Tendon injury (tendinopathy)

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

Doctors may use different terms to describe these injuries. You may hear tendinitis, tendinosis, or tendinopathy.

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.

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.

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.

• Rest the sore area. You may have to stop doing the activity that caused the tendon pain for a while.
• Take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Read and follow all instructions on the label.
• Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
• Put ice or a cold pack on the sore area for 10 to 20 minutes at a time. Try to do this every 1 to 2 hours for the next 3 days (when you are awake) or until any swelling goes down. Put a thin cloth between the ice and your skin.
• Prop up the sore area on a pillow when you ice it or anytime you sit or lie down during the next 3 days. Try to keep it above the level of your heart. This will help reduce swelling.
• Follow your doctor's advice for wearing and caring for a sling, splint, or cast. In some cases, you may wear one of these for a while to help your tendon heal.
• Follow your doctor's advice for stretching and physical therapy. Gently move your joint through its full range of motion. This will prevent stiffness in your joint.
• Go back to your activity slowly. Warm up before and stretch after the activity. You also can try making some changes. For example, if a sport caused your tendon pain, alternate the sport with another activity. If using a tool causes pain, switch hands or change your grip. Stop the activity if it hurts. After the activity, apply ice to prevent pain and swelling.
• Do not smoke. Smoking can slow healing. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.