Tendon Injury

Tendon injuries are a widespread problem that can affect anyone, from athletes to office workers, impacting the tough fibers connecting muscles to bones and causing pain that can last for months if not properly managed.

Table of contents

• What is a tendon injury?
• What causes tendon injuries?
• Signs and symptoms
• How are tendon injuries diagnosed?
• Treatment options
• How to prevent tendon injuries
• Healing time and recovery

What is a tendon injury?

Tendons are tough, flexible bands of tissue that connect your muscles to your bones, allowing you to move your joints and limbs^[1]. When these fibers become irritated or damaged, the condition is called a tendon injury, also known as tendinopathy^[1].

The term tendinopathy is the most accurate way to describe tendon pain and dysfunction. While people often use the word tendonitis, suggesting inflammation, research shows that most chronic tendon problems actually involve a degenerative process where the tendon fails to heal properly rather than active inflammation^[4].

Tendinopathy, Tendonitis, Tendon tear, Tendon rupture, Tendon damage

The areas most commonly affected by tendon injuries include the shoulder, elbow, wrist, hip, knee, and ankle^[1]. In the United States, tendon injuries account for at least 7% of all physician visits, with more than 30% of sports-related injuries involving tendons^[17]. Each year, more than 16 million tendon and ligament injuries are reported across the country^[18].

What causes tendon injuries?

Most tendon injuries result from gradual wear and tear over time due to overuse or aging^[1]. The condition develops when you repeatedly stress a tendon without giving it enough time to rest and recover between uses.

People who perform the same motions over and over in their jobs, sports, or daily activities face a higher risk of damaging a tendon^[1]. This includes athletes who play tennis, golf, or basketball, as well as workers whose jobs involve repetitive movements like painting, woodworking, gardening, or using hand tools^[8].

A tendon injury can happen suddenly or develop little by little. If a tendon has been weakened over time through repeated use, you become more likely to experience a sudden, acute injury^[1]. Sudden tendon ruptures can occur from an accidental twist or turn in the wrong direction, or from injury by a sharp object^[6].

With advanced age, tendons become more prone to degeneration and injuries^[4]. After age 40, tendons tolerate less stress, become less elastic, and tear more easily^[15]. Certain health conditions can also increase your risk, including diabetes, rheumatoid arthritis, gout, and osteoarthritis^[15].

Signs and symptoms

Tendon injuries typically cause pain with a gradual or insidious onset. Most patients report that a change in their activity pattern affected how they use the tendon^[17].

Common symptoms include^[1]:

• Pain, tenderness, redness, warmth, and swelling near the injured tendon
• Pain that gets worse when you use the tendon or are active
• Stiffness and loss of strength in the affected area
• Pain and stiffness that may be worse during the night or when you get up in the morning
• Crepitus, a crunchy sound or feeling when you use the tendon, which is usually uncomfortable or painful
• Stiffness in the joint near the affected area, though movement or mild exercise of the joint usually reduces this stiffness

The symptoms may affect just the spot where the injured tendon is located, or they may spread out from the joint area^[1]. If you rupture a tendon completely, you’ll typically feel a sharp pain followed by a snap or popping sensation, which can make you unable to use the affected body part^[8].

A tendon injury typically gets worse if the tendon isn’t allowed to rest and heal. Too much movement may make your symptoms worse or bring the pain and stiffness back^[1].

How are tendon injuries diagnosed?

Your doctor will diagnose a tendon injury based on your medical history, symptoms, and a physical examination^[1]. During the exam, the doctor will check your overall health, areas of pain and tenderness, range of motion, and strength. The examination may also include checking your nerve function, such as feeling and reflexes, and blood circulation through checking your pulses^[1].

If your injury relates to using a tool or sports equipment, your doctor may ask you to demonstrate how you use it^[1]. This helps identify movements or techniques that might be contributing to your tendon problem.

If your symptoms are severe or don’t improve with initial treatment, your doctor may order imaging tests^[1]:

• X-rays can show bone-related problems or deposits of calcium in tendons or joint structures
• MRI (Magnetic Resonance Imaging) can reveal small tears and areas of tendon, ligament, cartilage, and muscle injury
• Ultrasound can show thickening, swelling, or tears in soft tissues such as tendons

Treatment options

Treatment for tendon injuries aims to relieve pain, reduce irritation, and allow the damaged tissue to heal. The approach depends on the severity and duration of your injury.

Initial home care

Treatment most often starts with home care methods^[1]:

• Rest: The most important step is to stop or reduce activities that stress the injured tendon. You may need to avoid these activities for about three weeks^[12]
• Ice: Apply ice or a cold pack to the sore area for 10 to 20 minutes at a time, trying to do this every 1 to 2 hours for the next 3 days while awake^[20]
• Over-the-counter pain medicines: Medications like ibuprofen, naproxen, or acetaminophen can help reduce pain^[1]

You can use the RICE method—Rest, Ice, Compress, and Elevate—to relieve discomfort and help your tendon heal faster^[21].

Physical therapy and exercises

Your doctor may suggest physical therapy, which plays a central role in tendon recovery^[1]. Once symptoms have improved, you can gradually start putting more stress on the tendon again through specific exercises^[12].

Eccentric exercises, which involve lengthening the tendon while it’s under tension, are particularly effective for promoting tendon healing and strengthening^[12]. These exercises are beneficial for treating rotator cuff tendinopathy, lateral epicondylitis (tennis elbow), patellar tendinopathy, and midsubstance Achilles tendinopathy^[17].

The exercises may hurt a little, but the pain should only occur while stretching and not be worse afterward than before. It’s important to have a physical therapist show you how to do the exercises properly^[12].

Medical interventions

If home care and physical therapy don’t provide enough relief, your doctor may recommend:

• Prescription medications: Stronger pain relievers or anti-inflammatory drugs
• Corticosteroid injections: These can help relieve pain and swelling in the short term, though they should be used carefully near major load-bearing tendons due to a small risk of tendon rupture^[17]
• Immobilization devices: A brace, splint, sling, or crutches may be prescribed for severe or long-lasting injuries to allow tendons to rest and heal completely^[1]
• Topical nitroglycerin: With consistent use, this can reduce tendon pain associated with activity^[17]
• Extracorporeal shock wave therapy: This may benefit certain conditions like plantar fasciitis and calcific rotator cuff tendinopathy that resist initial treatment^[17]

Surgery

Surgery may be necessary if it’s too difficult to repair the tendon with physical therapy alone, or if the tendon has completely ruptured^[6]. During tendon repair surgery, the torn tendon is stitched back together through an incision^[18].

How to prevent tendon injuries

You can take several steps to lower your chances of developing a tendon injury^[8]:

• Warm up and stretch: Always take time to warm up before exercise and stretch afterward^[1]
• Modify activities: Try changing what activities you do or how you do them. For example, if running caused the injury, try swimming some days. If using a tool causes problems, try switching hands or changing your grip^[1]
• Use proper technique: If exercise caused the problem, take lessons or ask a trainer to check your technique^[1]
• Listen to your body: If you feel a dull ache or stiffness, let that area rest before symptoms worsen^[21]
• Stay physically fit: Regular exercise and building muscle tone help protect tendons^[8]
• Maintain proper posture: Good posture during daily activities reduces stress on tendons, especially in the wrist and elbow^[19]
• Avoid smoking: Smoking can slow tendon healing^[20]

Healing time and recovery

Tendon healing is a complex and gradual process. Understanding the timeframe can help you plan your recovery appropriately^[25].

Tendon healing occurs in three broad stages^[25]:

1. Inflammatory stage: Lasts approximately 1 to 7 days after injury. During this phase, it’s crucial to protect the injured tendon and manage pain and swelling
2. Repair stage: Extends from 1 to 6 weeks after the injury. The body creates new collagen fibers to bridge the gap in the damaged tendon. Physical therapy and targeted exercises often begin during this stage
3. Remodeling stage: Can last from several weeks to months or even years. The newly formed collagen fibers gradually mature and strengthen. Continuing exercises throughout this phase is essential

Tendon injuries normally take 12 to 16 weeks to heal, depending on the type and severity of the tear or injury^[6]. However, full tendon recovery can take 3 to 4 months or longer^[16]. Even after you return to full activity, your tendon may take 1 to 2 years to have the same tensile strength as the healthy side^[23].

Waiting too long to repair a torn or injured tendon can delay recovery time and possibly cause more scar tissue to develop^[6]. This is why seeking medical care early is important if you suspect a tendon injury.

Because tendons receive a lower blood supply than muscles, they heal more slowly^[4]. During recovery, it’s important to be patient and consistent with your rehabilitation routine, as improvements occur gradually over time rather than week to week^[23].