usually improves over a few weeks. If the symptoms persist, contact your primary care physician

Tennis Elbow (Lateral Epicondylitis)

Epicondylitis is a common elbow condition. One will hear terms such as: Tennis elbow and Golfer's Elbow. Lateral epicondylitis is caused by repetitively stressing the origin of the muscles that pull the hand/wrist upward. These originate on the outer aspects of the elbow. The pain can radiate into the forearm and hand. When acute, simple tasks such as lifting a tea cup or writing become very painful. The condition can be very chronic and recurrent. Histologically, there is evidence of microtearing of the tendon. This can scar down and become asymptomatic over time.
The most important aspect of treatment is identifying the activity causing the pain. Often, a wrist splint and/or an elbow band may be helpful in preventing the affected muscles from working too hard. Your doctor may suggest medication. The physical therapist can identify the specific exercises needed to stretch and strengthen the muscles, as well as provide modalities and soft tissue work. When pain persists despite conservative care, a surgeon may be consulted. Surgery is not commony done, but might help in severe cases.

References:
* Nirschl RP, Pettrone FA: Tennis elbow: JBJSAm 1979 Sep; 61(6A): 832-9
* Knee Surg Sports Traumatol Arthrosc. 2006 Jul;14(7):659-63. Epub 2006 Mar 23

Trochanteric Bursitis

This is an inflammation of the bursa on the outer side of the hip joint. The pain can radiate down the outer side of the thigh. A fall or direct blow can be causative, but it is often a repetitive friction condition of the Iliotibial Band (ITB). It is seen in runners. There may be biomechanical factors involved. A physical therapist can demonstrate the proper stretches and selective strengthening exercises to balance the mechanical forces around the hip. Modalities may prove helpful. As a last resort, a surgeon can be consulted to consider, among other alternatives, a cortisone shot.
Reference:
* Mayo Clin Proc. 1996 Jun;71(6):565-9
* J Clin Rheumatol. 2004 Jun;10(3):123-124

Total Joint Arthroplasty / Replacement

The most common joint replacements are the hip and knee. More shoulders are being done now as well. As humans live longer, our joints wear down. Of the over one hundred types of arthritides, the most prevalent is OA: osteoarthritis - the degenerative form. How much joints wear down is not well understood, since even young people can have arthritis and old people may have very little. In other words, inherent predispositions for joint degradation is probably a factor, added to the "microtrauma" of living over decades, and of course joint trauma itself. Besides living longer, humans are working and "playing" longer and harder. Increasing incidence of obesity adds yet another complication.
If conservative treatment (rehabilitation, medication, lifestyle modification...) does not control the pain and the pain is intractable - affecting daily living - an orthopedic surgeon may suggest joint replacement. This is a very significant and final surgery, with a long and arduous rehab. Since the joint is replaced, pain that used to stem from the arthritic joint is reduced. Incision and swelling pain abates over a time.
In the case of the knee, the the single most important aspect of rehab is regaining as much range of motion (ROM) as quickly as possible. Most critical is the ability to straighten the knee fully. If it doesn't, one will walk with a bent knee, which can affect your gait, hip or back. Depending on the type of prostheses, a minimal goal for bending the knee is 120 degrees, which would allow the descending of stairs without limping. Concurrently, intensive muscle strengthening is emphasized, the quads (front thigh muscle) being the most important. Normalizing gait is stressed immediately. The end result should allow for resumption of full normal activities of daily life. Some sports are not recommended, as this will wear down the prosthesis. Discussing realistic goals before surgery is important. A total knee is not a normal knee. What is predominantly gained from this surgery is pain relief. Revision of primary Total Knees is not a solution without significant risks, as the base of bone into which the prostheses sits is diminished with each revision. Choosing your sports carefully post-op will ensure longevity of the prosthesis. Cycling, hiking and swimming are gentle on the joint, yet can be done at a intensive level ensuring maintenance of good muscular, aerobic and functional levels.

Updated: April 28, 2007