Can tendinitis cause vertigo?

Can Tendinitis Cause Vertigo?

Yes, tendinitis can cause vertigo, specifically longus colli tendinitis affecting the cervical spine, though this is a rare and under-recognized cause of vertigo that requires specific imaging for diagnosis.

The Specific Connection: Longus Colli Tendinitis

The most direct evidence linking tendinitis to vertigo comes from longus colli tendinitis, an aseptic inflammatory process of the prevertebral neck muscle. A documented case demonstrates that longus colli tendinitis can present with vertigo as a primary symptom 1. This patient experienced dizziness, palpitations, and hand numbness that resolved completely within one week after treatment with corticosteroid injections and acupotomy 1.

Why This Matters Clinically

• This is an under-reported condition that physicians often miss 1
• Misdiagnosis leads to unnecessary interventions for vertigo 1
• The diagnosis requires MRI with fat-suppression sequences—standard imaging will miss it 1
• Lack of familiarity with prevertebral space anatomy makes clinical diagnosis difficult 1

The Broader Cervical Mechanism

Beyond longus colli tendinitis specifically, cervical pathology can cause vertigo through abnormal proprioceptive input:

Abnormal neck proprioception from diseased cervical structures creates a sensory mismatch with vestibular and other sensory information, resulting in subjective vertigo 2. This mechanism involves:

• Abnormal signals from Ruffini corpuscles in diseased cervical discs 2
• Muscle spindle dysfunction in tense neck muscles secondary to neck pain 2
• Suboccipital muscle dysfunction affecting head stabilization 3

Evidence of True Balance Disorders

Patients with chronic neck pain and vertigo demonstrate objective balance abnormalities on posturographic testing (both static and dynamic parameters) compared to those with neck pain alone or healthy controls 4. These patients also show:

• More restricted neck movement in all directions (p<0.001) 4
• Higher frequency of neck-related headaches (65.5% vs 40%, p=0.043) 4
• Impaired cervical proprioception 4

Critical Diagnostic Considerations

When evaluating vertigo, the ACR guidelines 5 outline specific clinical syndromes that help triage imaging needs:

1. Brief episodic vertigo with head movements → typically BPPV (use Dix-Hallpike testing)
2. Acute vestibular syndrome → requires HINTS examination by trained clinicians
3. Chronic recurrent vertigo → consider Menière disease or vertebrobasilar insufficiency

Cervical tendinitis falls outside these standard categories, which is why it's frequently missed 1.

Common Pitfalls to Avoid

• Don't rely on CT imaging for cervical causes of vertigo—it has only ~2% positivity rate for all dizziness presentations 5
• Don't assume all neck-related vertigo is the same—longus colli tendinitis requires specific MRI sequences 1
• Don't dismiss vertigo in patients with neck pain—25% of tension-type headache patients experience vestibular symptoms 6
• Don't confuse this with standard tendinopathies—general tendinitis literature 7, 8 doesn't address vertigo as a symptom

Treatment Approach

For confirmed longus colli tendinitis with vertigo:

• Corticosteroid injections provide immediate symptom relief 1
• Acupotomy may be beneficial as adjunctive therapy 1
• Complete resolution typically occurs within one week 1

The key is recognizing this rare entity exists and obtaining appropriate imaging (MRI with fat suppression) when cervical pathology is suspected in a patient with unexplained vertigo 1.