Tendons transmit muscular force to bone. They are strong, poorly vascularized, and slow to heal — which is why tendon pain, once established, tends to persist far longer than patients expect. At Remix Medical in Houston, our pain management physicians treat chronic tendon pain with targeted, image-guided intervention alongside the loading programs that actually remodel tendon tissue.
What is Tendonitis?
Tendonitis describes painful inflammation of a tendon or its surrounding sheath. In practice, most chronic cases are better described as tendinopathy — a degenerative, disorganized change in the tendon's collagen structure with limited true inflammation.
The distinction is not academic. Acute inflammatory tendonitis responds to anti-inflammatory measures. Chronic tendinopathy responds primarily to progressive mechanical loading, and injections play a supporting rather than a leading role.
Common Sites and Causes
1. Overuse and Repetitive Loading
The dominant cause. Tendon adapts to load, but only if given time between bouts. Volume increased too quickly outpaces repair.
2. Common Locations
- Lateral epicondyle (tennis elbow) and medial epicondyle (golfer's elbow)
- Rotator cuff, particularly supraspinatus
- Achilles tendon
- Patellar tendon (jumper's knee)
- Gluteal tendons at the hip
- De Quervain's tenosynovitis at the wrist
3. Age and Tendon Quality
Collagen turnover slows and tendon becomes less compliant.
4. Systemic Contributors
Diabetes, obesity, inflammatory arthritis, and certain antibiotics (fluoroquinolones) all raise tendon risk.
5. Biomechanical Factors
Muscle weakness, poor technique, and joint malalignment concentrate load at the tendon.
Symptoms of Tendonitis
- Pain localized precisely to the tendon, worsened by using the muscle it serves
- Tenderness on direct palpation
- Pain and stiffness at the start of activity, sometimes easing as it continues, then worse afterward
- Morning stiffness in the affected area
- Swelling or thickening along the tendon
- Crepitus or creaking with movement in tenosynovitis
- Weakness in the associated movement
How Remix Medical Can Help
Diagnosis is clinical and precise — tendon pain is exquisitely localized, and examination usually identifies it. Ultrasound assesses tendon thickness, tears, and fluid within the sheath, and permits accurate needle placement.
Our treatment options include:
- Ultrasound-guided injections into the tendon sheath or peritendinous space, with careful avoidance of intratendinous corticosteroid, which can weaken tendon
- Platelet-rich plasma (PRP) for chronic tendinopathy that has not responded to loading, with the honest caveat that evidence is stronger for some tendons than others
- Trigger point injections for the muscular pain that accompanies chronic tendon dysfunction
- Medication management for pain, with attention to your kidney function
- Physical therapy referral for eccentric and heavy slow resistance loading — the intervention with the best evidence base
- In-house chiropractic, exercise therapy, and ultrasound therapy
- Orthopedic referral for tendon rupture or refractory cases
| Approach | What it involves |
|---|---|
| Relative rest + physical therapy | Load management and eccentric exercise — the backbone of recovery |
| Anti-inflammatory measures | Topical or oral medication, ice, and activity change |
| Targeted injections | Used selectively; PRP may be preferred where steroids are risky near tendons |
| Procedures for stubborn cases | Considered when months of conservative care fail |
Relief from Tendon Pain at Remix Medical
Rest alone does not heal a chronic tendon; it deconditions it.