Tendinitis or Tendinosis? Why the Difference Is Important and What Treatments Help

Whether it’s an elbow, shoulder, hip, knee or ankle, a painful tendon is a troublesome condition that can affect just about anyone.

You’re probably familiar with an inflamed tendon being called tendinitis, but have you ever heard of tendinosis?

It’s a condition that sports medicine physicians Dominic King, DO, and Jason Genin, DO, see on a daily basis. But few people know the difference between these two conditions. We asked them to explain the differences between tendinitis and tendinosis, their diagnosis and their treatment.

Telling the difference between tendinitis and tendinosis

The pain from a tendon issue can come on gradually, building up over time, or it can feel sudden and severe.

• Tendinitis is an acutely inflamed swollen tendon that doesn’t have microscopic tendon damage. The underlying culprit in tendinitis is inflammation. This is often due to strain, overuse or injury.
• Tendinosis, on the other hand, is a chronically damaged tendon with disorganized fibers and a hard, thickened, scarred and rubbery appearance. The underlying cause in tendinosis is degeneration. That degeneration can be the result of overuse, trauma, osteoarthritis or aging.

“It’s important to make the distinction between the two conditions because the ultimate treatment can be very different,” Dr. King notes.

Tendinitis and tendinosis symptoms

Making that determination isn’t as simple as perusing the internet, though. As you can see — with a few exceptions — tendinitis and tendinosis often look similar:

Where tendinitis and tendinosis happen

Tendinitis and tendinosis are especially common in these areas:

• The common extensor tendon on the outside of your elbow — also known as tennis elbow.
• The rotator cuff tendons of your shoulder.
• The patellar tendon that connects your kneecap to your shin bone.
• The gluteal tendons on the outside of your hip.
• The Achilles tendon in the back of your heel.

Diagnosing tendinitis or tendinosis

So, how do you know if you have tendinitis or tendinosis?

According to Dr. Genin, providers can diagnose you using a very simple musculoskeletal ultrasound examination that can be performed right in their office.

“The ultrasound can easily detect the swelling and inflammation of tendinitis or the chronic degenerative changes of tendinosis,” he explains.

Tendinitis and tendinosis treatment

Treating tendinitis and tendinosis involves treating their respective underlying problems, namely inflammation or degeneration. These are the recommended treatments for each condition:

Tendinitis treatment

If you’ve got tendinitis, these are usually the first steps doctors recommend:

• Rest and avoid the repetitive motion that originally caused the pain.
• Take over-the-counter anti-inflammatories, such as ibuprofen or naproxen, for short-term pain relief.
• Brace the affected joint. A tennis elbow strap can be used for the elbow, for example. There are many kinds of braces and straps available for specific tendinitis issues, like patellar and Achilles tendinitis.

According to Dr. King, you can expect it to take between four to six weeks for these home remedies to help. If the pain hasn’t subsided by then, he advises you to call a doctor. It may be time to get an ultrasound of your tendon.

If the ultrasound shows you still have tendinitis, a corticosteroid injection may be the right treatment to decrease the inflammation and relieve the condition. “That, coupled with a physical therapy program, may be all you need to get back to your normal life,” he says.

Tendinosis treatment

Because tendinosis is the result of degeneration, the recovery process tends to be longer. In addition to rest and over-the-counter pain relief, Dr. Grenin usually recommends physical therapy to stretch the tendon and strengthen the surrounding muscles.

If the pain is still there three months in, your doctor will want to do additional tests to assess the severity of the situation.

If you’re in danger of rupturing the ligament, they might consider more invasive measures, like injecting platelet-rich plasma (PRP) from your own blood into your tendon, to try to stimulate a healing response. Other options include surgery and a fairly new procedure called ultrasonic percutaneous tenotomy.

Ultrasonic percutaneous tenotomy

Ultrasonic percutaneous tenotomy (PUT) has only been around for about 10 years, but it’s quickly become a go-to procedure for people with stubborn cases of tendinosis.

PUT is a minimally invasive office-based procedure that uses a thin metal probe that vibrates at 20,000 RPM (revolutions per minute) to gently dissolve and remove the damaged tendon tissue. It leaves the soft, pliable normal tendon unaffected.

Healthcare providers perform a PUT by:

• Injecting a local anesthetic to numb your skin and damaged tendon.
• Making a small puncture through your skin — about the size of the pointer arrow on your computer screen.
• Applying the vibrating probe for one to two minutes. With the local anesthetic, you should feel only a slight pressure during the procedure.
• Bandaging the procedure site — no stitches are necessary.

All told, PUT only takes about 20 minutes. The procedure relieves pain at the source, is covered by most insurance and — if it’s successful — will enable you to return to normal activities within five to six weeks.

The bottom line

Tendon issues are very common, but they aren’t all caused by the same problems. Tendinitis is a more acute injury caused by inflammation. Tendinosis, on the other hand, is the result of degeneration over time and usually takes longer to resolve. Getting a proper diagnosis is important as the two conditions often require very different treatments.