Beyond Tendonitis

Tendons can be injured all at once, as in an accident, or after long-term repeated use. Many people refer to tendon injuries as tendonitis, but this term really only applies if the tendon is inflamed. Tendinosis is the correct term for the degeneration of the tendon from overuse or other reasons. The difference is important, because the two conditions should be treated somewhat differently.

Tendinosis is not well understood. The goal of this study was to better understand the changes that occur in tendons with this condition. The authors reviewed research on people with tennis elbow, a common form of tendinosis. Medical researchers know that tendinosis seems to cause abnormalities in the tissues and cells of the tendon. They don't know whether these abnormalities are caused by degeneration or from the way tissues heal.

The authors examined the tendons of nine patients undergoing surgery for tennis elbow. All the patients tried treating their problem for one year using physical therapy, medications, electrical stimulation, ice treatments, and cortisone injections. The authors concluded that the tissue abnormalities found with tendinosis are caused by both tissue degeneration and the way the tissues heal. In either case, they describe tendinosis as "the result of failed tendon healing."

The authors conclude that promoting healing in tendons is not well treated by anti-inflammatory drugs, steroid injections, or ongoing physical therapy. They recommend:

  • using medications and treatments such as ice, massage, and electrical stimulation to control pain 

  • avoiding cortisone injections, unless the pain is so bad that the patient can't do exercises

  • keeping the joint moving, because immobilization hurts the tissues' ability to heal correctly

  • having a doctor put a needle into the tendon to get it to bleed, which helps stimulate the healing response

  • using a special brace

  • designing a short-term therapy program that addresses muscle timing and control, as well as strength, flexibility, and endurance

  • improving the strength of the muscles of the upper back and shoulder

  • adjusting athletes' form and technique to protect the injured tendon

  • testing the tendon during painful periods.

The authors say that a "handshake test" helps them determine which patients will probably respond best to treatment. They shake patients' hands with the arm completely outstretched, and then again with the elbow bent at a 90-degree angle. In both cases, they make the patients rotate their arms inward against resistance. If the pain is less when the arm is bent, the patient is more likely to do well with conservative treatment. If the pain is equal in both positions, the patient is more likely to eventually need surgery. 

References: Barry S. Kraushaar, MD, and Robert P. Nirschl, MD, MS. Tendinosis of the Elbow (Tennis Elbow): Clinical Features and Findings of Histological, Immunohistochemical, and Electron Microscopy Studies. In The Journal of Bone and Joint Surgery. February 1999. Vol. 81-A. No. 2. Pp. 259-278.