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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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.
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:
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.
Tendon injuries can be frustrating and take a long time to heal. Some factors put you more at risk.
Risk factors for chronic tendon pain include:
Without treatment, chronic tendon pain will only get worse. It can also lead to more severe injuries, such as partial or complete tendon tears.
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:
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.
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:
The two main tests your doctor may order are:
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.
You often can start treating a tendon injury at home by following these steps:
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.
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.
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.
Here’s how PUT works:
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.
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