What is Tendinitis & Tendinosis?

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Tendinitis refers to inflammation of a tendon. Tendons are strong bands of connective tissue that attach muscles to bones. It is more commonly associated with a relatively acute tendon injury or irritation, although inflammation may also be present to varying degrees in chronic tendon disorders. Common examples include achilles tendinitis, patellar tendinitis ("jumper's knee"), wrist tendonitis, and rotator cuff tendinitis.​

Tendinosis refers to chronic degenerative changes within a tendon. Rather than being primarily an inflammatory condition, the tendon develops changes in its collagen structure and ability to tolerate load. The broader term tendinopathy is often used  because tendon pain may involve both conditions. 

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Common Causes and Risk Factors

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• Repetitive movements

• Sudden increases in exercise or training intensity

• Excessive running, jumping, throwing, or lifting

• Poor technique or biomechanics

• Inadequate recovery between activities

• Occupational repetitive movements

• Reduced tendon flexibility or strength

• Previous tendon injury

• Increasing age

• Certain medical conditions, including diabetes and inflammatory disorders

• Certain medications such as fluoroquinolone antibiotics have been associated with tendinitis and tendon rupture. Systemic corticosteroid exposure may increase risk too. 

Common Tendinopathies
 

Tennis Elbow — Lateral Epicondylitis
 

Location: Outer portion of the elbow.

Tennis elbow is an overuse injury involving the tendons of the forearm muscles that extend the wrist and fingers, most commonly near their attachment to the lateral epicondyle.

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It can occur with:
 

• Racquet sports

• Repetitive gripping

• Manual labor

• Frequent use of hand tools

• Repetitive wrist extension
   

Symptoms commonly include pain and tenderness on the outside of the elbow, particularly with gripping, lifting, or extending the wrist against resistance.
 

Golfer's Elbow — Medial Epicondylitis
 

Location: Inner portion of the elbow.

Golfer's elbow involves the tendons of the forearm muscles that flex the wrist and assist with gripping and forearm rotation.

It may occur with:
 

• Golf

• Weightlifting

• Manual labor

• Repetitive wrist flexion or forearm rotation

Pain and tenderness typically occur on the inside of the elbow and may worsen with gripping or resisted wrist flexion.
 

Rotator Cuff Tendinopathy
 

Location: Shoulder.

The rotator cuff consists of several muscles and tendons that stabilize and move the shoulder.
 

Symptoms may include:
 

• Pain when raising the arm

• Pain with reaching overhead or behind the back

• Pain when lying on the affected shoulder

• Pain or weakness with certain shoulder movements

Rotator cuff tendinopathy may occur with repetitive overhead activity, sports, occupational use, age-related tendon changes, or other shoulder conditions.

Biceps Tendinopathy
 

Location: Usually the front of the shoulder.

The long head of the biceps tendon can become painful from repetitive loading or in association with other shoulder disorders.

Symptoms may include pain in the front of the shoulder that worsens with lifting, pulling, or overhead activity.
 

De Quervain Tenosynovitis

Location: Thumb side of the wrist.

This condition involves irritation and thickening around tendons that move the thumb.

Symptoms commonly include:
 

• Pain near the base of the thumb

• Pain with gripping or pinching

• Pain when lifting objects

• Pain with repetitive thumb and wrist movement

Despite being grouped with common tendon overuse disorders, de Quervain tenosynovitis primarily involves the tendon sheath rather than being a classic tendinosis.

Positive Finkelstein test = you make a fist with your thumb tucked inside your fingers, then bend your wrist down toward the floor.

Patellar Tendinopathy — Jumper's Knee
 

Location: Usually just below the kneecap.

The patellar tendon connects the kneecap to the tibia and is repeatedly loaded during jumping, running, and forceful knee extension.

Symptoms commonly include pain near the lower portion of the kneecap, particularly during:
 

• Jumping

• Running

• Squatting

• Stairs

• Sports involving repeated acceleration and deceleration

Achilles Tendinopathy
 

Location: Back of the ankle within tendon or at heel insertion.

Achilles tendinopathy commonly develops from repetitive loading associated with running, jumping, or sudden increases in activity.

Symptoms may include morning stiffness, tenderness, tendon thickening, and pain during or after activity.
 

A sudden pop, severe pain, or inability to push off normally may indicate an Achilles tendon rupture rather than routine tendinopathy and requires prompt evaluation.

Gluteal Tendinopathy
 

Location: Outer portion of the hip.

The gluteus medius and minimus tendons can become painful where they attach near the greater trochanter.
 

Symptoms may include:
 

• Pain on the outside of the hip

• Pain when lying on the affected side

• Pain with prolonged walking or standing

• Pain climbing stairs

• Pain with certain hip movements

Gluteal tendinopathy is a common component of greater trochanteric pain syndrome.

Hamstring Tendinopathy
 

Location: Commonly near the lower buttock where the hamstring tendons attach to the pelvis.

Symptoms may include deep buttock pain that worsens with:

• Running

• Sprinting

• Lunging

• Prolonged sitting

• Activities that heavily load the hamstrings

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Common Symptoms

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• Pain over or near a tendon

• Pain that worsens with use of the affected muscle or tendon

• Tenderness when the area is touched

• Morning stiffness or stiffness after inactivity

• Pain when beginning an activity that may temporarily improve as the tendon warms up

• Swelling or thickening around the tendon

• Reduced strength or function

• Difficulty performing repetitive activities

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Diagnosis

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-Tendinitis and tendinopathy can often be diagnosed through a medical history and physical examination.

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-Imaging is not always necessary. However, ultrasound, X-rays, or MRI may be used. X-rays do not show tendons well but may help identify other causes of pain, such as arthritis, fractures, calcification, or certain bone abnormalities.

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Treatment
 

-Physical Therapy
 

• Range-of-motion exercises

• Stretching when appropriate

• Isometric exercises

• Eccentric strengthening

• Slow resistance exercises

• Progressive strengthening

• Gradual return to sport or normal activity

• Correction of contributing movement or training problems

The goal is not simply to "rest the inflammation." Tendons generally need appropriately dosed mechanical loading to regain strength and improve their ability to tolerate activity.

Improvement can be gradual. Chronic tendinopathy may require several weeks to several months of rehabilitation.
 

-Ice = may provide temporary pain relief, particularly following activity or during an acute flare.

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-Pain Medications = NSAIDs (ibuprofen, naproxen) as needed, acetaminophen as needed, or duloxetine daily.

-Corticosteroid Injections = Corticosteroid injections may provide short-term pain relief for certain tendon-related conditions, but they can potentially weaken tendon tissue, particularly with repeated injections. Injection directly into the tendon itself is usually never performed. The potential benefits and risks depend heavily on the tendon involved and the specific diagnosis.

-Other treatments:
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• Bracing, splinting, taping, or orthotics when appropriate

• Extracorporeal shock-wave therapy for selected chronic tendinopathies

• Specialist evaluation

• Surgery for selected severe tendon injuries or persistent symptoms

Pain Near a Tendon Does Not Always Mean Tendinopathy
 

Other conditions can produce similar symptoms, including:

• Muscle strains

• Ligament injuries

• Bursitis

• Arthritis

• Stress fractures

• Nerve compression

• Tendon tears

• Growth-plate injuries in children and adolescents
   

Tendon Tears and Ruptures
 

A tendon can sometimes partially or completely tear. Seek prompt medical evaluation for:
 

• A sudden "pop" or snapping sensation

• Sudden severe tendon pain

• Significant bruising or swelling

• Sudden loss of strength

• Inability to perform a movement that was previously possible

• Inability to push off the foot normally

• A visible or palpable abnormality in the tendon

A complete tendon rupture may require urgent orthopedic evaluation and, depending on the tendon and patient, surgical or nonsurgical treatment.

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Prevention

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• Increasing exercise intensity gradually

• Stretching and preworkout warmups 

• Allowing adequate recovery

• Strengthening muscles and tendons progressively

• Using appropriate technique

• Avoiding abrupt increases in running, jumping, lifting, or throwing volume

• Addressing equipment or biomechanical problems when relevant

• Returning gradually after an injury or prolonged period of inactivity

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                                                      References & Guidelines
 

• American Academy of Orthopaedic Surgeons (AAOS)

• American College of Sports Medicine (ACSM)

• American Physical Therapy Association (APTA)

• U.S. Food and Drug Administration (FDA) — Fluoroquinolone antibiotic safety information

• Current evidence-based orthopedic and sports-medicine literature on tendinopathy diagnosis and rehabilitation

This information is intended for general patient education and does not replace an individualized medical evaluation, diagnosis, or treatment plan.