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Multiple sclerosis (MS) can trigger a variety of symptoms, including musculoskeletal pain that affects both muscles and joints. On MyMSTeam, the social network for people with MS, members often discuss tendonitis in different parts of their bodies.
One member asked, “Did anyone else randomly develop ‘tennis elbow’ because of MS?” Another wondered, “Has anyone experienced plantar fasciitis and MS?” Others share their common experiences with tendon pain, including neck, back, elbow, shoulder, hip, knee, and foot pain.
Learning about tendonitis (sometimes spelled “tendinitis”) can help you better understand what may be causing your pain and how to manage it.
Tendons are strong, ropelike tissues made of fibers that connect muscle to bone. Many tendons attach to bone near the joints. Muscles, tendons, and ligaments (which connect bones to each other) work together like a support system for joints, keeping them stable while allowing movement.
Tendonitis 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 develop almost anywhere in the body but tend to affect joints, including the wrists, elbows, shoulders, knees, and ankles. Other sites of tendinopathy include the heels, bottom of the foot, fingers, neck, and back.
How long does tendonitis last? 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 third 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 point to tendinopathy as the likely diagnosis.
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. Magnetic resonance imaging (MRI) scans can also be used to see inflammation, tears, and ruptures in tendons with great detail.
If you’re experiencing neuropathic pain, your neurologist might help diagnose the issue. They can work with you to figure out the cause of the pain and recommend treatment options.
Tendinopathy can be caused by injury, long-term overuse, and, rarely, certain medications. MS can cause or contribute to tendinopathy in several ways. In MS, the protective layer around nerves, known as the myelin sheath, gets damaged. This damage leads to small injuries, called lesions, in the brain and spinal cord, which are part of the central nervous system.
MS can affect walking and posture. Over time, abnormal movements can lead to tendinopathy. In rare cases, certain drugs can cause tendon damage, including some drugs used to treat MS. It’s 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.
People with MS can experience two types of pain: neuropathic pain and musculoskeletal pain. Neuropathic pain is nerve pain from 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 limited to specific muscles or joints rather than entire limbs.
It can be hard to figure out 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 tendonitis, 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. These symptoms can lead to difficulty walking and poor posture. Muscle spasticity caused by 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 tries to make up for the impairment 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 from medications for MS. It’s 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 this 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 develop in people with MS. They include:
Talk to your health care team if you’re 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 from the Journal of Bone and Mineral Metabolism has found that people with osteoporosis have a higher risk of rotator cuff injuries.
Treatment options for tendinopathy begin 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’s 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 you’re experiencing neuropathic pain, 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 adjusted to fit your physical abilities.
Stretching, either alone or with other exercises, can greatly improve tendon health. You can stretch alone or with someone to help you. 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.
If there’s a physical activity you’re doing for hours at a time, such as a long hike or playing video games, take breaks. These breaks will allow your joints to rest and help prevent tendonitis from developing.
If you’re getting back into an activity you love after tendonitis has healed, consider wearing a splint on the affected joint to help prevent tendonitis from recurring. You can ask your doctor about what type of splint would be most effective. Splints for various joints are usually sold at pharmacies.
Tendonitis and other tendon-related injuries can develop in people with MS due to abnormal movement, repetitive stress, or certain medications. Recognizing the symptoms and working with your health care team for an accurate diagnosis is important. Treatment often involves rest, physical therapy, and medication, while prevention strategies include exercise, stretching, and taking breaks during activities. Managing MS symptoms and caring for your tendons can help reduce pain and improve overall quality of life.
On MyMSTeam, the social network for people with MS and their loved ones, more than 215,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.
Have you had joint pain or tendonitis with MS? Share your experience in the comments below, or start a conversation by posting on your Activities page.
Chiara Rocchi, M.D.
completed medical school and neurology residency at Polytechnic Marche University in Italy.
Learn more about her 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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Had my tendons repaired due to trigger finger but in my thumb. Now they say I have a partially torn tendon behind my left knee. So yea my MS is causing every day Pain😢in my spine and my sciatica… read more
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