Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Insertionitis (Tenoperiostitis)

Attachment of a muscle to bone involves a gradual transition from muscle-tendon to cartilage and from mineralized cartilage to bone. Bone-tendon junctions are poorly supplied with blood because the fibrocartilage creates a ‘barrier’; this may explain why these injuries often take a long time to heal and may become chronic.

Inflammation of the muscle-tendon attachment to bone (insertionitis or tenoperiostitis) is caused by repeated strain on the attachment and periosteum. The resultant minor ruptures and bleeding cause irritation
and inflammation. Growing individuals rarely suffer from insertionitis because their tendons and muscles are relatively stronger than bone. Instead, they sustain inflammation and fragmentation of bone, for example
Osgood-Schlatter disease in the knee and calcaneal apophysitis.

Location

Insertionitis occurs most frequently in the elbow area (‘tennis elbow’, ‘golfer’s elbow’), in the groin at the attachment of the adductor longus muscle, in the knee at the proximal and distal attachments of the patellar tendon, in the heel at the Achilles tendon insertion into the calcaneus, and in the attachment of the plantar fascia into the calcaneus (plantar fasciitis).

Symptoms and diagnosis

Insertionitis is characterized by development of the following:
– pain at the attachment site of a muscle or tendon to bone;
– slight swelling and some degree of impaired function;
– a distinct, localized tenderness to pressure over the affected attachment;
– an increase in pain at the site of attachment when the muscle group concerned is contracted.

When insertionitis develops the athlete or trainer should:

Treatment

– restrict the activity that triggers the pain (crutches may be beneficial);
– cool the injury with ice packs in the acute phase to reduce pain and swelling;
– give support with strapping or taping;
– apply local heat and use a heat retainer after the acute phase.
The doctor may:
– give anti-inflammatory medication;
– prescribe an exercise program;
– prescribe a dorsiflexion splint to be used during sleep;
– give local steroid injections at a later stage, combined with rest for 1–2 weeks;
– operate in patients with prolonged pain and chronic conditions.

Prevention

The following measures will reduce the likelihood of insertionitis developing:
– correct training techniques;
– equipment appropriate for the sport concerned (new equipment, especially footwear, should be ‘worn in’);
– clothing and equipment suitable for the athlete concerned;
– good basic training, and specialized training aimed specifically at vulnerable areas.

Leave a Reply

You can use these HTML tags

<a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>