Tendonitis, tendinosis, tendinopathy: what's the difference?
The terms are often confused. Tendinitis refers to inflammation of the tendon, tendinosis refers to tissue remodeling without significant inflammation, and tendinopathy is the general name for pain and dysfunction of the tendon. When examining tissue, most patients find precisely degenerative changes: disordered collagen fibers, ingrowth of new vessels and nerve endings. This explains why anti-inflammatory drugs provide only temporary relief, but gradual strength training helps for a long time.
- Tendinitis - acute inflammation, often in the first days after overload
- Tendinosis is a chronic restructuring of tendon tissue.
- Tenosynovitis - inflammation of the tendon sheath in the canal
- Enthesopathy - damage to the site of attachment of the tendon to the bone
- Partial rupture is a complication of advanced tendinopathy
Causes and risk factors
The main reason is the discrepancy between the load and the ability of the tissue to recover. The risk increases sharply when the volume or intensity of training is increased quickly, shoes or surfaces are changed, or returning to sports after a break. At work, tendinitis is caused by monotonous movements: working with tools, at a computer, on a conveyor belt. Internal factors are also important: age-related decrease in collagen strength, diabetes mellitus, obesity, lipid metabolism disorders and thyroid diseases. Separately, there are fluoroquinolones and long-term treatment with glucocorticoids, which increase the risk of tendon damage.
- A sharp increase in training loads
- Monotonous hand work
- Violation of movement technique
- Inappropriate shoes and hard surfaces
- Age after 40 years
- Diabetes mellitus, obesity, metabolic disorders
- Taking fluoroquinolones and glucocorticoids
- Rheumatic diseases
Symptoms
Pain from tendonitis is local: it can be indicated with a finger in the area where the tendon attaches or along its course. A typical pattern is “it hurts at the beginning of exercise, it’s better after warming up, it’s worse in the evening and the next morning.” Morning stiffness is typical, which goes away within 10–20 minutes of movement. Sometimes a thickening of the tendon can be felt, and a creaking sound is heard when moving. Swelling and redness are usually slight; severe redness and heat indicate infection or inflammatory arthritis. A sudden loss of strength and a popping sound when loaded indicates a rupture.
- Point pain in the projection of the tendon
- Pain at the beginning of exercise and after it
- Morning stiffness
- Thickening of the tendon when palpated
- Creaking or clicking noise when moving
- Decreased muscle strength and endurance
Diagnostics
An inspection is usually sufficient. The doctor finds the painful point, checks the strength and pain when resisting movement, evaluates flexibility and movement technique, and excludes damage to the joint and nerve. Ultrasound is the main imaging method: it shows the thickness of the tendon, areas of restructuring, fluid in the sheath, calcifications and allows comparison with the healthy side. MRI is used when a rupture is suspected, the tendon is deep, and before surgery. An x-ray does not show the tendon itself, but reveals calcifications, bone spurs and helps rule out a fracture. If there is multiple damage to the tendons, blood tests are prescribed for inflammation and rheumatic diseases.
- Inspection and tests with resistance to movement
- Ultrasound of tendons and joints
- MRI of large bones and soft tissues of the selected area
- X-ray of joints and bones
- Blood tests for suspected rheumatic disease
- Assessment of movement technique and workplace
Treatment and prevention
In the first days after acute overload, relative rest, cold and temporary cessation of the provoking movement help. However, prolonged immobility is harmful: the tendon loses strength. The basis of treatment for chronic tendinopathy is a program of strength exercises with a gradual increase in load, including eccentric ones, under the supervision of a doctor or rehabilitation specialist. At the same time, equipment, shoes, organization of the workplace are corrected, stretching and strengthening of neighboring muscle groups are added. Shock wave therapy, ultrasound and phonophoresis reduce pain in persistent cases. Anti-inflammatory drugs are used in a short course as prescribed by a doctor; glucocorticoid injections into the tendon itself are not recommended due to the risk of rupture. Surgery is rarely needed - if there is a rupture or treatment is ineffective within six months.
- Relative peace and cold in the first days
- Gradual Strength Program for the Tendon
- Eccentric exercises under the supervision of a specialist
- Correction of equipment, shoes and workplace
- Shock wave therapy and phonophoresis
- Stretching and strengthening adjacent muscles
- Controlling weight and blood sugar levels
- Return to sports through a gradual increase in load