Tendinitis in Paris 13:What can you do when pain persists?

01Tendinitis or tendinopathy?

The word “tendinitis” is often used to describe pain linked to a tendon. If the pain can persist and limit certain movements or efforts, the term “tendinopathy” is then preferred. The causes and mechanisms can vary and do not always come down to simple inflammation. ^M1M2

The shoulder, elbow, Achilles tendon and patellar tendon are most often affected. But pain in these areas does not always come from the tendon. ^M3M4M5M10

02When should you consult for persistent tendinitis?

There is no single rule. There is no waiting period for every situation. The impact, its progression and the signs matter when deciding to consult and need to be considered individually.

A few pointers (not an exhaustive list) can help with the decision, for example when:

• the pain persists despite an initial course of care;
• the pain returns with every attempt to resume physical activity;
• there is an impact on life (it limits your work, your sleep, your sport or usual movements);
• or there is uncertainty about the diagnosis or the activities you can continue. ^M3M4M5

If in doubt or in a medical emergency in France, call 15 or 112. ^M7M8P1

03Why can pain last?

Many causes can explain a recurrence or persistence of tendinitis. The doctor reviews the timeline, medical history, current treatments and those already tried. Sometimes several factors can combine. The duration of symptoms alone does not explain their cause. ^M3M4M5

If rehabilitation has been undertaken, it is important to study the exercises performed, their progression and what improved, worsened or stopped the rehabilitation. This information helps to discuss or adjust the care options. It can sometimes help to reconsider the diagnosis.

04How are the symptoms assessed?

As always in medicine, it is first important to understand the symptoms and each person’s individual goals. Care varies from patient to patient. Improving walking or running, being able to carry objects, work with the arm or return to a sport are different goals and therefore call for different approaches. The sports medicine doctor asks about the history of the tendinitis (the medical history).

In addition to taking a history, the sports medicine doctor performs a clinical examination to identify the painful area, its location, mobility, strength and movements that provoke symptoms.

At the end of a medical consultation, the doctor may need to investigate another source of the pain (differential diagnosis). ^M3M4M5

05Ultrasound or MRI?

No examination is automatic. An X-ray, ultrasound or MRI can be useful when it can answer a specific question (differential diagnosis, response to treatment…).

The choice of examination depends on the tendon involved, the diagnosis and the medical history. Images alone are not enough to decide on the best care. Remember to bring examinations already performed to your medical appointment. ^M3M4M5

06Which treatments?

Treatment depends on the diagnosis, location and your goals. It can combine many approaches:

1. adapting demands
2. monitoring activity and rehabilitation
3. medication
4. specific treatment (e.g. cryotherapy)
5. a medical procedure (a PRP injection, for example)
6. surgery in some cases

Treatment is based on the expected benefits and an individual assessment of each person. ^M3M4M5M6

Do you have to stop sport completely?

The answer depends on the situation. For the tendon, a period of rest or adapting movements may be necessary. Intensity, frequency, movements and recovery can be changed. There is no single rule for returning that is acceptable for everyone. ^M3M4M5

Are injections or shockwave therapy essential?

These treatments are not systematic. Their value, limits and risks depend in particular on the tendon and the diagnosis. Persistent pain alone is not enough to justify a procedure. ^M3M4

07How long does it take to improve?

There is no miracle answer. The time varies. Most cases of tendinitis resolve quickly. But it is not possible to give a recovery date. A lack of improvement or worsening should lead to a review of the situation. ^M3M4