May/June 2019

Question:

What is the difference between tendonitis and tendinopathy and how can they be treated?

Answer:

Tendons attach muscle to bone and help the joints to move fluidly. They are made of different types of collagen. When injured, tendons have difficulty healing because they are poorly vascularized. The tendon will attempt to heal itself by laying down collagen that is not as strong as the original tendon fibers, which can create thickening and pain over time.

An injury to tendons can take up to 10 weeks to heal. In these initial weeks of healing, patients are diagnosed with tendonitis. If pain persists longer than 10 weeks, or the tendon appears thickened on imaging (such as MRI), patients are diagnosed with tendinosis or tendinopathy. Tendinopathy is a mix of tendinitis and tendinosis. Tendinosis typically refers to tendons that have chronic inflammation resulting in tendon thickening.

It Hurts! Now What?

There are many treatment options available. Initially, self-care should focus on icing the area, gentle massage and/or stretching, anti-inflammatories and rest.

A physician may recommend conservative treatment options such as physical therapy or cortisone injections into the tendon to reduce pain. We caution our patients against repeated cortisone injections though, because they may weaken the tendon over time. There is some evidence that supports eccentric-based exercises — stretching a muscle while it is under a load. A biceps curl with a dumbbell is an example. This type of exercise remodels the tendon and can lessen pain. More advanced tendinopathy may be treated surgically, but this is rare and may result in only some improvement.

Another treatment option is platelet-rich plasma and stem cell injections for tendon injuries. This is a procedure in which your own blood platelets or adult stem cells are injected into the injured area.

Warm weather means outdoor pastimes for many of us. If you like to read, this time of year means you’re heading to a porch or patio with a good book. Lorain Public Library System’s director of marketing Jennifer Black put out a call to their book club members for a few of their favorites. Enjoy!

The NINTH HOUR

By Alice McDermott

Dark and intense, The Ninth Hour begins with a suicide in 1920s Catholic Brooklyn. This sad incident begins a chain of events that ultimately deal with the meaning of grief and dignity, love and loss, as well as the meaning of faith. With dense, well-realized characters, this novel is not to be missed.

BITTER ORANGE

By Claire Fuller

Bitter Orange is a seductive novel that explores desperation and longing. With deft psychological portraiture, the novel recalls the fractured, damaged summer that one woman experienced in the English countryside in 1969. With evocative writing and a haunting plot-line, Bitter Orange is a perfect read for those who like their novels in the vein of Daphne du Maurier’s Rebecca.

HARRY TRUMAN’S EXCELLENT ADVENTURE

By Matthew Algeo

When Harry Truman left the White House in January 1953, he picked up a new Chrysler New Yorker and enjoyed a 2,500-mile road trip from his Missouri home to the East Coast and back. It was the last time a U.S. president or ex-president traveled without the Secret Service, and Truman’s hopes to travel privately unraveled almost immediately. The book offers a delightful glimpse into a vanished America, before interstate highways and chain restaurants.

LILAC GIRLS

By Martha Hall Kelly

World War II unfolds very differently for three women in this touching and inspiring tale of three women in the United States and Europe. An American socialite in New York City, a Polish teenager who is captured while working for The Resistance, and a German doctor who is assigned to a concentration camp all cross paths in unexpected ways as they are forced to deal with wartime conditions beyond their control.

As you travel the back roads for your weekly luncheon with mom, you think about the tasks to be completed that day:  A trip to the grocery store. A quick stop at the bank. Shuttling kids to and from sporting activities.

Your mind continues to compose the list as you pull over for an ambulance with lights and sirens blaring. As you round the corner of your parents’ street, you see your father and several neighbors in the driveway; your heart skips a beat.

Your father says mom walked to the mailbox, twisted her ankle, fell and hit her head. She laid in the driveway for about 20 minutes before dad went looking for her. The paramedics insisted on taking mom to the hospital for a quick review and assessment. And so, the ride begins.

Changed Plans, Many Decisions

The next three hours are spent providing insurance information, reviewing past medical history, answering questions about the incident, undergoing multiple tests and waiting to see the emergency department physician. Mom appears to be fine and so your mind starts to revamp the list from this morning: the groceries can wait until tomorrow, hit the ATM on the way home, my sister may be able to shuttle the kids around. Then, the doctor arrives. Test results show abnormalities and the physician recommends that mom stay for observation and additional tests.

Many of us will experience similar situations like the one described. Most of us desperately try to avoid a trip to the hospital, so we avoid talking about the possibility, making us unprepared to traverse this emotional rollercoaster ride. Nearly one in five Americans will visit an emergency department at least once a year, according to the U.S. Centers for  Disease Control and Prevention. We must get out of our comfort zone, do research, and be prepared for an unexpected hospital stay as well as what follows.