Tendinopathy

Diagnosis

Often a medical history and a physical exam are enough to diagnose many types of tendinopathy. Your healthcare professional may press on the affected joint and move the joint into different positions.

Sometimes your healthcare professional may use imaging tests to help with diagnosis. Imaging tests may include:

• X-rays. This imaging test can show bone spurs or other potential causes for your pain, such as arthritis. Your healthcare professional might use X-rays to rule out other conditions that could be causing the symptoms.
• Ultrasound. This type of imaging test uses sound waves to make images of structures within your body, such as muscles and tendons.
• Magnetic resonance imaging (MRI). An MRI uses radio waves and a magnetic field to create detailed images of the affected area of the body.

Treatment

The goals of tendinopathy treatment are to relieve pain, reduce irritation and prevent future tendon conditions. Self-care, including rest, ice and pain relievers, might be all that's needed. Changing how you do certain activities and doing physical therapy exercises can help improve pain and prevent future injuries. Other treatment options include noninvasive and surgical procedures.

Treatment options for tendinopathy may include:

Medicines

Nonsteroidal anti-inflammatory medicines, such as aspirin, naproxen sodium (Aleve), ibuprofen (Advil, Motrin IB, others), or acetaminophen (Tylenol, others) may relieve pain. You also can apply pain-relieving creams or gels to the skin.

Physical therapy

Physical therapy exercises can help strengthen the muscle and tendon in the affected area. You can do resistance exercises to effectively treat many long-lasting, called chronic, tendon conditions.

Surgical and other procedures

• Steroid injections. The effectiveness of steroid shots for tendinopathy varies depending on the condition. A steroid shot around a tendon might help ease the pain for a short time. But repeated steroid shots can weaken a tendon and increase the risk of the tendon tearing over time.
• Dry needling. In this procedure, a healthcare professional makes small holes in the tendon with a fine needle, which. can reduce tendon pain.
• Shockwave therapy. This treatment involves sending shockwaves to injured tissue to relieve pain and help the tissue heal. A tool placed on the skin delivers the shockwaves.
• Ultrasound therapy. This treatment can be used to promote healing in a damaged tendon by increasing blood flow to the area.
• Barbotage. This minimally invasive procedure uses a needle and saline to break up and remove calcium deposits. Ultrasound is used to guide the needle to the correct location.
• Tenotomy. This procedure is usually guided with ultrasound and uses either a needle or a specialized device to make holes in the tendon, which can help trigger factors involved in tendon healing. Specialized needle-like devices also can remove unhealthy tendon tissue, called debridement, which may make the procedure even more effective.
• Platelet-rich plasma therapy. This treatment involves taking a sample of your own blood and spinning the blood to separate out the platelets and other healing factors. The solution is then injected into the area of long-term tendon irritation. Research is still exploring the best way to use platelet-rich plasma, but it has shown promise in the treatment of many chronic tendon conditions.
• Surgery. Depending on the seriousness of the injury, you may need to have surgery to repair the tendon, especially if the tendon has torn away from the bone. There are both minimally invasive and open procedures. Minimally invasive techniques usually have less pain and quicker recovery time than an open procedure. An open procedure requires a larger incision. Which procedure is best for you may depend on the type of injury to the tendon and its location.

Self-care

Many times, tendon pain and injury can be treated at home. Self-care steps include:

• Rest. Avoid doing things that increase the pain or swelling. Don't try to work or play through the pain. Healing requires rest, but not complete bed rest. You can do other activities and exercises that don't stress the injured tendon. Swimming and water exercise may be good options.
• Ice. To decrease pain, muscle spasm and swelling, apply ice to the injured area for up to 20 minutes several times a day. Ice packs, ice massage, or slush baths with ice and water all can help. For an ice massage, freeze a paper cup full of water so that you can hold the cup while applying the ice directly to the skin.
• Pain relievers. Over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others) may help reduce the pain caused by swelling in the tendon.

Preparing for your appointment

You might start by talking to your family healthcare professional. Your healthcare professional may refer you to a specialist in physical medicine and rehabilitation, sports medicine, or orthopedic surgery for more-specialized care.

What you can do

You may want to write a list that includes:

• Details about your symptoms.
• Other medical conditions you've had.
• All the medicines, vitamins and supplements you take, including doses.
• Questions you want to ask the care team.

For tendinopathies, some basic questions to ask include:

• What is the most likely cause of my symptoms?
• Are there other possible causes?
• What tests do I need?
• What treatment do you recommend?
• Will I need to stop any of my medicines before or after the treatment?
• I have other medical conditions. How best can I manage them together?
• Will I need to limit my activities?
• What self-care can I do at home?

What to expect from your doctor

Your healthcare professional is likely to ask you questions, such as:

• Where do you feel pain?
• When did your pain begin?
• Did it begin all at once or come on bit by bit?
• What kind of work do you do?
• What are your hobbies?
• Have you been instructed in proper ways to do your activity?
• Does your pain occur or worsen during certain activities?
• Have you recently had a fall or other kind of injury?
• What treatments have you tried at home?
• What did those treatments do?
• What, if anything, makes your symptoms better?
• What, if anything, makes your symptoms worse?