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What is tendinitis
Tendinitis is a collective term for tendon pathology accompanied by load-related pain. A tendon is a dense collagen structure connecting muscle to bone. It has poor blood supply and therefore heals slowly.
Repetitive overload
Sports, occupational, daily loads. Microtrauma to collagen fibers accumulates faster than the tendon can regenerate.
Age-related changes
After 40 the collagen composition changes (more type I, less type III), elasticity decreases. Tendinopathies become common even without heavy loading.
Anatomic factors
Impingement syndromes (shoulder, hip), limb axis issues, weak stabilizer muscles — create chronic tendon conflict with surrounding structures.
Metabolic factors
Diabetes, hypercholesterolemia, gout, fluoroquinolone use — degrade collagen quality and raise spontaneous rupture risk.
Tendinitis vs tendinosis
Tendinitis (acute)
Acute inflammation of the tendon or its sheath. Lasts up to 6 weeks. Inflammatory response present: swelling, redness, rest pain. Typical example — de Quervain's tendinitis after unusual loading.
Tendinosis (chronic)
Chronic degeneration without classic inflammation. Lasts > 3 months. Structural collagen disorder, neovascularization on ultrasound. Most "tendinitis" in athletes is actually tendinosis.
Tendon tear
Complete or partial. Complete — function loss, surgery required. Whether regenerative treatment is an option in this condition is assessed by the clinic doctor. Decision via MRI and ultrasound.
Common locations
Shoulder — rotator cuff
Supraspinatus tendinitis is the most common cause of shoulder pain. Pain on abduction 60–120°, night pain. → More
Tennis elbow (lateral epicondylitis)
Lateral epicondylitis — pain on the outer elbow with grip and wrist extension. Not only in tennis players — office workers too. Regenerative treatment injects the degeneration zone under ultrasound.
Golfer's elbow (medial epicondylitis)
Pain on the inner elbow with gripping. Same treatment principles as lateral epicondylitis.
Achilles tendinopathy
Achilles tendon tendinopathy. Typical for runners. Pain 2–6 cm from insertion. Ultrasound-guided CGF — standard protocol.
Plantar fasciitis
Technically a fasciopathy, but the same mechanism. Morning heel pain. → More
Runner's / jumper's knee
Patellar tendinopathy. Pain below the kneecap. Whether regenerative treatment is an option in this condition is assessed by the clinic doctor.
De Quervain's
Tenosynovitis of the first extensor compartment at the wrist. Common in young mothers. → More
Trigger finger
Stenosing flexor tenosynovitis. Click on finger flexion. Targeted injection at the A1 pulley.
Tendinitis diagnosis
Clinical examination
Specific tests for each location: Tinel for de Quervain's, Jobe for supraspinatus, Thompson for Achilles. Assessment of pain on load and at rest.
Ultrasound — method of choice
Visualizes tendon structure, thickening, hypoechoic zones, calcifications, neovascularization (Doppler). Also used for image-guided injection.
MRI
If a partial or full tear is suspected, ultrasound is equivocal, or comorbid lesions are sought (meniscus with patellar tendinopathy, rotator cuff with shoulder pathology).
Tendinitis (tendinopathy): treatment options and what is known about them
The treatment plan is made by the clinic doctor after an examination and a review of your images. The table shows the options usually discussed for this diagnosis and how well they have been studied.
| Option | What to expect | How well studied |
|---|---|---|
| Exercise therapy and physiotherapy | Reduces pain, strengthens muscles, improves function; the basis of treatment | Well studied, recommended |
| Load management, weight loss | Takes load off the affected area; if overweight, losing 5–10% noticeably reduces pain | Moderate evidence |
| Shockwave therapy | A course of 3–5 sessions; helps some patients with chronic pain | Moderate evidence |
| Corticosteroid injection | Quickly reduces inflammation and pain, the effect is often temporary; frequent injections are undesirable | Limited or conflicting evidence |
| PRP / CGF | Concentrate from your own blood; may reduce pain, growth of new tissue has not been shown | Limited or conflicting evidence |
| Tendon surgery (rarely) | If conservative treatment does not help or there is an indication | When indicated — the doctor decides |
We send your request to several partner clinics. Some will suggest conservative treatment or injections, others surgery; each clinic quotes its own conditions and price. We help you compare the options.
Regenerative methods: realistic expectations
In tendinopathies the basis of treatment is graded loading of the tendon: specific exercises over 3–6 months. Shockwave therapy helps some patients. Evidence on PRP is conflicting: there are studies showing benefit in tennis elbow and plantar fasciitis, but no convincing evidence for other tendons. Corticosteroids relieve pain quickly, but the effect is often short, and repeated injections into a tendon are undesirable.
When surgery is discussed. Surgery is discussed for a complete tendon rupture or if pain persists for more than 6–12 months despite proper treatment.
If an injection helps, the effect usually builds up over 6–12 weeks, and the result is assessed after 2–3 months. No clinic can guarantee a result.
Recovery and timelines
After an outpatient injection procedure, most patients return to normal activity within 1–3 days. Sport and heavy loads are resumed according to the physician’s plan, usually after 2–6 weeks, alongside therapeutic exercise. The effect is assessed after 6–12 weeks. After surgery, rehabilitation takes longer and depends on the operation.
Who it is not suitable for and possible risks
Contraindications
- Active infection — at the injection site or systemic, with fever.
- Active cancer or ongoing chemotherapy.
- Blood clotting disorders or a low platelet count. Anticoagulants are discussed with the physician.
- Pregnancy and breastfeeding — the procedure is usually postponed.
- A corticosteroid injection into the same area in recent weeks.
- A complete tendon or ligament rupture with loss of function — surgical repair is usually needed.
Possible risks
- Pain and swelling at the injection site for 1–3 days.
- Bruising where blood or fat tissue is taken.
- Rarely, infection. The procedure is therefore performed under sterile conditions with ultrasound or X-ray guidance.
- The effect may be absent or smaller than expected.
If any of these apply to you, mention it in your request. The coordinator will check with the clinic physician whether treatment is possible. Contact a coordinator.
Scientific evidence
Studies of regenerative methods show mixed results. Clinic physicians rely on research including the following:
- Andia I et al. Platelet-rich plasma for muscle injury and tendinopathy. Sports Med Arthrosc Rev, 2013.
- Sheth U et al. Efficacy of autologous platelet-rich plasma use for orthopaedic indications: a meta-analysis. J Bone Joint Surg Am, 2012.
Next steps: Treatment methods · Treatment cost · How treatment in Germany is organised
Frequently asked questions
RegenPAS is a patient service centre in Munich, not a clinic. We review your images and symptoms and send a request to several partner clinics at once. Clinics that can accept you send their own conditions and price; prices differ between clinics, and you choose the option that suits you. The coordinator replies within 24 hours, and a clinic physician’s preliminary opinion follows in 1–3 business days. We then arrange the appointment, visa invitation, interpreter, transfers and accommodation. Treatment decisions are made by the clinic physician. Contact a coordinator.
Your MRI (or CT, X-ray) report and the images if you have them, plus a short description of your symptoms and previous treatment. Send them via the form on the website — the assessment is free and without obligation: the coordinator replies within 24 hours, and the clinic physician’s preliminary opinion follows in 1–3 business days.
The cost depends on the method, the diagnostics needed and the clinic itself: prices differ between clinics. We request offers from several clinics and send you their conditions and quotes so you can compare. Price guidance is on the treatment cost page. For an outpatient procedure, 2–3 days in Munich are usually enough: examination, procedure and follow-up visit.