Tendon Injury (Tendinopathy)

Condition Basics

What is a tendon injury (tendinopathy)?

Tendons are the tough fibers that connect muscle to bone. A tendon injury (tendinopathy) occurs when you have irritated or damaged these fibers. The areas most often affected are the shoulder, elbow, wrist, hip, knee, and ankle.

What causes it?

Most tendon injuries are the result of gradual wear and tear to the tendon from overuse or aging. They are more likely in people who make the same motions over and over in their jobs, sports, or daily activities. A tendon injury can happen suddenly or little by little.

What are the symptoms?

Tendinopathy usually causes pain, stiffness, and loss of strength in the affected area. The area may be tender, red, warm, or swollen. The pain may get worse when you use the tendon, and you may have more pain and stiffness during the night or when you get up in the morning.

How is it diagnosed?

Your doctor will ask about your past health and your symptoms and will do a physical exam. The doctor will check for pain, tenderness, range of motion, and strength. You may be asked to show the doctor how you use tools or sports equipment.

How is a tendon injury treated?

Treatment most often starts with home care, including rest, ice, and over-the-counter pain medicines. Your doctor may also suggest physical therapy. For a severe or long-lasting injury, your doctor may prescribe a brace, a splint, a sling, or crutches to allow tendons to rest and heal.

Cause

Most tendinopathy is the result of gradual wear and tear to the tendon from overuse or aging. Anyone can have a tendon injury. But people who make the same motions over and over in their jobs, sports, or daily activities are more likely to damage a tendon.

A tendon injury can happen suddenly or little by little. You are more likely to have a sudden injury if the tendon has been weakened over time.

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Prevention

To keep from hurting your tendon again, you may need to make some long-term changes to your activities.

• Try changing what activities you do or how you do them. For example, if running caused the injury, try swimming some days. If the way you use a tool is the problem, try switching hands or changing your grip.
• If exercise caused the problem, take lessons or ask a trainer or pro to check your technique.
• If your job caused the tendon injury, ask your human resources department if there are other ways to do your job.
• Always take time to warm up before and stretch after you exercise.

Symptoms

Symptoms of tendinopathy can include:

• Pain, tenderness, redness, warmth, and swelling near the injured tendon. Pain may get worse when you're active. Symptoms may affect just the spot where the injured tendon is located, or they may be spread out from the joint area.
• Crepitus, or a crunchy sound or feeling when the tendon is used. This is usually uncomfortable or painful.
• Pain and stiffness that may be worse during the night or when you get up in the morning.
• Stiffness in the joint near the affected area. Movement or mild exercise of the joint usually reduces the stiffness.

A tendon injury typically gets worse if the tendon isn't allowed to rest and heal. Too much movement may make your symptoms worse or bring the pain and stiffness back.

Exams and Tests

Your doctor will ask questions about your past health and your symptoms. You will also have a physical exam. During this exam, the doctor will check your overall health, any areas of pain and tenderness, and your range of motion and strength. Your exam may also include checking your nerve function (feeling and reflexes) and blood circulation (pulses).

If the injury is related to your use of a tool or sports equipment, the doctor may ask you to show how you use it.

If your symptoms are severe or don't improve with treatment, your doctor may want you to have a test.

• An X-ray can show any bone-related problems or bits of calcium in tendons or joint structures.
• An MRI can show small tears and areas of tendon, ligament, cartilage, and muscle injury.
• An ultrasound can show thickening, swelling, or tears in soft tissues such as the bursae and tendons.

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Treatment Overview

Treatment most often starts with home care, including rest, ice, and over-the-counter pain medicines. If these steps don't help to relieve pain, your doctor may:

• Prescribe physical therapy.
• Use a steroid shot to relieve pain and swelling. This treatment usually isn't repeated because it can damage the tendon.
• Prescribe a brace, a splint, a sling, or crutches for a short time to allow tendons to rest and heal.
• Recommend a cast to rest and heal a badly damaged tendon. Casting or surgery is often used to treat a ruptured tendon.

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Self-Care

Caring for yourself when you have a tendon injury means doing things that will help your tendon heal. Here are some steps you can take.

• Rest the affected area.

  Avoid any activity that may cause pain. And be sure to get enough sleep.

  To keep your overall health and fitness, keep exercising. But do it only in ways that don't stress the affected area. Don't restart a pain-causing activity as soon as your pain stops. Tendons require weeks of extra rest to heal. You may need to make long-term changes in the types of activities you do or how you do them.

• Apply ice or cold packs to the affected area.

  Do this as soon as you notice pain and tenderness in your muscles or near a joint.

  Apply ice 10 to 15 minutes at a time, as often as twice an hour, for 72 hours. Keep applying ice (15 to 20 minutes at a time, 3 times a day) as long as it relieves pain. Although heating pads may feel good, ice will relieve pain and inflammation.

• Take pain relievers.

  Use acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, as directed for pain relief. NSAIDs also reduce any inflammation you might have in or around the tendon (tendinitis). NSAIDs come in pills and in a cream that you rub over the sore area.

  Don't rely on medicine to relieve pain in order to keep overusing a joint.

• Do range-of-motion exercises each day.

  Gently move your joint through its full range of motion as directed by your doctor or physical therapist. Do this even during the time that you are resting the joint area. It will prevent stiffness in your joint. As the pain goes away, keep doing range-of-motion exercises, and add other exercises to strengthen the muscles around your joint.

• Gradually resume your activity.

  Do it at a lower intensity than you were doing before your symptoms began.

  Warm up before and stretch after the activity. Increase your activity slowly, and stop if it hurts. After the activity, apply ice to prevent pain and swelling.

  You can also make some changes. For example, if exercise has caused your tendon injury, try alternating with another activity. If using a tool is the problem, try switching hands or changing your grip.

• Don't smoke.

  Tendon injuries heal more slowly in smokers than in nonsmokers. Smoking delays wound and tissue healing.

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