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Tendinosis: Causes, Symptoms and Treatment

Tendinosis is a degenerative tendon condition caused by chronic overuse. It leads to structural changes in tendon tissue, resulting in pain and reduced function.

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Things worth knowing about "Tendinosis"

Tendinosis is a degenerative tendon condition caused by chronic overuse. It leads to structural changes in tendon tissue, resulting in pain and reduced function.

What is Tendinosis?

Tendinosis is a chronic, degenerative condition of tendon tissue that develops as a result of repetitive overloading. Unlike tendinitis, which involves acute inflammation, tendinosis is characterised by structural changes within the tendon itself – including disorganisation of collagen fibres, increased water content, and the formation of abnormal blood vessels (neovascularisation). It commonly affects the Achilles tendon, the rotator cuff tendons of the shoulder, the patellar tendon at the knee, and the tendons around the elbow.

Causes

Tendinosis typically develops when repetitive microtrauma accumulates faster than the tendon can repair itself. Common contributing factors include:

Repetitive movements in sports or occupational settings
Sudden increases in training load or intensity
Muscle imbalances or biomechanical abnormalities
Inappropriate footwear or sports equipment
Age-related decline in tendon elasticity and healing capacity
Metabolic conditions such as diabetes mellitus or hypercholesterolaemia

Symptoms

Symptoms of tendinosis usually develop gradually and may persist for months or even years. Typical presentations include:

Activity-related pain at the affected tendon that often improves with rest
Start-up pain, particularly in the morning or after prolonged periods of inactivity
Localised tenderness on palpation along the tendon
Swelling or a palpable thickening of the tendon
Reduced range of motion in the affected joint

Diagnosis

Tendinosis is primarily a clinical diagnosis, often confirmed by imaging studies:

Physical examination: Palpation of the tendon, pain provocation tests, and assessment of joint mobility
Ultrasound (sonography): A widely used method to visualise degenerative changes, structural irregularities, and calcifications within the tendon
MRI (Magnetic Resonance Imaging): Provides detailed images of tendon tissue and surrounding structures, particularly useful in unclear cases
X-ray: Used to rule out bony changes or calcific deposits

Treatment

Conservative Treatment

The majority of tendinosis cases respond well to conservative, non-surgical management. Key treatment approaches include:

Physiotherapy: Eccentric strengthening exercises are considered highly effective – for example, the Alfredson protocol for Achilles tendinosis
Load management: Reducing or modifying aggravating activities without complete rest
Extracorporeal Shockwave Therapy (ESWT): A non-invasive technique to stimulate tissue repair
Dry needling or PRP injections: Targeted stimulation of the tendon using needles or platelet-rich plasma (PRP) to promote healing
Pain relief: NSAIDs (non-steroidal anti-inflammatory drugs) may provide short-term symptom relief, though their benefit is limited in purely degenerative conditions

Surgical Treatment

If conservative management fails to provide adequate relief over several months, surgical intervention may be considered. Surgery typically involves the removal of degenerative tissue and reconstruction of the tendon.

Prognosis and Outlook

Tendinosis is a manageable condition, but recovery requires patience and consistent treatment. With a structured physiotherapy programme and appropriate load management, most patients experience significant improvement. Healing may take several months depending on the location and severity of the condition. Without treatment, there is an increased risk of tendon rupture.

References

Maffulli N, Khan KM, Puddu G. Overuse tendon conditions: time to change a confusing terminology. Arthroscopy. 1998;14(8):840-843.
Alfredson H, Lorentzon R. Chronic Achilles tendinosis: recommendations for treatment and prevention. Sports Med. 2000;29(2):135-146.
Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med. 2009;43(6):409-416.

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