TENDINITIS & OVERUSE INJURIES

Tendinitis & Overuse Injuries

Children playing in a sports hall

Osgood-Schlatter Disease

This is a common condition which primarily affects sporty adolescents – up to 1 in 5.

Boys are affected 3 times as often as girls, and both knees may be affected in a quarter of cases.

It is most common between 9 and 16 years, coming on earlier in girls. Sometimes it coincides with going through a growth spurt.

The condition is most associated with running, jumping and turning, so if you play football, rugby, netball, dancing etc, you are more likely to be affected by it.

What Are The Symptoms Of Osgood-Schlatter Disease

If you suffer from Osgood-Schlatter disease you will feel pain and tenderness in the bony prominence at the front of the tibia (shin bone) just below the knee.

This area is known as the tibial tuberosity. Early on there may be just pain, before a bump develops. The pain is worse with exercise, better with rest.

What Causes Osgood-Schlatter Disease?

The condition probably arises as a result of repetitive stresses, (overuse) where the patellar tendon joins the shin bone. The stresses lead the body to try to heal the area by creating new bone, called an apophysis.

X-rays may reveal this separate, prominent piece of bone. You can see this clearly on the x-ray shown here.

Tendinitis overuse injuries
Adolescent knee injury examination

How Do You Treat Osgood-Schlatter Disease?

The symptoms of the condition resolve over a period of 1-2 years, leaving the bony prominence enlarged, although by how much varies. The enlargement is permanent.

Rest, ice and anti-inflammatory medication are useful measures early on to relieve the pain but there is no evidence that continuing with sporting activities does any long-term harm. Physiotherapy, with quadriceps stretching can decrease the pain.

If the pain does not settle it is usually because of a mobile fragment of bone within the lower end of the patellar tendon. Occasionally, but rarely, this requires surgical removal in adulthood.

Adults who have had Osgood-Schlatter disease as a child often have prominence of the tuberosity. This might cause symptoms in some jobs involving kneeling, but usually no other problems.

Patellar Tendinitis or Tendinopathy

What Is Tendinitis?

Patellar tendinitis (you may also see it spelt tendonitis) is a long-lasting condition which produces pain at the front of the knee, typically in the central upper part of the patellar tendon immediately below the tip of the patella or knee cap. You can see the classic site of patellar tendinitis in the image here.

The condition is common in people who participate in jumping sports and activities, for example, basketball, volley ball etc, which is why patellar tendinitis is is also called ‘jumper’s knee’. It is believed to be associated with repeated loading of the patellar tendon.

What Is Tendinopathy?

Tendinopathy is a slightly different, more chronic progression, with degeneration of the deeper parts of the tendon. Patella tendinopathy generally effects those aged 30 or over.There is an overlap of the two conditions.

What Makes Tendinitis Worse?

Tendinitis and tendinopathy are improved by rest and made worse by running, jumping and similar activities. It may be a self-limiting condition, which means that the condition will settle given time although sometimes this can take a few years.

Tendinitis overuse injuries

How Do You Diagnose Tendinitis & Tendinopathy?

Your knee consultant will usually make a diagnosis based on the history of the condition and clinical examination.

Investigations may include ultrasound and/or MRI scan which will show abnormality in the top part of the tendon. An Xray may appear normal, but in chronic cases can show a bony spur at the patella tip.

How Do You Treat Patellar Tendinitis?

Treatment regimens are designed to speed up recovery or lessen symptoms whilst recovery is taking place.

Early treatment may include activity modifying your activities (so as not to aggravate the condition), ice, anti-inflammatories and physiotherapy.

Physiotherapy has an important role in tendinitis. With highly specific exercises, the majority of patients’ symptoms will improve.

Keyhole surgery knee operation

If the above conservative treatments fail, we may offer other treatments:

 

  • Steroid injections into the tendon are not generally used because of the risk of further weakening, and even rupture- which can be disastrous. There are a few circumstances, however, when steroid injections might be used around the tendon.

 

  • When symptoms are severe enough, the diagnosis has been confirmed and other treatments have failed, we may recommend surgery. This involves removal of the damaged tissue of tendon either by keyhole surgery or with a small open procedure. It can be 3-6 months before we know if it has been effective.

Bursitis

What Is Bursitis?

A bursa is a lubricated sac of tissue which lies between two structures allowing them to glide easily over each other.

There are several bursa around the knee. For example, there is one which lies between the kneecap and the skin (the pre-patellar bursa – seen in the first image here), and one which lies between the lower end of the patellar tendon, the bony prominence at the front of the tibia and the skin (the infra-patellar bursa – the image in the next section below).

The bursa may become inflamed and irritated due to constant friction between the skin and underlying area. It may swell up with fluid, sometimes quite dramatically. This is particularly common in some professions involving kneeling (e.g. carpet fitting, joinery, plumbing). You may see pre-patellar bursitis and infrapatellar bursitis described by the old-fashioned terms ‘housemaid’s knee’ and ‘clergyman’s knee’ respectively.

Tendinitis overuse
Positions of the common bursea - tendinitis overuse

How Do You Treat Bursitis?

Avoiding kneeling, rest, firm bandaging and anti-inflammatory tablets may all help.

Cortisone injections are not generally recommended, but may settle down a very painful episode (althoughthis may also increase the risk of introducing infection).

Although surgery is rarely required, we may recommend it if you have persistent recurrent episodes which interfere with your normal activities or work. If surgery is required, it involves an open incision to remove the inflamed bursal tissue.

Baker’s Cyst

What Is A Baker’s Cyst?

A BAKER’S CYST is a swelling in the back of the knee. Also known as a popliteal cyst (named after the correct term for the soft area at the back of the knee, the popliteal fossa).

A Baker’s cyst can be very small and only detectable with a scan, or very large and easily identifiable as a firm lump up to several centimetres across. It is not dangerous but can be uncomfortable.

What Causes A Baker’s Cyst?

A Baker’s cyst occurs when an excessive amount of the fluid which lubricates the knee, called synovial fluid, fills the normal knee lining to create a bulge.

If in doubt, the diagnosis can be confirmed with an MRI or ultrasound scan.

Bakers Cyst - tendinitis overuse injuries

How Do You Treat A Baker’s Cyst?

There is no direct treatment of the cyst. Taking the fluid off with a needle usually results in recurrence of the cyst and can be dangerous.

Surgical removal of the cyst is potentially dangerous to nerves and blood vessels, has a high risk of recurrence and is unnecessary.

Sometimes Baker’s cysts disappear spontaneously. They can also burst, causing pain in the calf which can be inflamed for a few days. This is not dangerous but is sometimes mistaken for a DVT (blood clot).

Whilst you would not treat a Baker’s cyst surgically, you may use surgery to treat the cause of excess fluid, for example to treat a cartilage tear or arthritis. This often gets rid of the cyst.

Runner’s Knee (Ilio-tibial Band Friction Syndrome)

What Is Runner’s Knee?

Sometimes called ITB syndrome or runners knee.

Runner’s knee, ITB or ilio-tibial band friction syndrome affects the firm, broad band of tissue which you may feel running down the lower part of the outer thigh towards the knee.

Repetitive stresses and irritation between the ITB and the underlying structures can cause pain.  This is usually made worse with certain vigorous activities, especially running.

Ilio-tibial Band Friction Syndrome - tendinitis overuse injury

How Do You Treat Runner’s Knee?

Modifying your activities (i.e. taking a break from running and other activities which aggravate the ITB), physiotherapy with ITB stretches and anti-inflammatories may all help.

Sometimes a steroid injection in to the painful area is required. In resistant cases with a tight ITB, you may require surgical release or lengthening through a small incision.

Right knee outer aspect: The ITB (purple) runs down the outer side of the thigh, towards the outer-front top of the tibia. You may be able to feel a bump of bone there, known as ‘Gerdy’s tubercle’. Runner’s knee can occur when the ITB repeatedly rubs over the outer side of the femur (red circle), as the knee bends and straightens.

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