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Tendonitis and MS: Are They Connected?

Posted on April 11, 2022
Medically reviewed by
Amit M. Shelat, D.O.
Article written by
Kristopher Bunting, M.D.

What Are Tendons? | What Is Tendonitis? | Diagnosis | Causes | Treatment | Prevention | Support

Multiple sclerosis (MS) can cause a wide range of symptoms, including pain in the muscles and joints (musculoskeletal pain). On MyMSTeam, the social network for people with MS, members often discuss tendonitis and joint pain.

One member asked, “Did anyone else randomly develop ‘tennis elbow’ because of MS?” Another wondered, “Does anyone experience pain in joints or have tendonitis they believe is a result of their MS or therapy drug?” Yet another member asked, “Has anyone experienced plantar fasciitis and MS?” Others have shared their common experiences with tendon pain, including neck, back, elbow, shoulder, hip, knee, and foot pain.

Learning about this painful symptom can help you better understand what may be contributing to your tendonitis and how it can be managed.

What Are Tendons?

Tendons are the fibrous tissue that connects muscle to bone. Many tendons attach to bone near the joints. Muscles, tendons, and ligaments (which connect bone to bone) are the infrastructure that supports joints, keeping them stable while allowing the joints to move.

What Is Tendonitis?

Tendonitis (sometimes spelled tendinitis) is a type of tendinopathy, an umbrella term to describe different types of tendon injury and inflammation. Tendinopathies include:

  • Tendonitis — Inflammation of tendons
  • Tenosynovitis — Inflammation of the sheath that surrounds tendons
  • Tendinosis — Tendon injury due to repetitive use
  • Plantar fasciitis — Most common cause of pain on the bottom of the heel and is closely related to Achilles tendonitis

Conditions that affect muscles, tendons, or ligaments can weaken normal joint movement, cause pain, and lead to injury. If left untreated, some tendon injuries can progress to more severe problems such as ruptured (torn) tendons.

Symptoms of Tendinopathy

Common symptoms of tendinopathy include:

  • Pain
  • Burning
  • Tenderness
  • Swelling
  • Weakness
  • Stiffness
  • Limited range of motion

Tendinopathies can occur almost anywhere in the body but tend to affect joints, including the wrists, elbows, shoulders, knees, and ankles. Other sites of tendinopathy include the heel, bottom of the foot, fingers, neck, and back.

Pain caused by tendinopathy may be constant, or it may come and go. Pain may occur during activity, at rest, or both. Depending on the joints and tendons involved, pain may make it difficult to sit, stand, walk, grip, or bend joints.

Types of Tendinopathy

Common forms of tendinopathies include:

MyMSTeam members have shared their struggles with tendinopathy. “The past several years I have also developed terrible pain,” shared one member. “It comes and goes, in both upper arms/shoulders as well as in one knee.” Another shared, “I get pain in my back from sitting too long … and also in my elbows, shoulders, and knees.” Another member agreed, “Same here, it’s like my shoulder hurts talking on the phone, or my elbow joints ache.”

How Is Tendinopathy Diagnosed?

Diagnosis of tendinopathy involves a medical history, physical exam, and sometimes imaging studies. A history of injury or repetitive movement can suggest a diagnosis of tendinopathy.

Ultrasound of the tendon can show inflammation. Additionally, X-rays can show if there are other causes of pain or bony changes due to tendinopathy. MRI scans can also be used to see inflammation, tears, and ruptures in tendons with great detail.

If you have neuropathic pain, your neurologist may be involved with the diagnosis.

Does MS Cause Tendinopathy?

Tendinopathy can be caused by acute (sudden) injury, chronic (long-term) overuse, and, rarely, certain medications. MS can cause or contribute to tendinopathy in several ways. In MS, damage to the myelin sheath that protects nerves leads to lesions on the central nervous system, made up of the brain and spinal cord.

MS can affect walking and posture, and abnormal movements can cause tendinopathy. In rare cases, certain drugs can cause tendon damage, including some drugs used to treat MS. It is important to remember, however, that having tendinopathy with MS does not necessarily mean that your symptoms are related to MS. Tendonitis can have many other causes besides those related to MS.

MS Pain

MS causes two types of pain: neuropathic pain and musculoskeletal pain. Neuropathic pain is nerve pain due to damaged nerve fibers caused by MS. Musculoskeletal pain is caused by tissue injury or damage, including damage to the muscles and joints.

Neuropathic pain can take on many forms — sharp, stabbing pain, burning, itching, pins and needles, and sensations that are difficult to describe. Musculoskeletal pain, on the other hand, can be sharp, dull, or achy and may be aggravated by movement. Pain may be temporary and short-lived, or it may become chronic pain. Musculoskeletal pain is usually localized to specific muscles or joints rather than entire limbs.

It can be hard to determine the type of pain someone is experiencing with MS, making it difficult to diagnose. Some MyMSTeam members have been frustrated by this. One member wrote, “I’ve seen four doctors and received four different diagnoses … One said plantar fasciitis, one tendinitis, one just inflammation, and one said it’s MS progression.”

Abnormal Gait and Posture

Muscle weakness, muscle spasms, fatigue, poor balance, and numbness or altered sensation are all common MS symptoms that can contribute to difficulty walking as well as poor posture. Muscle spasticity due to MS can make joints stiff and inflexible, preventing normal movement. Loss of sensation or painful sensations caused by nerve damage can also affect walking. Additionally, loss of muscle tone due to reduced physical activity can cause joint problems in people with MS.

With MS, your body attempts to compensate for dysfunction by moving differently and using additional muscles to try to stabilize joints. Over time, abnormal joint movement due to the effects of MS on gait (how you walk) and posture can result in joint and tendon injury and pain when walking or doing other normal daily activities.

Medication-induced Tendinopathy

Several MyMSTeam members have asked if their musculoskeletal pain could be due to medications for MS. It is rare, but some medications can contribute to tendon injury. Few medications used to treat MS are associated with tendon injury, but some drugs that treat more common conditions can cause tendon injury. When an injury is related to medication, the Achilles tendon is most often the site affected.

Disease-modifying therapies for MS that can cause joint pain or tendon damage include:

Some drugs used to treat common comorbidities (separate health conditions at the same time) of MS, including high cholesterol and high blood pressure, are known to cause tendon injury. Research shows that statins (cholesterol-lowering medications) are linked to tendon damage. The blood pressure medications amlodipine and drugs known as renin-angiotensin II receptor blockers can also cause damage to the tendons.

Long-term oral steroid use (glucocorticoids or corticosteroids) can cause tendon injury, but it is more common with steroid injections given near tendons.

Other drugs have also been shown to cause tendon injury. These drugs treat a wide range of diseases that are not typically linked to MS but sometimes occur in people with MS. They include:

  • Certain antibiotics (fluoroquinolones, cephalosporins, azithromycin)
  • Isotretinoin
  • Antiretrovirals
  • Sitagliptin
  • Aromatase inhibitors

Talk to your health care team if you are concerned that a medication you’re taking may be contributing to tendonitis.

Repetitive Stress Injuries

A very common cause of tendinopathy is repetitive movements. Tennis elbow is a repetitive stress injury involving the muscles and tendons of the forearm. The name is misleading because tennis elbow can be caused by many different activities, including using a computer mouse.

Excessive walking, running, or standing can also cause tendinopathy, such as tendonitis of the knee, Achilles tendonitis, and plantar fasciitis. Even playing video games can lead to repetitive stress injuries affecting the hands and wrists.

Osteoporosis and Tendinopathy

Osteoporosis (loss of bone density) is a comorbidity of MS that can contribute to tendinopathy. As bones become weaker from osteoporosis, it affects the attached tendons. Research has found that people with osteoporosis have a higher risk of rotator cuff injuries.

How Is Tendonitis Treated?

Treatment for tendinopathy begins with RICE: rest, ice, compression, and elevation. Avoiding activities that cause pain, applying ice to swollen areas, using a wrap or sleeve around the affected area, and keeping the affected body part elevated are the first steps in treating tendon pain and injury.

Further treatment for tendinopathy can include:

  • Immobilization
  • Physical/occupational therapy
  • Medications
  • Applying heat
  • Surgery (in severe cases)

Depending on the location of the tendinopathy, a splint or brace may be used to temporarily prevent a joint from moving in ways that will prevent the injury from healing. Physical therapy and occupational therapy can help treat and prevent tendon injury as well as help with symptoms of MS.

Applying heat with a heating pad, hot water bottle, or warm compress can help relieve pain, relax stiff tendons and muscles, and increase blood flow to promote healing. Prescription or over-the-counter nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen, can be used for pain management. Corticosteroid injections can treat pain and inflammation due to tendinopathy, but there is a very small risk that steroid injections given near an injured or painful tendon can cause tendon damage, including rupture.

Some people may try acupuncture or other complementary therapies. If neuropathic pain plays a role, your doctor may recommend medications including gabapentin or antidepressants.

How Can Tendinopathy Be Prevented?

There are several ways you can help prevent tendon, muscle, and joint injuries due to MS. First, finding an effective treatment regimen for MS can help. The other way to help prevent tendinopathy with MS is by safely exercising, including stretching.

Exercise has many benefits for MS, including strengthening muscles and joints. Warming up before exercise, by doing light exercise for five minutes, can reduce the chance of injury. Yoga and tai chi are great ways to get exercise with MS. Adaptive yoga and tai chi can be tailored to your physical limitations.

Stretching, either alone or in combination with other exercises, can greatly improve tendon health. Stretching can be performed alone or with someone to help you stretch. Regardless of how mild or severe your MS is, there are exercises and stretches that you can safely perform to improve your overall health, not just your joints and muscles.

Talk With Others Who Understand

MyMSTeam is the social network for people with MS and their loved ones. On MyMSTeam, more than 184,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Have you experienced joint pain or tendonitis with MS? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Multiple Sclerosis — Mayo Clinic
  2. A Survey of Severity and Distribution of Musculoskeletal Pain in Multiple Sclerosis Patients; a Cross-Sectional Study — The Archives of Bone and Joint Surgery
  3. Tendonitis and Tenosynovitis — University of Rochester Medical Center
  4. Tendinopathy and Tenosynovitis — Patient
  5. Tennis Elbow — Mayo Clinic
  6. Golfer‘s Elbow — Mayo Clinic
  7. Rotator Cuff Injury — Mayo Clinic
  8. Achilles Tendinitis — Mayo Clinic
  9. Plantar Fasciitis — Mayo Clinic
  10. Ultrasound — Mayo Clinic
  11. X-Rays — Johns Hopkins Medicine
  12. Magnetic Resonance Imaging (MRI) — Johns Hopkins Medicine
  13. Tendinitis — Cleveland Clinic
  14. Pain — Multiple Sclerosis Trust
  15. Common Overuse Tendon Problems: A Review and Recommendations for Treatment — American Family Physician
  16. Tendinopathies in Video Gaming and Esports — Frontiers in Sports and Active Living
  17. Weakness — National Multiple Sclerosis Society
  18. Spasticity — National Multiple Sclerosis Society
  19. Walking (Gait) Difficulties — National Multiple Sclerosis Society
  20. Osteoporosis — Mayo Clinic
  21. Multiple Sclerosis Is Associated With Low Bone Mineral Density and Osteoporosis — Neurology: Clinical Practice
  22. Osteoporosis Increases the Risk of Rotator Cuff Tears: A Population-Based Cohort Study — Journal of Bone and Mineral Metabolism
  23. Mini-Review: Toxic Tendinopathy — Toxicologic Pathology
  24. Alemtuzumab Injection (Multiple Sclerosis) — MedlinePlus
  25. Interferon Beta-1a (Intramuscular Route, Subcutaneous Route) — Mayo Clinic
  26. Interferon Beta-1b (Subcutaneous Route) — Mayo Clinic
  27. Comorbidity in US Patients With Multiple Sclerosis — Patient Related Outcome Measures
  28. Cephalexin-Associated Achilles Tendonitis: Case Report and Review of Drug-Induced Tendinopathy — Cureus
  29. Tendonitis/Tendinitis — HSS
  30. Exercise — National Multiple Sclerosis Society
  31. Aerobic Exercise: How to Warm Up and Cool Down — Mayo Clinic
  32. Yoga and MS — National Multiple Sclerosis Society
  33. Adaptive Tai Chi — National Multiple Sclerosis Society
  34. Stretching for People With MS: An Illustrated Manual — National Multiple Sclerosis Society
  35. Stretching With a Helper for People With MS: An Illustrated Manual — National Multiple Sclerosis Society
All updates must be accompanied by text or a picture.
Amit M. Shelat, D.O. is a fellow of the American Academy of Neurology and the American College of Physicians. Review provided by VeriMed Healthcare Network. Learn more about him here.
Kristopher Bunting, M.D. studied chemistry and life sciences at the U.S. Military Academy, West Point, and received his doctor of medicine degree from Tulane University. Learn more about him here.

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