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.
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.
Tendonitis (sometimes spelled tendinitis) is a type of tendinopathy, an umbrella term to describe different types of tendon injury and inflammation. Tendinopathies include:
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.
Common symptoms of tendinopathy include:
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.
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.”
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.
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 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.”
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.
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:
Talk to your health care team if you are concerned that a medication you’re taking may be contributing to tendonitis.
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 (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.
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:
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.
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.
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.