Tendinitis: Symptoms, Causes, Treatment & Prevention
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Introduction
Tendinitis is inflammation or irritation of a tendon 1,9,10. Tendons are strong cords that connect muscles to bones and help the body move 9,10.
Tendinitis can cause pain, tenderness, swelling, stiffness, weakness, and reduced movement near a joint 9,10. Pain often gets worse when the tendon moves or carries a load 7,9.
Repeated movement, sudden strain, and sharp increases in activity can trigger tendon pain 1,9,10. However, long-term tendon pain may involve failed healing and tissue wear instead of inflammation alone 1,8.
This guide covers tendinitis symptoms, causes, treatment, recovery, and prevention. It also explains when tendon pain needs medical care.
Overview: What Tendinitis Is and Where It Occurs
Tendinitis, tendinopathy, and tendinosis
Tendinitis describes an inflammatory response within an irritated tendon 1,9. The term often refers to new or sudden swelling and irritation 9.
Tendinopathy is a broad term for tendon pain and poor function 1,2. It may also cause a lower ability to tolerate exercise 2. The term does not point to one exact tissue change 1.
Tendinosis describes tendon wear with little or no inflammation 1. It can result from poor healing after repeated small injuries 1. Chronic tendinopathy often involves failed healing rather than inflammation alone 1,8.
Later tendon changes may include uneven collagen fibers and greater numbers of small blood vessels 2. Nerve changes and tendon cell loss may also occur 2. These changes can affect tendon strength and function 1,2.
The words tendinitis and tendinopathy often overlap in daily use 1,9. Yet the difference can shape the treatment plan. Anti-inflammatory care alone may not address the failed healing seen in chronic tendon pain 1,8.
Common tendons and body areas affected
Tendinitis can affect any tendon 9. Common sites include the shoulder, elbow, wrist, hip, knee, and heel 9,10.
Common types and locations include:
Rotator cuff tendons surround the shoulder and help move the arm 9.
Elbow tendon pain can follow repeated wrist, forearm, or arm movements 9.
Wrist or thumb pain may develop near the base of the thumb 10.
Gluteal tendon pain affects tendons near the hip 2.
The patellar tendon connects the kneecap to the shinbone 9.
The Achilles tendon connects the calf muscles to the heel bone 9.
Rotator cuff injuries often follow overhead movement or heavy lifting 9. Patellar tendon problems are common in sports that involve frequent jumping 9. Achilles problems may follow overuse or a sharp increase in running intensity 9.
New inflammation and long-term changes
A tendon injury may start with sudden overload, repeated strain, or chemical irritation 1. Acute tendinitis can involve inflammation, pain, swelling, and reduced function 1.
Chronic tendon pain often starts slowly after a change in activity 8. Many people with tendinopathy report symptoms lasting several months 7.
Long-term treatment often focuses on safe exercise and better function 5,8. This approach aims to raise the tendon’s ability to manage physical loads 5,8.
Symptoms and Warning Signs
Common pain and movement symptoms
Localized tendon pain is a common feature of tendinitis 9,10. The pain often feels like a dull ache 9. Movement or mechanical loading can make it worse 7,9.
Other tendinitis symptoms may include:
Tenderness can occur around the tendon or where it joins bone 9,10.
Mild swelling may appear around the painful area 9.
Stiffness can make the nearby joint harder to move 9,10.
Weakness may affect use of the injured area 9,10.
Exercise tolerance may fall as tendon pain and poor function increase 2.
Limited movement can interfere with normal use of the joint 1,2,10.
Cracking or popping may occur during movement 10.
Pain may start slowly or follow a sudden strain 10. Calcium deposits in affected tissue can cause sudden, severe pain in some cases 10.
Symptoms cannot show every change inside a tendon. A clinical exam can help identify the problem and assess other causes 6,8.
How symptoms differ by location
Shoulder pain may get worse with reaching or overhead movement 4,9. Rotator cuff pain can cause a dull ache that worsens at night 9. Active shoulder movement may also become limited 4.
Tennis elbow affects the outer elbow 9,10. Golfer’s elbow affects the inner elbow and may cause pain toward the wrist 9. Repeated wrist and forearm movements can place strain on these tendons 9.
Patellar tendon pain occurs below the kneecap, near the upper shin 10. Sports with frequent jumping can place repeated strain on this tendon 9.
Achilles pain occurs between the calf and heel 9,10. A sudden increase in running intensity can overload the Achilles tendon 9.
Thumb tendon symptoms may occur near the thumb’s base 10. Common hip tendinopathy affects the gluteal tendons 2.
Warning signs of a tendon tear
A tear can cause more weakness than tendinitis alone 4. Tendon rupture can also cause major loss of movement and function 10.
The following signs need medical assessment:
If marked weakness develops, arrange a medical assessment for a possible tendon tear 4.
If a tendon tear seems possible, seek prompt assessment because surgical referral may be needed 4.
If movement becomes very hard or impossible, arrange medical assessment for the lost function 10.
Do not keep loading a tendon when a tear seems possible. A significant acute tear may need assessment by an orthopedic surgeon 4.
Causes and Risk Factors
Repeated strain, overload, and poor recovery
Repeated movement is a common cause of tendinitis 9,10. Work, sports, and hobbies can place repeated stress on the same tendon 9,10.
Small tendon injuries may happen faster than the tissue can repair them 1. This pattern can begin after repeated strain or sudden overload 1.
Activities linked with repeated tendon stress include:
Gardening, painting, woodworking, and shoveling involve repeated or forceful movements 9,10.
Baseball, tennis, and golf can place repeated loads on arm tendons 9,10.
Running and jumping place repeated loads on tendons in the legs 9.
Heavy lifting can strain the rotator cuff tendons 4,9.
A sudden rise in training amount or difficulty can overload a tendon 9. Too little recovery after injury may further raise the risk 9. Returning too quickly after time away can also increase tendon strain 9.
Hard playing surfaces may increase the load on a tendon 9. Old shoes or poorly supportive equipment can also raise injury risk 9.
Body movement and age
Poor form can place too much force on a tendon 9. Awkward positions and repeated overhead reaching can increase work-related strain 9. Vibration and forceful movements may add further stress 9.
Muscle imbalance and limited flexibility can change how a tendon carries load 1. Body movement patterns, nutrition, and body mass may also affect tendon stress 1.
Tendons become less flexible with age 9. They may also heal more slowly and tolerate less stress 9,10.
Lifestyle and health risks
Several health and lifestyle factors can affect tendon strength or healing 1.
Important risk factors include:
Smoking lowers oxygen delivery to tendon tissue 1.
Diabetes changes collagen and affects the tendon’s response to low oxygen 1.
Dyslipidemia means unhealthy blood fat levels and can disrupt tendon collagen 1.
Higher body mass can change tendon loading and stress 1.
Genetic factors may affect tendon strength and healing 1.
Diabetes and high blood fats can raise the risk of rotator cuff problems 4.
Rheumatoid arthritis, gout, osteoarthritis, and infection can occur with tendinitis 10. A clinician can review these conditions as part of the assessment.
Medicines linked with tendon damage
Fluoroquinolone antibiotics have been linked with tendon cell death and tendon damage 1. Corticosteroid exposure can reduce tendon cell health and change tissue repair 1.
Repeated steroid injections may weaken tendons and raise the risk of tearing 6. Injections near major load-bearing tendons require care because rupture can occur 8.
Do not stop or change prescribed medicine on your own. Discuss new tendon symptoms with the clinician who prescribed the medicine.
Diagnosis and Treatment
Medical history and physical examination
Diagnosis often starts with a health history and physical examination 6,8. The clinician may ask about work, exercise, injuries, and recent activity changes 6,8.
The examination may include pressing over the painful tendon 6. The clinician may move the joint into several positions 6. Pain-provoking movements can help locate the affected tendon 2,8.
A physical examination can often identify tendinitis 6. Imaging may help when pain continues or the diagnosis remains unclear 6,8.
X-rays, ultrasound, and MRI
Imaging may help assess tendon pain or rule out other problems 6,8.
X-rays may show bone spurs, arthritis, calcium deposits, or other causes of pain 6,8.
Ultrasound uses sound waves to make pictures of tendons and muscles 6.
Ultrasound may show tendon thickening, uneven fibers, or increased blood flow 8.
MRI makes detailed pictures of the painful area 6.
MRI or ultrasound may help assess tendon wear or tearing 4,6,8.
Imaging results must be compared with symptoms and the clinical examination 8. Tendon thickening and uneven fibers may appear in people without pain 8. Calcium deposits can also appear in people without symptoms 8.
No single imaging test can confirm every case of tendinopathy 8. Ultrasound findings can depend on the skill of the person doing the test 8.
Activity changes and relative rest
Early treatment includes activity changes, relative rest, pain control, protection, and exercise 8. Relative rest means reducing painful loads without stopping all safe movement.
Complete rest can make the nearby joint stiff 6. Gentle movement can help keep the joint flexible after a short rest 6. Other activities may continue if they do not strain the injured tendon 6.
Avoid working or playing through pain that gets worse 6. Reduce or change the movement that triggers symptoms 6.
Ice and pain relief
Ice may reduce pain, swelling, and muscle spasms 6. Evidence for ice in chronic tendinopathy is limited 8. However, ice is a simple and low-cost option for pain relief 8.
Pain medicines may include acetaminophen or nonsteroidal anti-inflammatory drugs 6. These anti-inflammatory drugs are often called NSAIDs 6. Ibuprofen and naproxen are common examples 6.
Short-term NSAID use can reduce pain and improve movement 8. However, NSAIDs do not fix the tissue wear found in chronic tendinopathy 8.
Pain-relieving creams or gels may also ease symptoms 6. A clinician can help choose pain relief that fits personal health needs.
Physical therapy and exercise
Physical therapy can improve movement and strengthen the affected tendon and nearby muscles 6. Resistance exercise can help many long-term tendon problems 6.
Exercise therapy is generally safe and helpful for tendinopathy 3. People are often satisfied with the gains they make through exercise treatment 3. However, evidence comparing exact exercise plans is often low in quality 3.
Rehabilitation may include eccentric and concentric exercise 3,8. Eccentric exercise loads a muscle and tendon while they lengthen 8. Concentric exercise loads them while they shorten 8.
Many treatment plans combine both types 3,8. Combined exercise may work better than eccentric exercise alone 3. Still, research has not found one best plan for every tendon problem 3,8.
Injections and other procedures
A clinician may discuss procedures when physical therapy does not resolve symptoms 6. Benefits and risks can differ by tendon and treatment 2,6.
Possible procedures include:
Steroid injections may reduce pain quickly, but the relief can be short-lived 6.
The effect of steroid injections varies between tendon conditions 6.
Repeated steroid injections can weaken tendon tissue and raise tear risk 6.
Shockwave therapy sends strong sound or pressure waves into injured tissue 6.
Evidence for shockwave therapy varies across tendon conditions 8.
Platelet-rich plasma uses platelets and other factors from the person’s blood 6.
Evidence for platelet-rich plasma also varies by tendon condition 8.
Dry needling uses a fine needle to make small holes in the tendon 6.
Ultrasound therapy uses sound waves to heat tissue and increase blood flow 6.
A clinical assessment should come before these treatments. A clinician can explain the possible gains, limits, and risks.
Surgery
Surgery may be needed for a serious injury or a tendon torn from bone 6. Repair may use open surgery or a less invasive method 6.
The best method depends on the injury type and tendon location 6. A significant acute tear may need referral to an orthopedic surgeon 4.
Recovery and Prevention
Tendinitis recovery time
Full tendinitis recovery can take several months 6. Some chronic tendon injuries need more than six months for symptoms to resolve 8.
Rehabilitation first aims to restore comfortable movement 8. Treatment then builds strength and safe tendon loading 8.
Pain, function, and exercise tolerance can help track progress 2,8. A physical therapist can adjust exercise for the tendon and the person’s goals 1,6.
Progressive resistance and tendon loading
Resistance exercise is a main part of care for chronic tendinopathy 5,8. It can raise load tolerance and help restore function 5,8.
Exercise dose includes intensity, volume, and frequency 5. Research has not found one ideal dose for every tendon problem 3,5.
Higher-intensity exercise with added weight produced better average results than body-weight exercise alone 5. Less frequent sessions also produced better average results in the reviewed studies 5. More time between sessions may allow enough recovery 5.
These findings do not create one plan for every person. A clinician or physical therapist can guide progress and check exercise form 1,6.
How to prevent tendinitis
Prevention aims to avoid a sudden rise in tendon stress. Gradual changes in activity may lower the chance of a poor tendon response 8,9.
Helpful prevention steps include:
Increase work or training demands slowly instead of making sharp changes 9.
Allow enough recovery after an injury or a break from activity 9.
Use proper form during work, lifting, throwing, and exercise 9.
Choose shoes and equipment that provide good support 9.
Limit repeated activity on hard surfaces when practical 9.
Build strength through a progressive resistance plan 5,8.
Address limited flexibility when it changes tendon loading 1.
Reduce irritating activity when local tendon pain starts 6,8.
Avoid smoking because it lowers oxygen delivery to tendons 1.
Work with clinicians to manage diabetes and unhealthy blood fat levels 1.
Discuss medicine-related tendon risks with the prescribing clinician 1,6.
Prevention cannot remove every risk. Age, genes, health problems, and some medicines may still affect tendon health 1,9.
When to See a Doctor
Contact a healthcare professional if symptoms do not improve after several days 9. Medical assessment is also advised when tendon pain disrupts daily activities 9.
If a tendon tear seems possible, seek prompt medical assessment 4. A significant tear may require referral to an orthopedic surgeon 4.
Marked weakness can occur with a rotator cuff tear 4. If marked weakness develops, arrange prompt clinical assessment 4.
A clinician may order imaging when pain continues or the diagnosis remains unclear 6,8. Imaging may help assess other pain sources, tendon wear, or tearing 4,6,8.
Conclusion
Knowing tendinitis symptoms, causes, treatment, recovery, and prevention can support safer choices. Tendinitis involves inflammation, while chronic tendinopathy often involves failed healing and tissue wear 1,8.
Activity changes, relative rest, pain relief, and rehabilitation form the base of treatment 8. Progressive resistance exercise may improve function, but the plan should fit the person 3,5.
Tendinitis recovery time may last several months 6. Some chronic tendon problems can take more than six months to settle 8.
If marked weakness or a possible tear develops, seek prompt medical assessment 4. Early attention can help guide diagnosis and the next treatment steps 6,8.
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