What is Tendinosis?

Tendons are the cords or bands of thick, fibrous tissue that attach muscles to bones. Tendinosis (also spelled tendonosis) is a chronic condition characterized by the degeneration of collagen in the tendons. Tendinosis symptoms might feel like pain or stiffness when you try to move or touch the affected area. There may also be a visible bump on the affected area.

Tendinosis develops from overuse of the tendon. It can occur in any tendon, but is most common in the following tendons:

• Knee (patellar tendon)
• Heel (Achilles tendon)
• Elbow
• Wrist
• Shoulder

People sometimes confuse tendinosis with tendonitis, but there is an important distinction between the two conditions. In tendonitis, the tendon becomes swollen and inflamed and results from micro-tears that happen when the tendon is overloaded from a force that’s too heavy or too sudden. Tendonitis is an acute injury that usually resolves with rest and physical therapy. 

In contrast, tendinosis is a degenerative condition, which if left untreated, will worsen over time. There is no inflammation with tendinosis, rather a gradual wearing down of the tendon itself. In tendinosis, the tendon fibers are disorganized and appear hard, thickened, scarred, and rubbery. Additionally, if tendonitis is left untreated, it can develop into tendinosis. 

The distinction between these two conditions is important because it will dictate the type of treatment used. A doctor will use a muscular skeletal ultrasound to diagnose tendonitis from tendinosis.

Signs and Symptoms

Symptoms of tendinosis include:

• Pain and stiffness in the affected area
• Burning sensation in the affected area
• Loss of range of motion, or restricted joint movement
• Pain that worsens during or after activity
• In some instances, an appearance of a tender lump
• Pain that persists over several months

Consult with your healthcare provider if you are noticing any of these symptoms, and make sure to check with your doctor before starting any treatment regimen. 

Causes

The main cause of tendinosis is overuse of the tendon. It can also be caused by a physical trauma (car accident or fall) or sports injury. Certain professions, hobbies, and sports that require repeated stress on the tendon may cause tendinosis. 

Tendons take a long time to heal due to a lack of blood supply that would aid in healing. Repeated stress on the tendon without adequate time for healing increases the risk of developing tendinosis. Additionally, tendon problems are more prevalent in older adults because the joints become less flexible as we age. Arthritis also increases the risk for developing tendinosis. 

Most common causes include:

• Overuse of the tendon
• Certain professions, hobbies, or sports that require repeated stress on the tendon
• Physical trauma (car accident or fall)
• Aging (joints become less flexible)
• Arthritis

Diagnosis

To diagnose tendinosis, a doctor will conduct a physical examination, get a symptom history, and may recommend various imaging tests. In gathering your symptom history, you may be asked questions such as how long the pain has been there, where it’s located, what seems to aggravate it, and what the frequency and intensity of the pain is. 

During the physical exam, the doctor may check for range of motion, which will require you to move the joint. The doctor may also lightly push on the affected area. Additionally, it may be recommended to get an x-ray or imaging scans (MRI or ultrasound) to check for any structural damage, ruptures, or tears. 

Imaging tests

X-rays. In diagnosing tendinosis, x-ray images are often used to rule out other issues such as arthritis, stress fractures, or infection.

MRI. This machine uses magnets and computer processing to give a detailed image of the body’s internal structures and can show if there have been any structural changes to the tendon.

Ultrasound. This imaging test uses sound waves to generate an image that will show if there has been any thickening of the tendon

Treatment

Tendons can take a significant amount of time to heal. Treatment is aimed at expediting the body’s natural healing process. On occasion, tendinosis may require surgery, but usually nonsurgical options are effective. Treatment options include:

• Resting. Rest the affected tendon as much as possible, specifically avoiding repetitive movements of the tendon. This may mean taking 15-minute breaks in between activities that require repetitive movements on the tendon.
• Massaging. Massaging the affected area promotes healthy circulation, which contributes to the healing process.
• Stretching. Light and gentle stretching contributes to better range of motion and circulation.
• Strengthening. Light and slow eccentric strength training.
• Icing. Reduces swelling and inflammation and can offer pain relief.
• Braces or tape. This helps to reduce stress on the tendon.
• Making ergonomic and biomechanical adjustments. Adjusting the chair you sit on, keyboard you type on, and adjusting your body position and posture helps to reduce stress and pressure on the tendon.
• Move affected area through normal range of motion. This helps to promote circulation and keep the muscles from shortening.
• Physical therapy. A trained professional will be able to create a treatment plan that will help with the healing process. 

Other treatment options include:

• Extracorporeal shockwave therapy (EWST). This type of therapy applies pressure waves to the surface of the skin, which may help to regenerate tissue and contributes to the healing process.
• Corticosteroid injections. This provides a temporary relief from swelling and pain but has potential to weaken collagen production.
• Platelet-rich plasma (PRP) injections. This procedure uses the patient’s own blood and injects it into the affected tendon to promote cell repair and healing.
• Surgery. Less commonly used to treat tendinosis, but can be done to remove the damaged tissue, which can alleviate pain and promote healing.