Don't Assume It's Tendinitis

Tennis elbow, swimmer's shoulder, trigger finger—these are just a few names for the common phenomenon of tendon pain, or tendinopathy. The tendons are fibrous, cordlike connective tissues that attach muscle to bone. Tendons can withstand amazing amounts of force, but they're not indestructible. And when there's a problem, you’'l know it—by pain, stiffness and swelling, usually near a joint.

Patients who experience tendon pain often assume they have tendinitis—and are often diagnosed with it by their doctors—and treat the pain with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. However, a deeper examination of the causes of tendinopathy reveals that this approach may often be misguided.

What’s the real cause?

The common medical suffix "-itis" implies that inflammation is part of tendon pain. In fact, studies have found that the body's inflammatory response to injury—the characteristic redness, swelling and pain that occur—isn't necessarily to blame. Tendinitis may or may not exist—and in some cases, people may have tenosynovitis, where the synovial sheath around the tendons is inflamed. But tendons themselves don't contain many blood vessels, so it's hard for them to get inflamed.

Instead, most people over age 50 experience tendinopathy as the result of tendon degeneration. With the passage of time, the collagen that makes up the tendon breaks down, causing multiple microscopic tears. Blood circulation in the tendon also decreases with age, limiting its ability to heal these microscopic tears. This degenerative condition is called tendinosis.

It's common to develop tendinosis to some degree during your lifetime, but you may have no symptoms. Symptoms may suddenly appear owing to trauma or as a result of years of repetitive motion during exercise, sports or work activities.

The right way to treat tendinosis

People who rely on NSAIDs to relieve tendon pain may think that because their pain is eased they're cured, which isn't true. These drugs don't address the microscopic tears that are the reason for tendinosis pain, nor do they promote healing. NSAIDs may even slow the development of collagen, a key component of the tendon that’s vital for repair.

Cortisone shots, another commonly used treatment, also aren't recommended for tendinosis. Like NSAIDs, they target inflammation and therefore really aren’t helpful. In addition, some studies have shown that corticosteroids decrease tendon strength. (If you've been diagnosed with tenosynovitis—which often occurs in the wrist and thumb as DeQuervain's tenosynovitis—you have a true inflammatory condition, and anti-inflammatory treatments such as NSAIDs and cortisone shots will help.)

The most effective treatments for tendinosis start with limiting or stopping the aggravating activity, which helps to prevent further degeneration. Braces and supports also can lessen pain and degeneration, although it's best not to wear them all the time.

A knowledgeable physical therapist or sports medicine clinician can show you how to adjust your biomechanics during an activity—for example, by altering your tennis stroke or, in the case of wrist pain, using an ergonomic keyboard at your computer.

A course of physical therapy can help combat tendinosis by speeding collagen formation. And eccentric training, during which the muscles lengthen against the force of gravity, has been shown to be effective in helping rebuild the structure of the tendon.

Even with diligent treatment, tendinopathies are often slow to heal. In extreme cases, where there's no improvement after six to 12 months of treatment, surgery—which most often entails removing degenerated portions of the tendon—may be recommended.

Source: Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50

Publication Review By: the Editorial Staff at

Published: 19 Jul 2013

Last Modified: 05 Mar 2015