Tendon Disorder

Tendon disorders affect the flexible bands of tissue that connect your muscles to bones, causing pain and limiting movement. While often called tendonitis, these conditions usually involve tissue breakdown rather than inflammation, and they require rest, proper care, and time to heal.

Table of contents

• What are tendons and what are tendon disorders?
• Types of tendon disorders
• Where tendon disorders occur
• Symptoms
• Causes and risk factors
• Diagnosis
• Treatment options
• Prevention

What are tendons and what are tendon disorders?

Tendons are rope-like bundles or bands of strong, flexible tissue made mostly of a firm protein called collagen. They attach your muscles to your bones and help transfer force from the muscle to the bone so you can move your joints^[1]. Tendons are strong and can handle significant loads, but they are slow to heal because they receive less oxygen than muscles^[15].

Tendon disorders, also called tendinopathies, are medical conditions that cause your tendons not to work normally^[1]. The term tendinopathy is preferred over the older term “tendonitis” because research shows that these conditions usually involve tissue breakdown and failed healing rather than active inflammation^[2][13]. When you overuse a tendon or injure it, the tendon fibers can develop small tears, much like a rope becoming frayed. Without enough rest and healing time, these changes can become permanent and cause ongoing pain^[1].

There are two types of tendons in your body: tendons without protective coverings called sheaths, and tendons with sheaths. The sheath acts like a protective tube and contains fluid that helps the tendon move smoothly^[1].

Types of tendon disorders

Tendon disorders fall into several categories based on what happens to the tendon tissue^[2]:

Tendonitis (also spelled tendinitis) is the term traditionally used to describe inflammation or irritation of a tendon. It’s usually an acute response to an injury, meaning it comes on suddenly and is short-term^[3][7]. However, if the injury doesn’t heal properly, tendonitis can become chronic and lead to scarring, micro-tears, calcium deposits, or tissue breakdown^[2].

Tendinosis is the preferred term to describe chronic pain in a tendon that involves breakdown of the collagen fibers. This makes the tendon lose its strength and elasticity over time^[2][15]. The process is gradual and lasting. If left untreated, tendinosis can lead to muscle wasting, complete tendon tears, or disability^[2].

Tenosynovitis is inflammation of the tendon sheath, the protective covering around certain tendons. With repetitive movements or stress, the lubrication system inside the sheath can malfunction. It may not produce enough fluid, or the fluid may not lubricate well. This leads to inflammation and swelling of the sheath, which can thicken over time and restrict tendon movement^[1][4].

Where tendon disorders occur

Tendon disorders can affect any tendon in your body, but they are most common in certain areas that experience frequent use or stress^[1][2]:

Shoulder: Bicipital tendinopathy affects the tendon to the biceps muscle. Rotator cuff tendinopathy affects the group of tendons that help rotate your upper arm bone and lift your arm^[1].

Elbow: Lateral epicondylitis, commonly called tennis elbow, causes pain on the outer side of your elbow where forearm muscle tendons attach to the bone. Medial epicondylitis, or golfer’s elbow, causes pain on the inner side of the elbow^[1][4].

Hand and wrist: Flexor tendinopathy affects tendons on the palm side of your wrist and hand. Extensor tendinopathy affects tendons on the back of your hand and wrist. De Quervain’s disease involves inflammation of the tendon sheaths at the base of your thumb^[1][4].

Hip: Problems can occur in the tendons around the hip joint.

Knee: Patellar tendinopathy, also called jumper’s knee, affects the tendon below your kneecap^[2][7].

Ankle and heel: Achilles tendinopathy affects the large tendon that connects your calf muscles to your heel bone. Problems can also occur with the posterior tibial tendon, which supports your foot arch, and the peroneal tendons on the outside of your ankle^[2].

Symptoms

The main symptom of tendon disorders is pain that gets worse when you stretch the tendon or tense the muscle attached to it^[5]. For example, if you have Achilles tendon problems, standing on your tiptoes will hurt. The pain is often felt where the tendon attaches to the bone^[5].

Common symptoms of tendon disorders include^[2][3][6][7]:

• Pain at the site of your tendon and the surrounding area, which can get worse when you move
• Chronic tendon pain that doesn’t go away
• Reduced ability to exercise or use the affected body part
• Stiff joints or difficulty moving your joints
• A dull ache, especially when making certain motions
• Tenderness when pressing on the sore tendon
• Sometimes pain even when resting
• Swelling, often with skin discoloration ranging from red to purple
• Hearing or feeling a crackling, popping, or grating sensation when you move the tendon
• Limited movement in the affected part of your body

The pain may develop gradually or come on suddenly and severely, especially if calcium deposits form in the tendon^[7]. If you hear a pop or snap and suddenly cannot use a body part, your tendon may have completely torn, which requires immediate medical attention^[3].

Causes and risk factors

Tendon disorders usually develop when you put too much mechanical stress on a tendon. This leads to small injuries and reduced blood supply to the area. Over time, scarring and calcium deposits can occur in the tendon tissue^[5].

The most common cause is overusing your tendon through repetitive movements^[2][7]. Athletes can strain their tendons by training too intensely. People who aren’t regularly active can strain a tendon by suddenly increasing their activity. Any task repeated too often without enough rest in between can cause problems^[2].

Common activities that can lead to tendon disorders include^[1][2][5][6]:

• Playing sports like tennis, golf, baseball, basketball, volleyball, or running
• Gardening and landscaping
• Woodworking and carpentry
• Shoveling
• Painting
• Scrubbing
• Typing or using a computer mouse for long periods
• Sewing
• Weight training

Other factors that can contribute to tendon problems include^[2][5][7]:

• Poor posture or technique during activities
• Lack of flexibility or strength
• Muscle imbalances
• Problems with how you walk or stand
• Poor equipment or workspace setup
• Foot deformities or unsuitable shoes
• Putting too much weight on a tendon
• Sudden movements or strain
• Direct injury

Your risk of developing tendon disorders increases with^[5][7]:

• Age: After age 40, your tendons tolerate less stress, are less elastic, and tear more easily
• Certain medical conditions including diabetes, rheumatoid arthritis, gout, osteoarthritis, and autoimmune diseases
• Being overweight
• Smoking

Some medications can cause tendon damage as a side effect, including fluoroquinolone antibiotics (a type of antibiotic), corticosteroids (anti-inflammatory medicines), and statins (cholesterol-lowering drugs)^[2][7].

Diagnosis

A healthcare provider will diagnose tendon disorders by taking your medical history and performing a physical exam^[8][9]. During the exam, your provider may press on the affected area and move your joint into different positions to see which movements cause pain.

In many cases, the history and physical exam are enough to make a diagnosis. However, your provider may sometimes use imaging tests to help confirm the diagnosis or rule out other conditions^[9][12]:

X-rays can show bone spurs, arthritis, or other potential causes of your pain. They help rule out conditions that might have similar symptoms^[9][12].

Ultrasound uses sound waves to create images of your tendons and surrounding structures. It can show tears, swelling, or other abnormalities in the tendon^[9][12].

Magnetic resonance imaging (MRI) uses radio waves and a magnetic field to create detailed images of the affected area. An MRI can show damage to tendons and surrounding tissues in great detail^[9][12].

Treatment options

The goals of treating tendon disorders are to relieve pain, reduce irritation, and prevent future problems^[3][9]. Most tendon disorders can be treated without surgery. Rest and avoiding activities that worsen symptoms help tendons heal^[7].

Self-care and RICE method

For the first two to three days after symptoms begin, follow the RICE method^[18][22]:

• Rest: Try to avoid moving the tendon and stop activities that increase pain or swelling
• Ice: Put an ice pack wrapped in a towel on the tendon for up to 20 minutes every two to three hours
• Compression: Wrap an elastic bandage around the area or use a support brace. It should be snug but not tight, and should be removed before sleeping
• Elevation: Prop the affected area above the level of your heart to reduce swelling

Rest is very important and should continue for at least three to six weeks to allow the tendon to heal^[5]. Full recovery might take several months^[14].

Immobilization

Keeping the injured area from moving can speed healing. Depending on the location of the problem, your provider may recommend a brace, splint, or boot^[18][22].

Medications

Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), acetaminophen (Tylenol), or aspirin can help ease pain^[12][14]. These nonsteroidal anti-inflammatory drugs (NSAIDs) and other pain medicines provide short-term relief and can help you complete physical therapy exercises, even though research shows little inflammation is actually present in chronic tendon problems^[13][15].

Pain-relieving creams or gels applied to the skin can also help and may avoid side effects like stomach upset that can occur with oral medications^[12][14].

Corticosteroid injections near the affected tendon can help ease pain in the short term^[15]. However, repeated steroid shots can weaken a tendon and increase the risk of the tendon tearing, so they should be used carefully and not for long-term treatment^[12][14].

Physical therapy and exercises

Physical therapy exercises can help strengthen the muscle and tendon, restore range of motion, and improve flexibility^[3][18][22]. Early initiation of rehabilitative exercises is beneficial^[15].

Eccentric strengthening exercises, which emphasize contracting a muscle while it’s lengthening, are particularly effective for many chronic tendon conditions including rotator cuff problems, tennis elbow, patellar tendinopathy, and Achilles tendon problems^[12][15]. These exercises help the tendon gradually get used to normal amounts of strain again^[5].

Once you can move the injured area without pain, it’s important to keep moving it so the joint doesn’t become stiff^[26].

Other treatment options

Topical nitroglycerin patches can reduce tendon pain associated with activity when used consistently^[15].

Extracorporeal shock wave therapy uses vibration to stimulate healing. Research shows it may help with plantar fasciitis (heel pain), hip pain, and calcific rotator cuff problems that don’t respond to initial treatment. However, it has no clear benefit for non-calcific rotator cuff problems or tennis elbow^[15].

Platelet-rich plasma (PRP) injections involve taking a sample of your own blood, processing it to concentrate healing factors, and injecting the solution into the area of chronic tendon irritation. While research is ongoing to find the best way to use this treatment, it has shown promise for many chronic tendon conditions^[14].

Custom orthotics (specially made shoe inserts) can reduce strain and stress on specific tendons in your feet and ankles by changing your foot position^[18][22].

Physical therapy modalities such as ultrasound (which uses vibration to warm tissue and increase blood flow) and massage may also be options^[6].

Surgery

Surgery is usually considered only when other treatments haven’t worked or if you’ve completely torn a tendon^[3][18][22]. Surgery may be needed to remove damaged tissue or repair a ruptured tendon^[12]. Because surgery carries risks and requires recovery time, it remains the last option^[13].

Prevention

You cannot always prevent tendon disorders, but you can reduce your risk^[26]:

• Warm up before exercising and gently stretch afterwards
• Listen to your body and rest if you feel a dull ache or stiffness
• Take regular breaks from repetitive activities
• Avoid overexercising tired muscles
• Don’t start a new sport without some training or practice
• Maintain proper posture and technique during activities
• Use proper equipment and maintain good workplace ergonomics
• Wear supportive shoes or insoles for exercise
• Gradually increase activity levels rather than making sudden changes

If you feel discomfort when making certain motions or bearing weight on any limb, don’t wait to seek care. Addressing tendon problems early helps protect the tendon from further damage, shortens healing time, and decreases discomfort^[24].