Tendon Injuries

Condition

The heel and elbow joints are common sites of tendon injuries. For more information about tendon injuries in these areas, see the topics Achilles Tendon Problems and Tennis Elbow.

This topic does not address severe tendon tears or ruptures. To help you assess a tendon injury, see the topic Shoulder Problems and Injuries, Elbow Injuries, Knee Problems and Injuries, Finger, Hand, and Wrist Injuries, or Toe, Foot, and Ankle Injuries.

Tendons are the tough fibers that connect muscle to bone. For example, the Achilles tendon camera.gif connects the calf muscle to the heel bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to happen suddenly, but usually it is the result of many tiny tears to the tendon that have happened over time.

Doctors may use different terms to describe a tendon injury. You may hear:

  • Tendinitis. This means “inflammation of the tendon.”
  • Tendinosis. This refers to tiny tears in the tissue in and around the tendon caused by overuse.

Most experts now use the term tendinopathy to include both inflammation and microtears. But for many years most tendon problems were called “tendinitis.” Many doctors still use this familiar word to describe a tendon injury.

Most tendon injuries are 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.

Tendinopathy usually causes pain, stiffness, and loss of strength in the affected area.

  • The pain may get worse when you use the tendon.
  • You may have more pain and stiffness during the night or when you get up in the morning.
  • The area may be tender, red, warm, or swollen if there is inflammation.
  • You may notice a crunchy sound or feeling when you use the tendon.
  • The symptoms of a tendon injury can be a lot like those caused by bursitis.

Symptoms

  • Pain, tenderness, redness, warmth, and/or swelling near the injured tendon. Pain may increase with activity. Symptoms of tendon injury may affect the precise area where the injured tendon is located or may radiate out from the joint area, unlike arthritis pain, which tends to be confined to the joint.
  • 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 getting up in the morning.
  • Stiffness in the joint near the affected area. Movement or mild exercise of the joint usually reduces the stiffness. But a tendon injury typically gets worse if the affected tendon is not allowed to rest and heal. Too much movement may make existing symptoms worse or bring the pain and stiffness back.

Treatments

Initial treatment for a tendon injury (tendinopathy) typically includes rest and pain relievers. Acetaminophen can reduce pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce both the pain and inflammation you might have from a tendon injury. The goals of this early treatment are to:

  • Reduce pain and inflammation of the tendon.
  • Restore normal motion and strength.

If you are still having pain, stiffness, and weakness after initial treatment, your doctor may recommend some type of physical therapy. Also, you may need to make long-term changes in the type of activities you do or how you do them to prevent your tendinopathy from returning. The goals of ongoing treatment are to:

  • Reduce pain.
  • Avoid further degeneration or tearing of the tendon.
  • Encourage regeneration of the damaged tendon.

Treatment for tendinopathies

Take the following steps to treat tendinopathies:

  • Rest the affected area, and avoid any activity that may cause pain. Get enough sleep. To keep your overall health and fitness, continue exercising but only in ways that do not stress the affected area. Do not resume an aggravating activity as soon as the pain stops. Tendons require weeks of additional 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 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. Continue 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 if needed. 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. Do not rely on medicine to relieve pain in order to continue overusing a joint.
  • Do range-of-motion exercises each day. Gently move your joint through its full range of motion, even during the time that you are resting the joint area. This will prevent stiffness in your joint. As the pain goes away, continue range-of-motion exercises and add other exercises to strengthen the muscles around your joint.
  • Gradually resume your activity at a lower intensity than you maintained before your symptoms began. Warm up before and stretch after the activity. You can also try making some changes. For example, if exercise has caused your tendinopathy, try alternating with another activity. If using a tool is the problem, try alternating hands or changing your grip. Increase your activity slowly, and stop if it hurts. After the activity, apply ice to prevent pain and swelling.
  • Avoid tobacco smoke. Tendon injuries heal more slowly in smokers than in nonsmokers. Smoking delays wound and tissue healing.

Staff

Charles White, DPM
Foot & Ankle Surgery / Podiatry

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