Chronic Tendon Pain

Tendons are the tough fibers that connect your muscle to your bones. If you work them too hard, they can get inflamed. This is tendonitis.

But they can also get small tears and develop scarring. Some people call this chronic tendonitis, but the more accurate name is tendinosis. It means that your tendons are damaged, not just temporarily irritated.

Until recently, there haven't been many good treatments for this chronic tendon pain. But a newer treatment called percutaneous ultrasound tenotomy (PUT) helps remove the scar tissue that causes tendinosis.

We offer this treatment here at UPMC. It’s less invasive than surgery and can help you get back to your normal routine, without pain.

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On this page

• What Is Chronic Tendon Pain?
• What Are the Symptoms of Chronic Tendon Pain?
• How Do You Diagnose Chronic Tendon Pain?
• How Do You Treat Chronic Tendon Pain?

What Is Chronic Tendon Pain (Tendinosis)?

Chronic tendon pain is tendon pain that lasts for three months or more. It usually affects your elbows, shoulders, knees, hips, and Achilles heel.

When you have chronic tendon pain, you have small tears in your tendon. These tears happen with age, repetitive motion, or injury, and they cause your tendon to form scar tissue. This leads to tendon pain.

Unlike tendonitis, which is temporary inflammation of the tendon, there's actual damage with tendinosis. It’s degenerative, meaning the damage will keep getting worse. 

Both tendonitis and tendinosis are types of tendinopathy, which is an umbrella term for any condition that causes tendon pain or swelling.

How common is chronic tendon pain?

Both tendonitis and tendinosis are common. Although the term tendonitis may be more familiar, many people who think they have tendonitis may actually have tendinosis.

Chronic tendon pain is very common in athletes — tendon injuries make up about 50% of all sports injuries. But anyone who does repetitive motion is at risk for chronic tendon pain.

Chronic tendon pain happens most in:

• The tendon on the outside of your elbow (called tennis elbow).
• The patellar tendon that connects your knee and shin (called jumper’s knee, but common in runners).
• The rotator cuff tendons in your shoulder.
• The Achilles tendon in your heel.
• The gluteal tendons that connect your hip and butt.

What causes chronic tendon pain?

Overusing the tendon is the main cause of tendinosis. But physical trauma, like a fall or sports injury, can also damage the tendon.

Activities or jobs that require you to put repeated stress on your tendons can cause tendinosis. Athletes and manual laborers, for example, are more likely to get chronic tendon pain.

Tendon problems are also more common in older adults because your joints become less flexible as you age. People with joint conditions, such as arthritis, may also be more prone to tendinosis.

What are chronic tendon pain risk factors and complications?

Tendon injuries can be frustrating and take a long time to heal. Some factors put you more at risk.

Tendinosis risk factors

Risk factors for chronic tendon pain include:

• Being over 60.
• Being overweight.
• Being an athlete in a sport that has a lot of repetitive motion.
• Having a job that requires repetitive motion.
• Having rheumatoid arthritis or gout.
• Having a sedentary lifestyle.
• Having type 2 diabetes.

Tendinosis complications

Without treatment, chronic tendon pain will only get worse. It can also lead to more severe injuries, such as partial or complete tendon tears. 

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What Are the Signs and Symptoms of Chronic Tendon Pain?

Chronic tendon pain happens because of small tears in the tendon which form scar tissue. This scar tissue causes much of the pain that you feel, including:

• Pain, stiffness, and a feeling of weakness in the tendon.
• Sharp pain when you use the tendon.
• Decreased range of motion.
• Pain and stiffness when trying to sleep or when you wake up.
• Tenderness or swelling in the area around the tendon.
• Crunchy sound or feeling when using the tendon.

When should I see a doctor about my chronic tendon pain?

If pain is keeping you from doing the things you love or interfering with daily life, see a doctor. Once you know what’s going on with your tendon pain, you can get a treatment plan.

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How Do You Diagnose Chronic Tendon Pain?

Orthopaedic doctors and sports medicine specialists usually diagnose tendon problems. A sports medicine primary care doctor may also be a good place to start. (These are primary care doctors with extra training in sports medicine.)

Your doctor will work to figure out if you have tendonitis or tendinosis. These two conditions overlap, and some of the treatments are the same. But there are differences, too.

The key difference is that tendonitis is about inflammation, but tendinosis means the tendon has damage and degeneration. Getting the right diagnosis will ensure you get the right treatment.

Your doctor will:

• Take a medical history, including past injuries and any medicine you take.
• Ask about your activities and job, and what sports you play.
• Ask about the severity and location of your pain.
• Look for signs of swelling.
• Touch the tendon and surrounding areas to see how tender it is.
• Test your range of motion and move your foot, knee, hip, shoulder, or elbow around.

Tests to diagnose chronic tendon pain

The two main tests your doctor may order are:

• MRI. An MRI can show damage to your soft tissues, like tendons and ligaments. It’s more detailed than an x-ray.
• Ultrasound. An ultrasound can show changes in your tendon, like swelling, inflammation, or degeneration.

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How Do You Treat Chronic Tendon Pain?

Tendons usually take a long time to heal. But we have treatments for tendinosis that help speed up the body's natural healing processes.

We always start with the most conservative treatment option.

At-home treatment for chronic tendon pain

You often can start treating a tendon injury at home by following these steps:

• Resting the painful area.
• Applying ice or cold packs for 10 to 15 minutes at a time, as often as twice an hour, for the first 72 hours.
• Taking over-the-counter pain relievers such as acetaminophen or NSAIDs (like ibuprofen or naproxen).
• Doing gentle range-of-motion exercises and stretching to prevent stiffness.

If these steps don’t help, talk to your doctor about physical therapy. PT can help stretch and strengthen the areas around the tendon.

If your injury is severe or long-lasting, your doctor may have you use a splint, brace, or cast to hold the tendon still.

How long is at-home treatment?

As soon as you start feeling better, you can return to your activities. But you should take it easy for a while.

Make sure to build up to your previous level slowly, and stop if it hurts. Warming up before you exercise and doing gentle stretching afterward can help prevent future injury.

While these steps are generally effective, it may take weeks or months for your tendon injury to heal. You now have other options. 

Minimally invasive surgery for chronic tendon pain

The best option doctors used to have to treat chronic tendon pain was an invasive surgery to scrape out the scar tissue on the tendon. It was usually followed by a long recovery.

But now, there’s a far better option called percutaneous ultrasound tenotomy (PUT). PUT is a minimally invasive procedure that usually takes less than 20 minutes. It gets rid of chronic tendon pain for about 90% of people.

Doctors have been using ultrasound for a long time as an imaging tool. PUT uses ultrasound as an energy source to cut and remove scar tissue on the tendon.

Removing the damaged tissue from the tendon helps increase blood flow to the tendon. This helps the tendon heal more quickly, all without harming the healthy tendon tissue. 

What to expect with PUT

Here’s how PUT works:

• The doctor uses ultrasound imaging to see the injured area and pinpoint the exact location of the damaged tendon.
• Next, they numb the area with a local anesthetic.
• Then they use the PUT tool. Shaped like a pen that contains two needles, the tool's first needle breaks up the scar tissue. Meanwhile, a saline flushing system inside the second needle vacuums up the tissue debris.
• Finally, they cover the small wound with an adhesive bandage (no stitches required).

You may feel uncomfortable for a day or two after PUT. Your doctor will give you guidelines about activity. Most people recover within six to eight weeks.

Learn more about chronic tendon pain 

From UPMC HealthBeat:

• Seeking Care for Tendonitis.
• What May Cause Your Elbow Pain.
• Achilles Tendon Problems: What You Need to Know.

From our health library:

• Tendon Injury (Tendinopathy).
• Tennis Elbow.
• Tennis Elbow: Should I Have Surgery?
• Tennis Elbow: Stretches And Strengthening Exercises.