I’m a rock climber with an elbow issue and am confused by the terms used to describe it. What is the difference between tendonitis and tendonosis?

Athletes like rock climbers, tennis players, golfers, runners or skiers tend to traumatize their joints with repetitive motions. Common injuries in these settings are muscle strains, ligament tears and tendon disruptions. It sounds like your elbow has a “tendonopathy” or injury to the one of the tendons that connects a muscle to a bone.

Commonly, these injuries are named tendonitis, or inflammation of the tendon. This term implies that inflammation is involved, meaning cells mediated by the immune system have been summoned to the area in response to a recent injury. By definition, tendonitis is a term related to an acute, or new injury of a tendon. However, when the pain is chronic or lasting more than three months past the original injury, what you have is tendonosis. This term describes the change in the cellular makeup of the tendon itself.
Interestingly, very few, if any, inflammatory cells are present with tendonosis. What is clear is that the cellular makeup of the tendon changes over time with repetitive stress. The collagen matrix, which gives the tendon its stretch and pliability, degenerates. The tendon loses its strength, blood vessels appear where they shouldn’t and the tendon itself appears scarred. Tendonitis usually heals with proper medications and rest, where tendonosis is much more difficult to treat and can lead to tendon rupture.

In your last column, you discussed symptoms of vertigo, but not treatment options. I’ve had BPPV for 10 years, with increased symptoms in the last six months. What treatment do you recommend?
BPPV, or benign paroxysmal positional vertigo, is a problem that can plague its sufferers on and off for years. Most cases are idiopathic, or have no known cause. Sometimes trauma to the head or whiplash is the culprit.
In any case, the treatments are the same. Since the cause is calcium particles floating in the inner ear canals where they don’t belong, it makes sense that treatments are aimed at moving the particles back where they do belong.
The two common “particle repositioning maneuvers” are the Epley and Semont maneuvers. Both involve rotation of the head combined with rapid position changes from seated to lying. Both can also be modified so the patient can perform the maneuvers without the assistance of a doctor. Studies show both methods are equally effective, and a person treated with them is 37 times more likely to improve than an untreated person.
These maneuvers can be repeated if there is a relapse, or if there is no response after the first try. In extreme cases, where no treatment is successful, surgery is an option. If medicines are prescribed, they are used to treat the symptoms of vertigo, not the underlying problem.

“Pink eye” seems to be going around. Do we need to see a doctor for this?
Acute conjunctivitis, AKA “pink eye,” is commonly caused by either a virus or bacteria, and less commonly, allergy. It’s an irritation of the eye’s conjunctiva, the tissue lining the inside of the eyelids and the surface of the eyeball. Just like the common cold, viral conjunctivitis does not require treatment with antibiotics, while bacterial causes do.
How to tell the difference? Viral conjunctivitis typically has early morning crusts on the eyelids with watery discharge through the day. Other symptoms can include itching, burning or gritty feeling and either one or both eyes may be affected. Bacterial conjunctivitis also has morning crusting. However, the drainage during the day is thick and globular with white, yellow or green coloring that reappears within minutes of wiping the eyelids. It, too, can affect one or both eyes.
It’s important to distinguish between the two causes so the proper medication can be used, if necessary. Allergic conjunctivitis presents similarly to viral, however the patient usually has a history of allergies or can remember a potential allergen causing the symptoms. See your doctor if you’re unsure of the cause, if you believe the cause is not viral, or if your vision is affected.

Maren Dunn, D.O., is owner of Gallatin Family Medicine, a medical clinic in the Big Sky Meadow Village. Have a question? Email her at inquiries@gallatinfamilymedicine.com.
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