Tendinitis or Tendinosis? Why the Difference Is Important, What Treatments Help

Contributors: Dominic King, DO and Jason Genin, DO

Whether it’s an elbow, shoulder, hip, knee or ankle, a painful tendon is a troublesome condition that can affect just about anyone. You are probably familiar with an inflamed tendon being called tendinitis, but have you ever heard of tendinosis?

This is a condition that we see on a daily basis. However, very few patients understand the difference between these two conditions.

Important distinction

The pain from a tendon problem can come on gradually, building up over time, or it can feel sudden and severe.

Tendinitis is an acutely inflamed swollen tendon that doesn’t have microscopic tendon damage. The underlying culprit in tendinitis is inflammation.

Tendinosis, on the other hand, is a chronically damaged tendon with disorganized fibers and a hard, thickened, scarred and rubbery appearance. The underlying cause in tendinosis is degeneration.

It is important to make the distinction between the two because the ultimate treatment can be very different.

That distinction is made by a very simple musculoskeletal ultrasound examination that can be performed in the doctor’s office. The ultrasound can easily detect the swelling and inflammation of tendinitis or the chronic degenerative changes of tendinosis.

Where tendon problems occur

Tendinitis and tendinosis are especially common in these areas:

• The common extensor tendon on the outside of the elbow — also known as tennis elbow
• The rotator cuff tendons of the shoulder
• The patellar tendon that connects the knee cap to the shin bone.
• The gluteal tendons on the outside of the hip
• The Achilles tendon in the back of the heel.

Treatment

Treating tendinitis or tendinosis involves treating their respective underlying problems, namely inflammation or degeneration.

For tendinitis:

• Rest, avoid the repetitive motion that originally caused the pain
• Short term use of over-the-counter anti-inflammatories, such as ibuprofen or naproxen
• A tennis elbow strap can be used for the elbow; there are various other types of braces and straps for patellar and Achilles tendinitis

Give about four to six weeks for these home remedies to help. But if the pain persists, call your doctor, because an ultrasound of the tendon may be needed.

If the ultrasound shows tendinitis, a corticosteroid injection may be the right treatment to decrease the inflammation and relieve the condition. This, coupled with a physical therapy program, may be all you need to get back to your normal life.

For tendinosis:

• A physical therapy program to stretch the tendon and strengthen the surrounding muscles
• If pain persists, your next step may be an injection of platelet-rich plasma (PRP) from your own blood to try to stimulate a healing response

When pain doesn’t subside

If you have tendinosis, the pain persists past three months and nothing else has helped, we may recommend a new, minimally invasive office-based FDA-approved procedure called ultrasonic percutaneous tenotomy.

The procedure uses a thin metal probe that vibrates at 20,000 rpm to gently dissolve and remove the damaged tendon tissue. It leaves the soft, pliable normal tendon unaffected.

Here’s what to expect:

• We inject a local anesthetic to numb the skin and damaged tendon.
• We makes a small puncture through the skin — about the size of the pointer arrow on your computer screen.
• Just one or two minutes of the 20-minute procedure involves the vibrating probe. With the local anesthetic, you should feel only a slight pressure during the procedure.
• After the procedure, a bandage is applied — no stitches are necessary.

The procedure relieves pain at the source, it is covered by most insurances and if it is successful, you can return to normal activities in five to six weeks.