ConditionInjuries & poisoning
Tendon Injury
A tendon injury is damage to a tendon, the tough cord that attaches muscle to bone. It ranges from overuse problems (tendinitis or tendinopathy), which cause gradual pain and stiffness, to partial tears and complete ruptures, which happen suddenly, often with a pop, and cause weakness or loss of movement. Common sites are the Achilles tendon, rotator cuff, elbow, knee and fingers. Overuse injuries usually heal with load management and exercise. Complete ruptures often need surgery and should be assessed quickly.
Also called: Tendinitis, tendinopathy, tendon tear, tendon rupture, tendonitis, tendon strain
At a glance
- Overuse injuries
- Tendinitis and tendinopathy, with gradual pain and stiffness, worse with activity.
- Acute injuries
- Partial tears and complete ruptures, sudden pain, a pop, weakness or loss of function.
- Common sites
- Achilles, rotator cuff, biceps, elbow, patellar and quadriceps tendons, wrist and fingers.
- Diagnosis
- Examination; ultrasound or MRI to assess tears.
- Treatment
- Load management and progressive exercise for overuse; bracing or surgery for ruptures.
When to get help
Call 911 or go to the ER
- A deep cut over a tendon with heavy bleeding, or a cold, pale or numb hand or foot
See a doctor within a day or two
- A sudden pop or snap followed by weakness, such as being unable to push off the foot, straighten the knee, lift the arm, or bend or straighten a finger
- A visible gap, bulge or change in muscle shape after an injury
- A cut on the hand, wrist or foot followed by inability to move a finger or toe normally
- A hot, red, swollen tendon area with fever
Book a routine appointment
- Tendon pain lasting more than 2 to 3 weeks despite rest from the trigger
- Repeated flare-ups of tendon pain
- Tendon pain after starting a fluoroquinolone antibiotic (stop and contact your prescriber)
Usually safe to manage at home
- Mild aching along a tendon after a new or increased activity, improving with load reduction and gentle exercise
Types of tendon injury
| Type | What happens | Typical symptoms |
|---|---|---|
| Tendinitis (acute) | Short-term inflammation after overload | Pain, warmth, swelling |
| Tendinopathy (chronic) | Degeneration and failed healing from repeated overload | Gradual pain, morning stiffness, thickened tendon |
| Tenosynovitis | Inflammation of the sheath around a tendon | Pain, swelling, creaking, triggering |
| Partial tear | Some fibers torn | Pain and some weakness |
| Complete rupture | Tendon fully torn | Sudden pop, severe weakness, loss of movement |
| Laceration | Cut tendon | Inability to move a joint after a cut |
Common tendon injuries
- Achilles: tendinopathy in runners; rupture in middle-aged people playing stop-start sports, often feeling like being kicked in the heel
- Rotator cuff (shoulder): tendinopathy and tears, with pain lifting the arm and night pain
- Elbow: tennis elbow and golfer's elbow; distal biceps rupture with a "Popeye" bulge
- Knee: patellar tendinopathy (jumper's knee); patellar and quadriceps tendon ruptures causing inability to straighten the knee
- Wrist and hand: De Quervain's tenosynovitis, trigger finger, flexor tendon injuries, mallet finger
- Foot and ankle: posterior tibial tendinitis, peroneal tendon injuries
Causes and risk factors
- repetitive movements and sudden increases in training load
- poor technique or equipment
- age, as tendons become less elastic
- obesity, diabetes, high cholesterol and inflammatory arthritis
- fluoroquinolone antibiotics (ciprofloxacin, levofloxacin), especially in older adults or with steroids
- steroid injections into or near tendons
- previous tendon injury
Diagnosis
A clinician examines the area for tenderness, swelling, gaps and strength. Specific tests include the Thompson test (squeezing the calf to check the Achilles) and strength testing of individual tendons. Ultrasound is quick and shows tears and tendinopathy; MRI gives more detail; X-rays look for bone fragments or calcification.
Treatment
Overuse injuries
- relative rest: reduce or modify the aggravating activity, but keep moving
- progressive loading exercises: isometric, then slow heavy and eccentric exercises, over 6 to 12 weeks or longer, the most effective treatment for tendinopathy
- ice for pain and swelling in the short term
- pain relief: acetaminophen (paracetamol), or topical or oral NSAIDs for short periods; avoid NSAIDs with kidney disease or stomach ulcers
- braces, straps or orthotics to offload the tendon
- shockwave therapy for some persistent cases
- steroid injections are used cautiously: they help short-term pain but can weaken tendons and are avoided in the Achilles and patellar tendons
Tears and ruptures
- Achilles rupture: treated with surgery or with a functional boot and early rehabilitation; both work well when started promptly
- complete rotator cuff, distal biceps, patellar and quadriceps ruptures: usually surgical repair, ideally within days to weeks
- cut hand tendons: urgent surgical repair
- partial tears: often managed with bracing and rehabilitation
Recovery
- mild tendinitis: a few weeks
- chronic tendinopathy: 3 to 6 months or more with a structured exercise program
- surgical repair of a rupture: 6 to 12 months to return to full sport
Returning to activity gradually, guided by pain, prevents recurrence.
Frequently asked questions
How do I know if a tendon is torn?
Signs of a torn tendon include a sudden pop or snap, sharp pain, rapid swelling and bruising, and weakness or inability to perform a movement such as pushing off the foot or straightening the knee. A gap may be felt in the tendon. See a doctor promptly.
What is the difference between tendinitis and tendinopathy?
Tendinitis means inflammation of a tendon, usually short-term after overload. Tendinopathy is a broader term for chronic tendon pain, which mainly involves degeneration rather than inflammation. Treatment for tendinopathy focuses on progressive loading exercises.
How long does a tendon injury take to heal?
Mild tendinitis often settles in a few weeks. Chronic tendinopathy can take 3 to 6 months or longer. A surgically repaired rupture usually needs 6 to 12 months before full return to sport.
Should I rest an injured tendon completely?
Usually not for overuse injuries. Reduce the activity that causes pain, but keep the tendon working with gentle, progressive exercises. Complete rest can weaken the tendon. A suspected rupture should be protected and assessed promptly.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Orthopaedic Surgeons (OrthoInfo): Tendinitis; Achilles tendon rupture; Rotator cuff tears
- National Institute of Arthritis and Musculoskeletal and Skin Diseases: Sprains, strains and tendinitis
- MedlinePlus: Tendinitis; Tendon repair
- NHS: Tendonitis
- American Academy of Family Physicians: Achilles tendinopathy