"Physicians must acknowledge that the cause is most often due to tendinosis, rather than tendinitis, and treat the problem using a fundamentally different paradigm." From Overuse Tendinosis, Not Tendinitis



A review in The Lancet published online in October 2010 found that corticosteroid injections only provided short-lived benefit with potential for longer-term harm.



"Repetitive motion, such as grasping tools, scanning groceries, and typing, resulted in the longest absences from work among the leading events and exposures in 2002 - a median of 23 days." From The Bureau of Labor Statistics

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What Is Tendinosis?

Tendinosis is an accumulation over time of small-scale injuries that don't heal properly; it is a chronic injury of failed healing. Although you can't see the tendinosis injury on the outside of your body, researchers can see the injury on the cellular scale by viewing slides of tendons under the microscope. Tendinosis can occur in many different areas, such as the wrist, forearm, elbow, shoulder, knee, and heel.

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Tendons are rope-like structures that attach muscles to bones. Ligaments are similar structures that attach bones to other bones. When muscles and bones move, they exert stresses on the tendons and ligaments that are attached to them.

When your muscles move in new ways or do more work than they can handle, your muscles and tendons can sustain some damage on a cellular scale. If the increase in demand is made gradually, muscle and tendon tissues will usually heal, build in strength, and adapt to new loads. Athletes use these principles to build muscle and tendon strength with good training programs.

You can, however, do some activity that injures a tendon on a microscopic scale and then do more injury before the tendon heals. If you continue the injurious activity, you will gradually accumulate these micro-injuries. When enough injury accumulates, you'll feel pain. This kind of injury that comes on slowly with time and persists is a chronic injury. (Acute tendon injuries, on the other hand, are sudden tears that cause immediate pain and swelling.) Tendon injuries often require patience and careful rehabilitation with physical therapy because tendons heal more slowly than muscles.

Tendinosis vs Tendinitis

The suffix "itis" means inflammation; the term tendinitis should be reserved for tendon injuries that involve acute injuries accompanied by inflammation. The suffix "osis" implies a pathology of chronic degeneration without inflammation, so doctors prefer the term tendinosis for chronic tendon injuries of failed healing. Tendinosis is an accumulation over time of microscopic injuries that don't heal properly. Although inflammation can be involved in the initial stages of the injury, it is the inability of the tendon to heal that perpetuates the pain and disability.

Who Is At Risk?

keyboardTendinosis can result from long hours of activities such as playing sports, using computers, playing musical instruments, or doing manual labor. It can result from activities performed as part of your profession or recreation. Some occupations that have increased risk for chronic tendon injuries include assembly line workers, mail sorters, computer programmers, writers, court recorders, data entry processors, sign language interpreters, cashiers, professional athletes, and musicians

Another risk factor for tendon problems is the use of antibiotics in the fluoroquinolone family, such as Cipro. After taking these drugs some people can have serious tendon injuries. Not all patients are aware of this risk or given the chance to decide whether to take an alternative antibiotic. For help or more information you can visit this website: SaferPills.org, The Quinolone Vigilance Foundation. I receive so many emails from people about fluoroquinolones that I thought I should mention the issue even though it is a different topic than the overuse kind of tendinosis injuries addressed by this website.

Minimizing Your Risk

You can minimize your risk for tendinosis by using equipment that has good ergonomic design and is sized correctly for your body, by using good technique for your activity (whether it is sports or music or typing), by taking plenty of breaks, by minimizing long overtime hours (easier said than done!), and by avoiding fluoroquinolone drugs (see the information in the Who Is At Risk section above for more about fluoroquinolones). You can also listen to your body's pain signals. Warning signs of tendinosis include burning, stinging, aching, tenderness to the touch, and stiffness.

Tendinosis usually sneaks up on you. At first the pain only comes after a long or hard session of the activity that aggravates it. Later the pain comes at lower levels of the activity and it lasts longer. Finally, the pain becomes a part of your daily life and even normal activities can make it worse. Try to catch the injury as early as you can.

What Can I Do If I Have Tendinosis? What Treatments Are Best?

You should see a doctor for diagnosis and treatment. Sports medicine doctors and physiatrists are often excellent choices for tendinosis care, and they will likely refer you to a physical therapist. You can also use this site to learn more about your injury and treatments for it.