Chronic Tendinitis


Do you suffer from tennis elbow or Achilles tendinitis? If you do, then are one of the many Americans that suffer from what is referred to in the medical world as a tendinopathy, which means “disease of the tendon.”

Tendon pain or tendinopathy is a common injury in athletes, but it can also develop in non-athletes. Tendinopathy which is often times referred to as tendinitis, especially when chronic can be difficult to treat and typically interferes not only with sporting activities but also normal daily activities and a person’s quality of life. From a diagnostic standpoint healthcare providers for decades referred to tendon pain as tendinitis (the “itis” refers to inflammation being present) but we now know that in the overwhelming majority of cases tendon inflammation cannot be found. Therefore, the term tendinitis has been replaced by the word tendinosis. Let’s learn a little bit about tendon pain or tendinopathy.

What is Tendinopathy

What we know about tendinopathy comes mainly from surgical biopsies taken from athletes with chronic tendon pain who have failed conservative treatment and undergone surgery to repair the tendon. Surprisingly, researchers did not find inflammation but instead chronic degenerative changes in tendon such as scarring and/or a failed healing response with thickening of the tendon.

With the increased participation in recreational sporting activity, particularly among middle-aged and older adults, has been an increased incidence of overuse tendinopathies. As we get older our tendons take longer to repair after a vigorous workout. Combine this with the perception that we are still 25 years old and well it becomes a recipe for injury.

There is an increased incidence of overuse tendinopathies over the age of 35 including Achilles tendinitis, tennis elbow, golfer’s elbow and rotator cuff tendinitis in throwing athletes and manual laborers.

Causes of Tendon Pain

There are multiple factors that can be involved in overuse tendinopathies the most common being a sudden increase in training load (e.g.  playing too many games of tennis in the same day or week) without adequate rest to allow the tendon to recover and repair itself. An example of this would be a runner who decides to double his/her running distance from one week to the next in order to get ready for an upcoming event. One of the reasons that tendons take longer to heal after a hard workout is that they inherently have poor blood supplies. This in sharp contrast to muscles that while they can get very sore after a training session they repair themselves within a few days because they have a great blood supply.

Clinical Findings

Clinical findings often include pain with palpation of the tendon or with loading of the tendon. Superficial tendons like the Achilles often times will demonstrate noticeable thickening. In the shoulder the thickening is not readily observable but clinically it causes a problem as the enlarged tendon impinges on the surrounding tissues in what is know was the subacromial space resulting in pain.

Diagnostic imaging with ultrasound or MRI can confirm the diagnosis of tendinosis. Other changes that can be seen include tears in the tendon, bone spurs, enthesophytes (abnormal bony projections at the attachment of a tendon or ligament), and calcium within the tendon itself (calcific tendinitis in the rotator cuff).

Most of my patients that are seen for tendon pain are in the chronic stage (over three months of symptoms). Those that have had pain for more than 6 months often times will not improve without some type of medical intervention such as physical therapy, percutaneous tenotomy (Tenex procedure) or surgery. That is not to say that healing cannot occur going forward of if left untreated, however, it can take up to two years and sometimes longer.