Tendinopathy (tendonitis)
A common cause of tendon pain, often from overuse, where accurate assessment guides effective treatment and recovery
Tendinopathy, sometimes called tendonitis, is a common problem in which a tendon becomes painful and does not work as well as it should, often as a result of overuse or repeated strain. It can affect tendons around the shoulder, elbow, wrist, hip, knee, ankle and elsewhere. With the right assessment and a structured plan, most tendon problems improve.
Written for patients and reviewed by Dr Liubov Borukhson, Consultant Rheumatologist (GMC 7021928). Last clinically reviewed: June 2026.
Common symptoms
Tendon problems tend to share a recognisable pattern. Features may include:
- Pain near a tendon, often worse with use of the affected limb
- Stiffness, particularly after rest or first thing in the morning
- Tenderness, and sometimes mild swelling or thickening of the tendon
- Reduced strength or difficulty with particular movements
How it is diagnosed
Tendinopathy can often be recognised from the history and examination. Confirming which tendon is involved, and the state it is in, helps guide the right treatment and rules out other causes of the pain.
Ultrasound is particularly valuable for tendons. It shows the tendon in detail, can confirm the problem and its severity, and helps direct treatment accurately. Dr Borukhson uses point-of-care ultrasound during the consultation, so the tendon can often be examined in the same visit. You can read more on the ultrasound clinic page.
How it is treated
The mainstay of treatment is usually a structured programme of activity modification and graded exercise to load the tendon appropriately and help it recover, alongside measures to manage pain. This approach, used consistently, is effective for most people. In selected cases an ultrasound-guided injection around the area may help, and ultrasound guidance ensures it is placed accurately. The plan is agreed with you.
When tendon pain may point to inflammatory arthritis
Most tendon problems are mechanical, caused by overuse or strain, and settle with the right plan. Sometimes, though, tendon pain is a clue to an underlying inflammatory arthritis. This is more likely when tendon problems keep coming back, affect several different sites, come on without a clear mechanical cause, or appear alongside other features such as psoriasis, swelling of a whole finger or toe, inflammatory back pain, or a family history of these conditions.
In this situation the inflammation is often at the entheses, the points where tendons and ligaments attach to bone. This pattern, known as enthesitis, is characteristic of the spondyloarthritis family, which includes psoriatic arthritis and axial spondyloarthritis, among others. Recognising it matters, because the treatment is quite different from that of an overuse tendon problem. Ultrasound helps here too, as it can show the inflammatory changes that point towards this diagnosis, and Dr Borukhson can assess for the wider pattern during the consultation.
Why assessment helps
Tendon pain that is not settling is worth assessing properly, both to confirm the cause and to put in place a plan that supports recovery rather than allowing the problem to persist. If you have ongoing tendon pain, a specialist review, with ultrasound where helpful, can guide effective treatment.
Ongoing tendon pain?
A specialist assessment, with ultrasound where helpful, can confirm the cause and agree a structured plan to support recovery
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