Tendon pain often arises from repetitive strain or overuse. While “tendonitis” refers to acute inflammation, most chronic, long-lasting pain is “tendinopathy,” involving tendon fiber degeneration without significant inflammation. This distinction is important because treatment must focus on tissue repair and strengthening, not just reducing swelling. For the vast majority of people, surgery is not necessary and is reserved as a final option after all non-operative therapies have been exhausted. Treatment typically follows a progressive, tiered approach, moving from simple home care to advanced procedures.
Initial Conservative Management
Managing tendon pain begins with simple, non-invasive strategies designed to calm symptoms and prevent further damage. This approach starts with activity modification, often described by the RICE principle: Rest, Ice, Compression, and Elevation. Rest involves avoiding the specific activity that causes pain, allowing the tissue to begin recovery.
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) provide short-term pain relief, but their role is limited for chronic tendinopathy since the condition is degenerative. The foundational element of conservative management is physical therapy, which is crucial for restructuring the damaged tendon and improving its capacity to handle load.
Physical therapists focus on eccentric exercises, where the muscle lengthens while contracting under load (e.g., slowly lowering a weight). This loading stimulates collagen production and proper alignment within the tendon, which is necessary for long-term recovery. For many patients, a consistent program of relative rest, bracing, and a structured, progressive strengthening regimen over several weeks is sufficient to resolve symptoms.
Targeted Non-Surgical Procedures
If initial conservative management fails to provide sufficient relief after six to twelve weeks, specialists may move to targeted non-surgical procedures. These interventions are designed to stimulate a stagnant healing process or address structural changes associated with chronic pain. Corticosteroid injections are one option, providing temporary pain relief by reducing local pain.
Corticosteroids are used cautiously for chronic tendinopathy because they may inhibit the tendon’s natural repair mechanisms and potentially increase the risk of rupture. Platelet-Rich Plasma (PRP) therapy is a different approach, using a concentration of the patient’s own platelets injected into the injured tendon. Platelets contain growth factors that promote tissue regeneration by stimulating the body’s healing response.
Other procedures include Extracorporeal Shock Wave Therapy (ESWT), which delivers acoustic waves to the painful area to promote blood flow and stimulate healing. Minimally invasive techniques like dry needling or tenotomy procedures may also be used. A tenotomy often uses a specialized, ultrasound-guided needle to precisely break down and remove small areas of degenerative or scarred tendon tissue.
When Operative Intervention Becomes Necessary
Surgery is typically considered only after a rigorous, sustained course of non-operative treatments has failed to provide relief for six to twelve months. The decision is based on strict criteria, indicating that the structural damage is too extensive for natural repair. These criteria include chronic, debilitating pain that severely limits daily function, or evidence of significant structural damage like a large partial-thickness tear or a complete tendon rupture. Surgery may also be indicated if a bony abnormality, such as an impingement, prevents the tendon from gliding smoothly.
The goal of surgical intervention is to remove damaged tissue and restore the tendon’s integrity and function. A common procedure is debridement, where the surgeon removes degenerative, scarred tissue. This is often performed minimally invasively using an arthroscope or tiny incisions, creating a healthier environment for the tendon to heal.
For cases involving significant tearing, a tendon repair is necessary to sew the torn ends back together. In severe cases, such as a large gap or chronic poor tissue quality, a tenodesis or tendon transfer may be performed. Tenodesis involves reattaching the tendon to a different spot on the bone to relieve tension. A tendon transfer uses a healthy tendon from a nearby area to replace the damaged one.
Surgical techniques vary, ranging from traditional open surgery, which requires a larger incision, to minimally invasive or arthroscopic procedures using small incisions and a camera. While surgery can successfully address severe structural problems, it marks the beginning of a lengthy rehabilitation process. Patients must commit to an extended period of physical therapy and restricted activity, with full return to high-demand activities often taking six to nine months.