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:
- Tennis elbow or computer elbow — Affects the outer elbow (lateral epicondylitis)
- Golfer’s elbow — Affects the inner elbow (medial epicondylitis)
- Rotator cuff tendonitis — Affects the top of the shoulder
- Achilles tendonitis — Causes pain on the back of the ankle and heel
- Plantar fasciitis — Causes pain in the heel as well as the arch and ball of the foot
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
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