What is tendonitis?
Tendonitis, or tendinitis, is a condition where tendons become swollen or inflamed. Tendons are fibrous tissues that connect muscle to bone or to another body part, such as an eyeball.
Tendons can become swollen, inflamed or damaged through injury or stresses created by overuse. Ageing can also lead to tendonitis as body tissues lose elasticity.
Tendon damage is not always present with inflammation. Where inflammation is absent, the condition is often referred to as tendinosis, rather than tendonitis. Tendonitis, tendinosis and tendon ruptures are all forms of tendinopathy, a general term to describe tendon degeneration.
Tendonitis is a common condition. People who take part in sport and exercise are more likely to develop tendonitis, as are people who perform repetitive actions, such as playing racket sports, running or typing.
Tendonitis will typically heal with appropriate treatment. The recovery time will depend on how severely the tendon is damaged and may take up to several months.
Symptoms of tendonitis
- Pain is feltalong a tendon, particularly near a joint
- Increased pain when moving the joint
- In the early stages, pain is only felt when the tendon is in use
- In the early stages, pain may go away after a warm-up exercise
- In later stages, pain may also be felt as a dull ache after the tendon is used
- Pain may be experienced as a burning sensation
Other symptoms of tendonitis can include:
- Tenderness around the joint
- Swelling of the joint area
- Thickening of the tendon
- Nodules on the tendon
- Crepitus, a grating sound or feeling, usually experienced in Achilles tendonitis
- Heel (Achilles tendonitis)
- Elbow (such as tennis elbow or golfer’s elbow)
- Knee (patellar tendonitis)
- Wrist and thumb (De Quervain’s tendinosis)
- Shoulder (rotator cuff tendonitis)
- Foot (posterior tibial tendonitis, peroneal tendonitis or extensor tendonitis)
- Hands (extensor tendonitis)
Causes of tendonitis
The most common cause of tendonitis is overuse of or injury to the tendon. This can arise from a number of activities, which include:
- Playing sport or exercising, particularly with poor technique or equipment
- Using a hard or high-friction surface to play sport
- Repetitive motions, such as lifting, gripping or twisting
- Lack of body flexibility
- Lack of cardiovascular conditioning
- Using some muscles more than others
- Accidents, such as falls
- Previous history of tendonitis
Repeated use of tendons is thought to be the primary cause of tendonitis. Tendonitis linked to overuse of a joint is a form of repetitive strain injury.
The Achilles tendon connects the calf muscle to the heel. Achilles tendonitis is most often caused by overuse or sometimes by injury.
- If there is a sudden increase in activity levels
- When running on hard surfaces
- Due to not wearing properly fitting footwear
- When calf muscles are tight
- During running or exercising to excess
- During repeated jumping
Achilles tendonitis can also be caused by bone spurs in the heel rubbing and irritating the tendon. This is more common in people with arthritis.
Tennis elbow (lateral epicondylitis)
Tennis elbow, also known as lateral epicondylitis, is caused by overuse of the tendons on the outside of the elbow. Although this condition is often called tennis elbow, it is related to excessive wrist flexing and is more common in people who do not play tennis.
- Playing racket sports, such as tennis
- Repetitive gripping, such as cutting meat, painting or using a screwdriver
In some cases, the cause of tennis elbow cannot be determined.
Patellar tendonitis, also known as jumper’s knee, affects tendons connecting the kneecap to the shinbone. It usually affects athletes in sports which require a lot of jumping, such as basketball or volleyball. It is caused by repeated stresses to the knee, particularly when jumping on hard surfaces.
Peroneal tendonitis can sometimes be misdiagnosed as an ankle sprain.
De Quervain’s tendonitis
De Quervain’s tendonitis affects tendons in the wrist and thumb. It causes pain and swelling in the thumb side of the wrist.
Tendonitis in the wrist and thumb occurs due to overuse of the wrist, through repetitive activities such as typing or scanning. Tendons for the thumb pass through a tunnel in the wrist. If these tendons, or their protective sheath, swell or become inflamed, it can put pressure on nerves and cause pain.
Pregnant people can also develop De Quervain’s tendonitis. It usually goes away four to six weeks after birth.
De Quervain’s tendonitis may be confused with carpal tunnel syndrome. For more information, see the resource on carpal tunnel syndrome.
De Quervain’s tendonitis can also be called De Quervain’s tenosynovitis and De Quervain’s tendinosis, as the condition is not technically tendonitis. Tendinosis is degeneration of the tendon without inflammation being present, and tenosynovitis is inflammation of the sheath covering a tendon.
Shoulder tendonitis (rotator cuff tendonitis)
The rotator cuff is a group of tendons and muscles around the shoulder joint. These tendons can develop tendonitis through overuse and age, as well as by rubbing against bone to become inflamed.
Activities that can cause tendonitis in the shoulder include:
- Repeatedly lifting the arm overhead, such as while painting, swimming, playing basketball or racquet sports, doing gymnastics
- Overuse of the shoulder in sports, such as while rowing and kayaking
- Keeping the arm in the same position for long periods of time, such as while typing
- Poor posture
- Sleeping on the same arm
Biceps tendonitis occurs around the front of the shoulder, in the long head of the biceps tendon. It often presents alongside tendonitis in the rotator cuff tendon. Biceps tendonitis can develop through overuse and age.
Activities that can cause tendonitis in the biceps include:
- Repeatedly lifting the arm overhead, such as while swimming or playing basketball or tennis
- Sudden overuse, more commonly seen in older people
Foot tendonitis (posterior tibial tendonitis)
Tendonitis in the foot, also known as posterior tibial tendonitis, posterior tibial tendon dysfunction or adult acquired flatfoot, occurs when the tendon connecting one of the calf muscles to the inside of the foot becomes damaged or inflamed.
Posterior tibial tendonitis can occur because of an injury or overuse. People at particular risk include:
- People who play high-impact sports, such as basketball or tennis
- Women over the age of 40
- People who are obese
Over time, damage to this tendon causes the arch of the foot to fall, also known as flat foot. This can create pain in other areas of the foot as the shape of the foot changes.
Extensor tendons are located in the backs of the hands and the top of the foot. There is little skin or protective tissue around them, and they are prone to damage, as the hands and feet are in almost constant use.
Extensor tendonitis is most commonly caused by overuse. Activities that can cause the condition include:
- Wearing shoes that are too tight
- Prolonged typing with force or without ergonomic support
- Being on one’s feet a lot
- Running uphill excessively, such as on a treadmill
- Playing a musical instrument
Hip tendonitis affects the tendons in the hip area, and may be accompanied by strain to the hip muscles. It can be caused by:
- Performing repetitive actions
- An injury or impact to the joint
- Exercising to excess
- Not warming up properly before exercise
The hamstring muscles are in the back of the thigh and allow the knee to bend. The hamstring tendons attach at the back of the knee. Hamstring muscles can be strained, resulting in pain at the back of the thigh, or the tendons can become inflamed, resulting in pain in:
- The back of the knee
- The back of the thigh
- Lower back
Hamstring tendonitis is generally caused by excessive overuse.
Diabetes and metabolic diseases
Diabetes and metabolic diseases, such as hyperparathyroidism and haemochromatosis, can lead to calcium deposits in the body, particularly around the shoulder area. This can irritate the tendons in the rotator cuff and cause tendonitis. This condition is known as acute calcific tendinitis.
If the bacteria that cause gonorrhea spread to the bloodstream and around the body, this creates a condition known as disseminated gonococcal infection. This condition usually causes tendonitis or joint pain as an early symptom.
Risk factors for tendonitis
There are a number of factors that can increase a person’s risk of developing tendonitis.
- Athletes, including anyone playing sport or exercising
Adults in middle age are more at risk of developing tendonitis. Tendons become weakened during a lifetime, due to everyday activities. Additional stresses can cause tendonitis in weakened and age-damaged tendons.
A person with a history of tendonitis is at risk of developing tendonitis again.
Diagnosing tendonitis is usually done by taking the person’s medical history and performing a physical examination.
During a physical examination, a healthcare professional will look for:
- Changes when the joint is moved
- X-ray, which does not show tendons, but can reveal abnormalities with bones that indicate tendon problems
- Ultrasound, which uses sound waves to create an image of a joint
- MRI, which uses magnets and radio waves to look inside the body, does show tendons and can be useful if surgery is needed
Treatment for tendonitis
There are various treatments for tendonitis which can reduce immediate pain and inflammation and also repair the tendon in the long run.
There are some simple treatments for non-severe tendonitis that do not involve pharmaceutical intervention.
Rest is necessary to allow the tendon to heal. It is important to reduce activities and, if possible, stop those which make the pain worse. When experiencing tendonitis, it may be necessary to rest the joint for three to six months, or potentially more, depending on the severity of the injury. There are no set recommendations for the duration of rest, but people should restrict painful activities for as long as necessary.
Wearing a brace, splint or strap may help keep the joint from being used. A sling may be helpful for shoulder tendonitis.
Cooling a swollen and painful joint with ice is a common home remedy for tendonitis. Ice can numb the skin and provide short-term pain relief in the first 24-48 hours if the condition first occurs as a sudden injury. However, there is a lack of evidence to show whether using ice is helpful for long-term tissue repair.
Physical therapy to reduce stress on tendons by strengthening surrounding muscles may be helpful for tendonitis conditions such as tennis elbow and Achilles tendonitis. A physiotherapist can identify the best exercises for a particular injury, such as gentle stretches and strengthening exercises.
Strengthening and stretching exercises should not be attempted until after the pain has gone. Exercises that focus on lengthening muscles, known as eccentric training, can be beneficial for tendonitis.
Physical therapy can help the healing process and make future episodes of tendonitis less likely. Physiotherapy will also typically be recommended to strengthen joints after any surgery.
Ultrasound and TENS therapy
Some practitioners offer ultrasound or Transcutaneous electrical nerve stimulation (TENS) treatment for tendonitis. However, there is no evidence that these treatments offer any benefit over placebo or standard care plans of rest and physical therapy.
Pain-killing medication may be useful in the short term to manage the pain of tendonitis. Medication should be used to ease any pain felt while resting the joint as it heals. Any attempt to mask pain while continuing with activity will risk damaging the tendon further.
Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help where the tendon is swollen. However, not all cases of tendonitis are inflammatory and may instead be caused by degeneration of the tendon. In such cases, painkillers such as paracetamol may be as effective. A doctor will be able to advise on the most appropriate option. Painkillers should only be taken for a limited period of time.
Corticosteroid injections into the site of tendonitis can provide short-term pain relief. Injections are administered by a health professional and can offer relief from pain for up to 48 hours.
Injections of corticosteroids should never be given to the heel as they are thought to increase the chance of Achilles tendon rupture. Ruptures of the Achilles tendon have been reported after a single use of corticosteroid injections. Repeated injections into the same site or into a tendon should be avoided as this can also increase the risk of tendon rupture.
Tendonitis that does not respond to rest, painkillers or physical therapy may be referred for surgery. The type of surgery will depend on the location and severity of the condition. Types of surgery that may be suggested include:
- Debridement and repair, which is the removal of damaged parts of the tendon. This is performed if less than 50 percent of the tendon is damaged.
- Debridement with tendon transfer, which is performed when more than 50 percent of the tendon is damaged. The remaining tendon is supported with tendon tissue moved from elsewhere in the body. In Achilles surgery, for example, tendon tissue is taken from the big toe.
- Releasing the sheath or pulley, which is performed for De Quervain’s tendonitis and other tendonitis conditions of the hand and wrist, where a mechanical problem is preventing the tendon from functioning normally.
Surgery for tendonitis is rare, as cases usually improve with rest and non-surgical treatment.
Complications of tendonitis
If tendonitis is left untreated, the affected tendons may rupture. A rupture occurs when the tendon partially or completely tears away from the bone. Without treatment, a tendon rupture could result in permanent disability.
- Warming up and stretching before exercising
- Avoiding using joints in a repetitive motion as much as possible
- Strengthening muscles with exercise to provide support to joints and tendons
- Easing into new, strenuous activity
- Providing padding or cushioning for joints at risk of tendonitis
- Maintaining good posture to keep joints in the correct position
- Not continuing with activities that cause pain
Q: Are tendonitis and tennis elbow the same thing?
A: Tennis elbow is a form of tendonitis called lateral epicondylitis. It is caused by overuse of the tendons on the outside of the elbow. (See Causes of tendonitis.)
Q: How do you cure tendonitis?
A: Unless the tendonitis is severe enough to need surgery, time, rest and physiotherapy exercises should be enough to heal it. How long a person needs to rest and what will help the process, depends on how damaged the tendon is. (See Treatment for tendonitis.)
Q: How do I ease the pain of tendonitis?
A: If possible, reduce use of the joint that has tendonitis and rest it. A brace or splint can help stop the joint moving while it heals. If pain persists, painkillers such as ibuprofen or paracetamol can help for a short period of time. Putting ice on the joint can also provide temporary relief. Severe pain in some joints can be treated with corticosteroid injections. (See Treatment for tendonitis.)
Q: Can tendonitis go away?
Tendonitis can go away if the affected joint is rested. Continuing with activities that put strain on the affected tendon will not allow the tissue to heal, and risks making the condition worse.
US National Library of Medicine. “Tendinopathy: Why the Difference Between Tendinitis and Tendinosis Matters.” March 2012. Accessed May 28, 2018. ↩ ↩
American Family Physician. “Diagnosis and Treatment of Biceps Tendinitis and Tendinosis.” September 2009. Accessed May 2, 2018. ↩ ↩
US National Library of Medicine. “Posterior Tibial Tendon Dysfunction: An Overlooked Cause of Foot Deformity.” March 2015. Accessed May 2, 2018. ↩
British Journal of Sports Medicine. “Is there an association between tendinopathy and diabetes mellitus? A systematic review with meta-analysis.” July 2016. Accessed May 2, 2018. ↩
US National Library of Medicine. “Cigarette smoking and musculoskeletal disorders.” June 2013. Accessed May 2, 2018. ↩
US National Library of Medicine. “Is ice right? Does cryotherapy improve outcome for acute soft tissue injury?” February 2008. Accessed May 2, 2018. ↩
US National Library of Medicine. “Patellar tendinopathy in athletes: current diagnostic and therapeutic recommendations.” 2005. Accessed May 2, 2018. ↩