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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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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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